Executive Editor: Joseph Schatzker, Peter Trafton

Authors: Ernst Raaymakers, Inger Schipper, Rogier Simmermacher, Chris van der Werken

Proximal femur - Trochanteric fracture, pertrochanteric, simple

back to skeleton

Glossary

General considerations

In extracapsular fractures there is minimal risk of osteonecrosis of the femoral head.

In simple pertrochanteric fractures the fracture line can begin anywhere on the greater trochanter and end either above or below the lesser trochanter. The medial cortex is interrupted in only one place.

These fractures cause significant shortening, but they are stable after reduction and fixation, largely because of the excellent contact of the fracture surfaces and lack of comminution. The lesser trochanter, the so-called medial buttress, is intact.

These fractures may be treated with a sliding hip screw and plate, or a cephalomedullary nail.

Note: Because healing of these fractures may take 12 or more weeks, if contraindications can be corrected soon enough, operative treatment of the fracture may be beneficial even if delayed. If definitive treatment will be delayed for more than 2 or 3 weeks, temporary skeletal traction might be considered to help maintain alignment.

MIO - Sliding hip screw
Main indication Skill Equipment
Surgeon's preference; closed reduction possible Some specialized surgical experience Simple surgical and imaging resources

Indications

  • All fractures that can be reduced closed
  • Patient is medically fit for surgery

Contraindications

  • Irreducible fracture 
  • Significant hip joint arthritis 
  • Patient not fit for surgical treatment 
  • Severe soft-tissue problems in surgical area (pressure sores, acute infection, burns etc)

Advantages

  • Less expensive implant than IM nail
  • May convert to ORIF for reduction or improved fixation
  • Fracture stability 
  • Early mobilization
  • Semi-open procedure, fracture site left untouched

Disadvantage

  • Risks of surgery
Nailing
Main indication Skill Equipment
Surgeon's preference; unstable fracture; closed reduction possible Some specialized surgical experience Full specialized surgical and imaging resources

Indications

  • Fractures which can be reduced closed
  • Desire for smaller surgical wound 
  • Patient is medically fit for surgery

Contraindications

  • Bone deformity or previous surgery that prevents nailing 
  • Irreducible fracture
  • Significant hip joint arthritis 
  • Severe soft-tissue problems in surgical area (pressure sores, acute infection, burns etc)
  • Patient not fit for surgical treatment

Advantages

  • Improved fixation stability, with reduced risk  of secondary displacement
  • Early mobilization
  • Semi-open procedure, fracture site left untouched

Disadvantages

  • Demanding technique 
  • More expensive implant than sliding hip screw
  • Risks of surgery
ORIF - Sliding hip screw
Main indication Skill Equipment
Inability to achieve closed reduction Highly experienced and skilled surgeon Simple surgical and imaging resources

Indications

  • Irreducible fractures
  • Inadequate closed reduction
  • Patient is medically fit for surgery

Contraindications

  • Significant hip joint arthritis
  • Patient not fit for surgical treatment 
  • Severe soft-tissue problems in surgical area (pressure sores, acute infection, burns etc)

Advantages

  • Anatomical reduction 
  • Increased stability with reduced risk of secondary displacement 
  • Early mobilization

Disadvantages

  • Bone devitalization
  • May delay healing
  • Risks of surgery
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v2.0 2010-11-14