Complications of intertrochanteric fractures

Elderly people are very prone to bone diseases, mainly due to aging, slower metabolism, bone aging, long-term overwork, and hard labor. When they reach a certain age, they will experience pain here and there, which is particularly torturous. Intertrochanteric fracture is a common disease among the elderly, mostly caused by external force. So how can we prevent and treat it?

Causes

Fractures are mostly caused by indirect external forces. Fractures may occur due to sudden twisting of the lower limbs, forceful adduction or abduction when falling, or direct external impact, and most fractures are comminuted. Elderly people suffer from osteoporosis, and sudden twisting of the lower limbs or falls can cause fractures.

Clinical manifestations

1. Local pain, swelling, tenderness and functional impairment are obvious after trauma. Sometimes subcutaneous ecchymosis can be seen on the outside of the hip. The movement of the affected limb is limited after injury, and the patient cannot stand or walk.

2. The greater trochanter is swollen and tender, the injured limb is shortened, and the distal fracture segment is in an extreme external rotation position, which can reach 90° in severe cases. May also be accompanied by adduction deformity.

examine

The auxiliary examination method for this disease is mainly imaging examination, including X-ray examination, CT examination and MRI.

1. X-ray examination

Routine X-ray examinations can detect fractures, but in some special types of fractures, such as incomplete fractures and fatigue fractures, since the fractures are not displaced and only have irregular cracks, they cannot be shown on X-rays. In addition, the greater and lesser trochanters, intertrochanteric lines, ridges and soft tissue shadows of the femur overlap on X-rays, and fractures are very easy to be missed.

2. CT examination

CT significantly reduces the missed diagnosis rate of femoral neck base, trochanter and intertrochanteric fissure fractures, and can show the continuity of the bone cortex and the internal structure of the bone fracture layer. However, due to the irregularity of the femoral neck base, trochanter and intertrochanteric bone, interference from the nutrient vessel shadows, missed scanning layers and other factors, it also causes certain difficulties in diagnosis.

3. Magnetic resonance imaging (MRI)

MRI scanning has high sensitivity, significantly better than X-ray and CT. MRI examination has obvious advantages in treating incomplete fractures, fatigue fractures and other fracture types of femoral neck base, trochanter and intertrochanteric fissure that cannot be displayed by X-rays. MRI can show bone marrow changes, even though X-rays cannot show minor fractures. But pay attention to minor injuries, as local exudation may cause signal shadows similar to fractures.

diagnosis

1. History of trauma.

2. Based on clinical symptoms and signs: pain, tenderness, external rotation deformity, etc. are helpful for diagnosis.

3. Fractures can be seen on X-rays.

treat

1. Conservative treatment

Conservative treatment can be divided into two categories according to whether the patient can walk after treatment. For patients who cannot walk at all, wear T-shaped shoes or short-term skin traction, perform analgesic symptomatic treatment, and encourage them to sit up as soon as possible. For patients who hope to walk, supracondylar femoral or tibial tubercle traction can generally be used, X-rays can be taken regularly, and the reduction and traction weight can be adjusted as appropriate. If X-ray examination shows callus formation, skin traction or T-shoe fixation should be used for 4 to 8 weeks. Indications for skeletal traction for intertrochanteric fractures are:

(1) Those with severe concomitant diseases or early complications who have not responded to systemic treatment for 2 weeks and cannot tolerate surgery;

(2) The condition improves after systemic treatment, the fracture has lasted for more than 3 weeks, and the patient is unwilling to undergo surgery;

(3) For patients who have had acute myocardial infarction, cerebral infarction or cerebral hemorrhage within 3 months, surgical treatment may induce recurrence of the disease;

(4) Patients with acute myocardial infarction, cerebral infarction, and cerebral hemorrhage within 6 months have a higher risk of surgery and are relatively unsuitable.

2. Surgery

There are several types of surgical treatment for intertrochanteric fractures:

(1) External fixator The single-arm external fixator is a semi-invasive pin-through external fixation method between surgery and non-surgery. It is suitable for elderly patients with multiple diseases who cannot tolerate surgery.

(2) Multiple nails and multiple Steinmann wires are the most suitable for hip biomechanics, but due to their structural defects, they have disadvantages such as loosening, pin fall-off, and no pressure effect on the fracture ends. In order to overcome the above disadvantages, multiple hollow screws are now used as a substitute.

(3) Lateral nail plate type.

(4) Intramedullary nail system: ① Gamma nail; ② Proximal femoral intramedullary nail (PFN); ③ PFN-A.

(5) Artificial prosthesis replacement surgery For elderly patients with intertrochanteric fractures whose life expectancy is expected to be less than 10 years, as long as their physical condition can tolerate it, bone cement artificial prosthesis replacement surgery can be selected as a treatment option.

prevention

The focus of this disease is on patient care, including preoperative and postoperative care, attention to proper nutrition, and early functional exercise. Functional exercise is an important part of fracture treatment and can help the affected limb quickly restore normal function. Functional exercise must be carried out step by step in a certain way, otherwise it will cause adverse consequences.