Intertrochanteric fracture of femur
Introduction
Introduction to intertrochanteric fractures Intertrochanteric fractures, also known as intertrochanteric fractures, refer to fractures in the femoral neck base to the lower trochanteric plane, which is an extracapsular fracture of the joint. The most common among the elderly over the age of 65, more women than men. Due to the rich blood supply in the trochanter, there is very little non-union after fracture, but hip varus is prone to occur. Long-term bed rest in older patients causes more complications. basic knowledge The proportion of sickness: 0.01%-0.05% Susceptible population: common in older people over the age of 65, more women than men. Mode of infection: non-infectious Complications: hemorrhoids Deep vein thrombosis of lower extremities
Cause
Causes of intertrochanteric fractures
Most of the fractures are caused by indirect external force. The lower limbs are suddenly twisted. When they fall, they are strongly adducted or abducted, or they can be caused by direct external impact. Because local osteoporosis is fragile, the fractures are mostly comminuted, and the elderly fractures are loose. When the lower limbs suddenly Twisting, falling is easy to cause a fracture, due to varus in the trochanter, causing hip varus deformity.
Prevention
Prevention of femoral intertrochanteric fracture
The disease is mainly caused by traumatic factors, so pay attention to production and life safety, avoiding trauma is the key to the prevention of this disease. Others should pay attention to the general condition and prevent various life-threatening complications caused by bed rest after fracture. Pneumonia, acne and urinary tract infections, etc., patients need early joint exercise to prevent joint stiffness.
Complication
Complications of intertrochanteric fractures Complications, deep venous thrombosis of lower extremities
The main complication of this disease is postoperative complications. Because of the previous treatment, many conservative traction treatments can make most patients achieve fracture healing, but prolonged bed-ridden bed is easy to cause lung infection, hemorrhoids, urinary tract infection and Lower extremity venous thrombosis, its disability rate and mortality are higher.
In terms of surgery, patients with internal fixation often have lag screws to cut femoral head, hip varus and other complications.
Symptom
Femoral intertrochanteric fracture symptoms Common symptoms Hip varus lower abdomen local pain joint swelling
More common in elderly patients, there is a history of direct violence and hip trauma. After the intertrochanteric fracture, the performance is similar to that of the femoral neck. Local pain and swelling after injury, and the function of the affected limb is limited, but there are two differences: First, because of the extracapsular fracture of the joint, there is no restriction of the joint capsule, and the external rotation of the lower extremity occurs. Shortness and deformity are more obvious than femoral neck fractures. The typical external rotation deformity is 90°. Second, the local hematoma is relatively serious, and there may be extensive subcutaneous congestion. In elderly patients, patients with femoral neck are often older, mostly over 70 years of age. During the examination, it was seen that the ipsilateral trochanter was elevated, and local swelling and ecchymosis were visible, and local tenderness was obvious. Defying the heel often causes severe pain in the affected area. It is often necessary to undergo X-ray examination before the diagnosis can be confirmed and the X-ray film is used for typing.
Examine
Examination of intertrochanteric fractures
The auxiliary examination method for this disease is mainly image examination, including X-ray examination, CT examination and MRI examination:
1, X-ray inspection:
X-ray examination is routinely used for the examination of the disease. Generally, fractures can be found, but in some special fracture types, such as incomplete fractures, fatigue fractures, due to fractures without displacement, only irregular fractures, X The X-ray film can not be displayed on the line, and the X-ray film overlaps the femur, the small rotor, the intertrochanteric line, the tendon and other bone folds, and the soft tissue shadow. The fracture is easily missed.
2, CT examination:
CT significantly reduced the rate of missed diagnosis of the femoral neck basal or trochanteric and intertrochanteric fractures, showing the continuity of the cortical bone and the internal structure of the bone fracture layer, but nourishing the vascular shadow due to the irregularity of the femoral neck base or the trochanter and intertrochanteric bone. Factors such as interference, leakage level and other factors also cause certain difficulties in diagnosis.
3. MRI examination:
MRI scan is superior to X-ray and CT, incomplete fractures of femoral neck base or trochanteric and intertrochanteric fractures, fatigue fractures and other fracture types that cannot be shown by X-ray. MRI examination has obvious superiority, X-ray can not The slight fracture shown, MRI shows bone marrow changes, high sensitivity, but pay attention to minor injuries, local exudation leads to similar fracture signal, T1, T2 fracture line low signal, fat suppression can improve the diagnosis rate, but pay attention to the volume Effect artifacts can be avoided by thin layer scanning. Do not use the sacral line as a fracture line.
Diagnosis
Diagnosis and diagnosis of intertrochanteric fractures
Diagnose based on
1. History of trauma: Even minor injuries in the elderly, such as hip sprains from the bed, may also lead to fractures.
2, symptoms
(1) Most of the patients are elderly people, causing severe pain in the hip after trauma.
(2) Hip joint activity is limited, can not stand, walk.
(3) The above symptoms are mild when there is no displacement of the inserted fracture or a stable fracture with less displacement.
3, signs
(1) When the examination showed that the affected side had a large trochanter, the hip was swollen and the skin was subcutaneously congested.
(2) 90° external rotation and shortening deformity of the lower limbs are obvious.
(3) Local tenderness in front of the hip is obvious, and the tender point is mostly in the large trochanter.
(4) The big trochanter has aching pain.
(5) Lower extremity conduction pain.
4, auxiliary examination for patients with suspected fractures should be taken on the hip lateral X-ray film to confirm the diagnosis and classification. Pay special attention to the fractures in the small trochanter. If the X-ray is still unclear, CT bone scan and 3D reconstruction are required.
Differential diagnosis
Intertrochanteric fractures and femoral neck fractures are common in the elderly, and clinical manifestations and systemic complications are similar. However, the femoral trochanter is rich in blood supply, swelling is obvious, there are extensive ecchymoses, tender points are mostly in the large trochanter, the lower extremity shortening is generally greater than 3cm, the affected limb is shortened, adducted, externally rotated, and its external rotation ratio The femoral neck fracture is more obvious, the prognosis is good; the femoral neck fracture is less swollen, the tender point is mostly in the midpoint of the inguinal region, the lower limb shortening is generally less than 3cm, the affected limb is curved hip, shortened, external rotation, and the intracapsular fracture is healed. difficult. X-ray films can help identify.
