IT Fractures

INTERTROCHANTERIC FRACTURES
Classification
Depending on the number of displaced fracture parts: femoral neck, shaft, greater trochanter, and lesser trochanter
2-part fracture : intertrochanteric fracture
3-part fracture : Intertrochanteric fracture with fracture of 1 trochanter
4-part fracture : Intertrochanteric fracture with fracture of both trochanters
Mechanism of Injury
Direct : Fall on greater trochanter
Indirect : Muscle forces transmitted to the intertrochanteric area due to a fall
Examination
Painful hip movements
Affected hip externally rotated, flexed and shortened.
Exclude sciatic nerve injury
Management
Determine cause of fall in elderly patients: e.g. bleeding GIT causing anaemia / hypotension; AMI; CVA; poor eye-sights; slippery floor; tripping against objects, etc.
Exclude head injury
Determine premorbid status and medical problems
Take for blood FBC, U/E/Cr/Glu, PT/PTT, CXR, ECG, group & save
Admit to Ortho Dept if no urgent medical/surgical problems
Admit to Surgical Dept if bleeding GIT, unstable head injury/haemorrhagic stroke
Admit to Medical Dept if uncontrolled hypertension, DKA/HHNK, AMI, new CVA, i.e. cases where medical conditions are more pressing