Intertrochanteric Fracture - Types, Symptoms, and Management

Introduction

A hip fracture is a break of the femoral head or neck, most of which occur in elderly patients whose bones have become weakened by osteoporosis. In younger patients, it is typically the result of a high-energy event, such as a fall from a ladder or vehicle collision. Hip fractures can be very painful. For this reason, prompt surgical treatment is recommended. This article discusses intertrochanteric hip fractures, their probable complications, treatment modalities, and postoperative complications following surgery.

What Are the Types of Hip Fractures?

A single or multiple breaks can happen in a bone. A hip fracture is thus classified by the specific area of the break and the type of break in the bone.

1. Femoral Neck Fracture - The femoral neck is located about 1 to 2 inches from the hip joint and is common among older adults, related to osteoporosis. Such fractures may cut off the blood supply to the head of the femur.

2. Intertrochanteric Hip Fracture - An intertrochanteric hip fracture occurs about 3 to 4 inches from the hip joint and does not usually interrupt the blood supply of the bone, thus making repair easier.

3. Stress Fracture - A stress fracture of the hip is harder to diagnose as a hairline crack in the thigh bone that may not involve the entire bone caused by overuse, and repetitive motion can cause a stress fracture mimicking symptoms of tendonitis.

Who Is at Risk of Intertrochanteric Hip Fractures?

The risk for a hip fracture is considerably raised with osteoporosis and older age. Other risk factors are as follows;

• Excessive alcohol consumption.

• Lack of physical activity.

• Low body weight.

• Poor nutrition with low calcium and vitamin D intake.

• Female predilection.

• Tall stature results in increased stress in stress-bearing areas.

• Vision problems lead to being more prone to falls or accidents.

• Dementia and conditions associated with mental retardation.

• Certain medicines may cause bone loss.

• Cigarette smoking.

• Living in an assisted-care facility.

• Increased risk for falls stems from weakness, disability, or unsteady gait.

• Other risks, depending on specific health conditions, may also occur.

What Can Be the Principal Signs and Symptoms of Intertrochanteric Hip Fracture?

The common symptoms of a hip fracture include the following;

• Hip pain or pain that is felt in the knee.

• Lower back pain.

• Inability to stand or walk.

• Bruising.

• Swelling.

• The foot is turned out at an odd angle, making the leg look shorter.

How Is Intertrochanteric Hip Fracture Diagnosed?

A good medical history and physical exam, along with diagnostic procedures for hip fracture, include the following:

• X-rays.

• Magnetic resonance imaging (MRI).

• Computed tomography (CT) scans.

How Is Intertrochanteric Hip Fracture Treated?

Surgery is the general form of treatment. Metal devices or prostheses may be used to strengthen and stabilize the joint. In some cases, a partial or total hip replacement may be necessary. The surgical repair and its success depend on the type of fracture, with the goal of treatment being relief from pain and enabling one to resume normal activity levels. Hip surgery usually requires an in-hospital stay and physical therapy exercises to regain the hip's strength and range of motion. Postoperatively, physical therapy will continue at home or on admission to a rehabilitation facility.

What Are the Types of Intertrochanteric Hip Surgery?

There are various surgical options for the treatment of intertrochanteric fracture, which includes:

• Dynamic hip screw (DHS).

• Compression hip screw (CHS).

• Percutaneous compression plate (PCCP).

• Proximal femoral nail (PFN).

• Gamma nail.

• Proximal femoral nail anti-rotating (PFNA).

• Medoff sliding plate.

• Less invasive stabilization system (LISS).

Can the Surgery Be Minimally-Invasive?

Minimally invasive hip surgery aims to impact minimally on the adjacent healthy tissue such as bone, muscle, nerves, and blood vessels.

The advantages are as follows :

• Low risk of muscle damage.

• Less pain.

• Quick and easy recovery.

• Less limping.

• Short hospital stay.

• Low chance of hip dislocation.

What Are the Complications of Intertrochanteric Hip Fracture?

A hip fracture can cause complications such as blood clots in the veins, usually in the legs, or pulmonary embolism, which can be fatal. Other complications can include:

• Pneumonia.

• Muscle atrophy (wasting of muscle tissue).

• Postoperative infection.

• Nonunion or malunion.

• Mental deterioration post-surgery in older patients.

• Bedsores.

Femoral avascular necrosis is a complication that may happen depending on the type of fracture and the blood supply to the head of the thigh bone, which is more commonly seen in intertrochanteric fractures.

How Long Does Postoperative Recovery Take?

Usually, one to two weeks of in-hospital stay is necessary after a hip fracture, with the recovery period being lengthy and admission to a rehabilitation facility. In addition, it can result in a loss of independent movement, reduced quality of life, and depression, especially for older people.

What Are the Preventive Measures?

Preventive measures include consuming enough calcium every day, whether through diet or supplements. Menopausal women should regularly consider having a bone density test, which measures bone mineral content and bone thickness. The measurement can indicate decreased bone mass or more brittle bones prone to fracture easily. A bone density test for osteoporosis and the risk of fractures is the primary diagnostic measure. Regular weight-bearing exercises, such as walking, jogging, or hiking, are advised to keep bone integrity. In addition, exercise programs such as “Tai chi” help promote strength and balance.

Other preventive measures may include:

• Medication to prevent bone loss.

• A vitamin D and calcium-rich diet.

• Quit smoking.

• Reduce alcohol consumption.

• Removing objects, such as loose electrical cords near or on the stairs and floors, prevents tripping and falling.

• Use slip-resistant rugs next to the bathtub.

• Installing grab bars in the tub or showers.

• Positioning of night lights from the bedroom to the bathroom.

• Use rug pads or non-skid backing to keep rugs in place to prevent slipping and falling.

• Using steady furniture.

• Using step ladders to stand on.

• Ophthalmologist consultation every year to have vision checked and vision loss treated.

Conclusion

Intertrochanteric hip fractures can result in a loss of independence, reduce the quality of life, and cause depression, especially in older people. In addition, recovery usually takes a relatively long time, especially with greater age. Therefore, postoperative care and physical therapy are paramount in such cases.