Review of Rare Femoral Fracture PatternSubtrochanteric femoral fractures are rare. When they do occur, they require careful diagnosis and treatment. Failure to recognize this fracture pattern can lead to problems with surgical repair.
Subtrochanteric femoral fractures involve the area or zone between the lesser trochanter and the place where the middle third of the femur (thigh bone) meets the upper portion of the bone. The lesser trochanter is a cone-shaped bump at the base of the femoral neck. Several hip and thigh muscles attach to this area of bone.
In this article, an orthopedic trauma surgeon describes the system used to classify these fractures. Evaluation and initial treatment are discussed. Even with X-rays, it may not be easy to identify a subtrochanteric fracture correctly. Sometimes the diagnosis takes place in the operating room.
The author offers detailed instruction in the stabilization of these fractures. The placement of internal fixation with plates, screws, or nails is demonstrated with drawings and X-rays.
With careful surgical repair, the patient shouldn't need bone grafts. Compression plates apply indirect reduction and stabilize the fracture during healing. Union rates of 90 per cent or better have been reported using this method without bone graft.
Deep vein thrombosis (DVT) or blood clots are a major concern with this type of fracture pattern. The surgeon must pay attention to this potential problem even before surgery. Pneumatic compression along with blood thinners may be needed before and after surgery. Patients must be monitored carefully for any signs and symptoms of DVTs.
Douglas W. Lundy, MD, FACS. Subtrochanteric Femoral Fractures. In Journal of the American Academy of Orthopaedic Surgeons. November 2007. Vol. 15. No. 11. Pp. 663-671.
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