SUMMARY
Intertrochanteric fractures are extracapsular injuries with preserved blood supply. Healing potential is good, but outcomes depend on mechanical stability and fixation quality.
EPIDEMIOLOGY
Most common hip fracture
Elderly population
Osteoporotic bone
ETIOLOGY & MECHANISM
Low-energy fall
Direct impact over greater trochanter
PATHOANATOMY
Metaphyseal cancellous bone
Rich blood supply → good healing
Deforming forces:
Iliopsoas → flexion
Gluteus medius → abduction
CLASSIFICATION
AO/OTA
31-A1 → stable
31-A2 → comminuted
31-A3 → reverse obliquity
STABILITY CRITERIA
Posteromedial cortex (calcar)
Lateral wall integrity
PRESENTATION
Pain
External rotation
Limb shortening
IMAGING
AP pelvis
Lateral hip
Evaluate:
Lateral wall
Comminution
Reverse obliquity
TREATMENT
Stable fractures
→ DHS (sliding hip screw)
Unstable fractures
→ Cephalomedullary nail
IM nail biomechanically superior (short lever arm)
SURGICAL PRINCIPLES
Tip-apex distance <25 mm
Central screw placement
Restore alignment
COMPLICATIONS
Cut-out
Varus collapse
Implant failure
PROGNOSIS
Depends on:
Reduction quality
Stability
Implant position