Skip to main content

Extracapsular Proximal Femoral Fractures (Pertrochanteric Intertrochanteric and Fractures with Reverse Obliquity)

  • Chapter
  • First Online:
Fracture Reduction and Fixation Techniques

Abstract

Intertrochanteric, pertrochanteric, and reverse oblique fractures belong to the extracapsular group of hip injuries. Surgical fixation of intertrochanteric fractures is based on restoring the normal alignment angle between the neck and the shaft of the femur and allowing controlled collapse in both stable and unstable fractures. For stable intertrochanteric fractures, dynamic hip screw (DHS) continues to be the most common implant of osteosynthesis used. Cephalomedullary devices are the choice of implants for pertrochanteric, reverse oblique, and in general unstable fracture patterns.

The mechanical effectiveness of internal fixation is determined by five independent variables: (a) bone quality, (b) fragment geometry, (c) quality of reduction, (d) appropriate implant selection, and (e) correct implant placement. All of these parameters are controlled by the surgeon. In this chapter, the principles of fixation of intertrochanteric, pertrochanteric, and reverse oblique fracture patterns are discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 179.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Evans E. The treatment of trochanteric fractures of the femur. J Bone and Joint Surg Br. 1949;31:190ā€“203.

    ArticleĀ  Google ScholarĀ 

  2. Jensen J. Classification of trochanteric fractures. Acta Orthop Scand. 1980;51(5):803ā€“10.

    ArticleĀ  CASĀ  Google ScholarĀ 

  3. Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF. Fracture and dislocation classification compendium-2018. Journal of Orthopaedic trauma. 2018;32(Suppl 1):32ā€“5.

    Google ScholarĀ 

  4. Nyholm AM, Gromov K, Palm H, Brix M, Kallemose T, Troelsen A, Danish Fracture Database Collaborators. Time to surgery is associated with 30-day and 90-day mortality after proximal femoral fracture: a retrospective observational study on prospectively collected data from the Danish Fracture Database Collaborators. J Bone Joint Surg Am. 2015;97(16):1333ā€“9.

    ArticleĀ  Google ScholarĀ 

  5. Steinberg EL, Sternheim A, Kadar A, Sagi Y, Sherer Y, Chechik O. Early operative intervention is associated with better patient survival in patients with intracapsular femur fractures but not extracapsular fractures. J Arthroplasty. 2014;29(5):1072ā€“5.

    ArticleĀ  Google ScholarĀ 

  6. Baldwin PC 3rd, Lavender RC, Sanders R, Koval KJ. Controversies in intramedullary fixation for intertrochanteric hip fractures. J Orthop Trauma. 2016;30(12):635ā€“41.

    ArticleĀ  Google ScholarĀ 

  7. Fitzpatrick DC, Sheerin DV, Wolf BR, Wuest TK. A randomized, prospective study comparing intertrochanteric hip fracture fixation with the dynamic hip screw and the dynamic helical hip system in a community practice. Iowa Orthop J. 2011;31:166ā€“72.

    PubMedĀ  PubMed CentralĀ  Google ScholarĀ 

  8. Baumgaertner MR, Curtin SL, Lindskog DM, Keggi JM. The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg Am. 1995;77(7):1058ā€“64.

    ArticleĀ  CASĀ  Google ScholarĀ 

  9. Bonnevialle P, Saragaglia D, Ehlinger M, Tonetti J, Maisse N, Adam P. Trochanteric locking nail versus arthroplasty in unstable intertrochanteric fracture in patients aged over 75 years. Orthop Traumatol Surg Res. 2011;97(6 Suppl):S95ā€“100.

    ArticleĀ  CASĀ  Google ScholarĀ 

  10. Palm H, Jacobsen S, Sonne-Holm S, Gebuhr P, Hip Fracture Study Group. Integrity of the lateral femoral Wall in intertrochanteric hip fractures: an important predictor of a reoperation. J Bone Joint Surg (Am). 2007;89-A:470ā€“5.

    Google ScholarĀ 

  11. Haidukewych GJ. Intertrochanteric fractures: ten tips to improve results. Instr Course Lect. 2010;59:503ā€“9.

    PubMedĀ  Google ScholarĀ 

  12. Kammerlander C, Hem ES, Klopfer T, Gebhard F, Sermon A, Dietrich M, Bach O, Weil Y, Babst R, Blauth M. Cement augmentation of the Proximal Femoral Nail Antirotation (PFNA)ā€”a multicentre randomized controlled trial. Injury. 2018;49(8):1436ā€“44.

    ArticleĀ  Google ScholarĀ 

Download references

Conflict of Interest

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this chapter.

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

Ā© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Giannoudis, P.V., BaƱa, E.A. (2020). Extracapsular Proximal Femoral Fractures (Pertrochanteric Intertrochanteric and Fractures with Reverse Obliquity). In: Giannoudis, P. (eds) Fracture Reduction and Fixation Techniques. Springer, Cham. https://doi.org/10.1007/978-3-030-24608-2_15

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-24608-2_15

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-24607-5

  • Online ISBN: 978-3-030-24608-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics