Subtrochanteric fractures in old age

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Subtrochanteric fractures

A subtrochanteric fracture of the femur is a fracture located between the lesser trochanter and a point 5 cm below it. The subtrochanteric segment of the femur supports important biomechanical loads. The medial and posteromedial corticals are subjected to significant compressive forces, while the lateral cortex is subjected to high tensile forces. The subtrochanteric region of the femur consists mainly of cortical bone. Therefore, it is less vascularized and its consolidation potential is less than that of pertrochanteric fractures. The deforming muscular forces acting on the proximal fragment are the abducting action of the buttock, the external rotation of the short rotators and the flexion by action of the psoas. The distal fragment is displaced in the proximal and varus direction by the adductor muscles.

how are they produced?

- ***Low energy mechanisms:*** elderly patients who suffer a minor fall and in whom the fracture is produced through a weakened (pathological) bone. - ***High energy mechanisms:*** young adults with healthy bone who suffer injuries related to traffic accidents, gunshot wounds or falls from heights. - ***Pathological fracture:*** the subtrochanteric region is also a frequent location of pathological fractures, corresponding to 17% to 35% of all subtrochanteric fractures.

https://cdn.steemitimages.com/DQmQfPXPYe3113aXkimgeS31i9A7oxnkr4aNqLND466ykV3/IMG_20190611_200653_378.jpg

Treatment

Surgical treatment is indicated for most fractures and preferably by means of an intramedullary nail: - When an intramedullary nail is used, it should be checked that it does not protrude into the posterior portion of the proximal fragment. It is also necessary to check for possible (and frequent) misalignment of the proximal fragment, in varus and in flexion. In the anterior cortex of the distal fragment, a false pathway may occur due to a mismatch between the radii of curvature between the femur and the nail.

Dr. Leopoldo Maizo - Orthopedic Surgeon

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Originally posted here: https://steemit.com/fundition/@drmaizo/subtrochanteric-fractures-in-old-age-1560300583