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Chapter-184 Subtrochanteric Fractures of the Femur

BOOK TITLE: Textbook of Orthopedics & Trauma (4 Volumes)

Author
1. Babhulkar Sudhir
ISBN
9789385891052
DOI
10.5005/jp/books/12869_185
Edition
3/e
Publishing Year
2016
Pages
11
Author Affiliations
1. Sushrut Hospital and Research Centre, Nagpur, India, Sushrut Hospital and Research Centre, Ramdaspeth, Nagpur, Indira Gandhi Medical College and Mayo General Hospital, Nagpur, Maharashtra, India; Sushrut Hospital, Research Center and Postgraduate Institute of Orthopedics, Nagpur, Maharashtra, India, Indira Gandhi Medical College, Nagpur, Maharashtra, India; Sushrut Hospital, Research Center and Postgraduate Institute of Orthopedics, Nagpur, Maharashtra, India, E-mail: sudhirbabhulkar@gmail.com, Sushrut Institute of Medical Sciences, Nagpur, Maharashtra, India, Sushrut Hospital, Research Centre and Postgraduate Institute of Orthopedics, Nagpur, Maharashtra, India
Chapter keywords
Subtrochanteric fracture, femur, proximal femur, Seinsheimer’s classification, subtrochanteric hip fracture, dynamic condylar screw, locked intramedullary nailing, DCS

Abstract

Surgery of internal fixation is indicated in all types of subtrochanteric fractures in adults. The nonoperative treatment produces poor results. Anatomy and biomechanics of subtrochanteric fractures and of the implants much be thoroughly understood to treat these fractures. L-plate technically difficult, Smith-Peterson nail or Jewett nail should not be used for subtrochanteric fractures. Ender’s nail is associated with many complications. Currently, the present trend is to use of second-generation interlocking nails depending on the fracture geometry. It is advisable to use sliding device when the intertrochanteric area is fractured and the bone is osteoporotic. If the piriformis fossa and intertrochanter both are fractured, sliding screw with long barrel plate is ideal. The use of sliding device is restricted to patients who have a fracture of intertrochanter and piriformis fossa, where one may consider use of dynamic compression screw (DCS).

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