Pertrochanteric or intertrochanteric fracture
There pertrochanteric fracture, This type of fracture, also called an intertrochanteric fracture, is located in the upper part of the femur, between the greater and lesser trochanters. It involves the bone located just below the neck of the femur and can be more or less displaced or unstable.
It often occurs after a fall in an elderly person whose bones are weakened by osteoporosis. In a younger person, a high-energy trauma can also be responsible. The pain is usually significant, and putting weight on the leg becomes very difficult, or even impossible.
Prompt hospital admission allows for confirmation of the fracture, pain management, assessment of the patient's overall condition, and preparation of the most appropriate treatment. In most cases, surgery is necessary to stabilize the fracture and allow for early mobilization.
UNDERSTANDING PERTROCHANTERIC OR INTERTROCHANTERIC FRACTURE
RECOGNIZING THE SYMPTOMS
A pertrochanteric or intertrochanteric fracture It usually causes sudden pain in the hip or upper thigh after a fall or injury. Movement becomes difficult and weight-bearing on the leg is often impossible.
- Severe hip or groin pain: The pain can spread to the thigh and be aggravated by the slightest movement.
- Inability or great difficulty in gaining support: The person is often unable to walk normally after the trauma.
- Leg turned outwards: The lower limb may appear in external rotation, sometimes with apparent shortening.
- Swelling or bruising: A hematoma may appear around the hip and thigh, but its absence does not rule out a fracture.
After a fall, significant hip pain or the inability to get up should be considered an emergency. Do not force weight-bearing or attempt to realign the leg yourself.
WHY DOES A PERTROCHANTERIC FRACTURE OCCUR?
A pertrochanteric or intertrochanteric fracture occurs when the force exerted on the upper part of the femur exceeds the bone's strength. In older people, a fall from a low height can be enough when the bone is weakened. In younger people, the trauma is usually more severe.
FALL
A fall on one's side can transmit the impact directly to the trochanteric region. This mechanism is common in older people, particularly those with osteoporosis or balance disorders.
BONE FRAGILITY AND OSTEOPOROSIS
Decreased bone density makes the femur more vulnerable. A fracture following moderate trauma should prompt an investigation for bone fragility and measures to prevent the risk of further fractures.
HIGH-ENERGY TRAUMA
In young adults, a road accident, a serious fall or a violent sports injury can cause a complex fracture, sometimes associated with other injuries.
Factors Contributing to Falls
Vision problems, balance issues, certain medications, muscle weakness, or a hazardous environment can increase the likelihood of a fall and should be considered after the fracture.
MAKE THE RIGHT DIAGNOSIS
Diagnosis is based on clinical examination and imaging. A pertrochanteric fracture is usually visible on X-rays of the hip and pelvis. A CT scan may be requested when the fracture is complex, poorly visible, or when its morphology needs to be clarified before surgery.
01 – THE CLINICAL EXAMINATION
The doctor looks for pain, deformity, limb rotation, weight-bearing capacity, and any wounds. Sensation, movement, and circulation in the foot are also checked.
02 – X-RAYS
X-rays of the pelvis and hip usually confirm the fracture, assess its displacement, and guide treatment.
03 – THE SCAN AND THE PRE-OPERATIVE ASSESSMENT
A CT scan can determine the number of fragments and the stability of the fracture. Before surgery, a general, biological, and anesthetic assessment is carried out to tailor the treatment to the patient's health condition.
A normal or difficult-to-interpret X-ray does not always rule out a fracture: if pain and inability to bear weight persist, further examination may be necessary.
TREAT THE FRACTURE AND STABILIZE THE HIP
The management of a pertrochanteric or intertrochanteric fracture is usually performed in a hospital. The goal is to relieve pain, reposition the fragments when necessary, and then stabilize the fracture to allow for rapid mobilization.
RELIEVE PAIN AND PROTECT THE LIMB
The limb is placed in a comfortable position and weight-bearing is avoided until the fracture has been assessed. Pain medication is administered and the patient's general condition is monitored. In an elderly person, prevention of dehydration, confusion, and complications related to immobilization begins upon hospitalization.
REDUCE AND STABILIZE THE FRACTURE
In most cases, surgery is performed to bring the fragments together and hold them in place using a suitable device. Depending on the stability and morphology of the fracture, the surgeon may use a cephalic nail or a sliding plate and screw. The choice depends on X-rays, CT scans, and the condition of the bone.
ORGANIZING EARLY MOBILIZATION
After fixation, wheelchairing and assisted walking begin as soon as the patient's medical condition and the stability of the fixation allow. The permissible weight-bearing depends on the type of fracture, the quality of the bone, and the strength of the fixation.
PREVENTING COMPLICATIONS AND FURTHER FALLS
Monitoring focuses on the scar, anemia, phlebitis, infection, confusion, and loss of independence. An assessment of bone fragility, osteoporosis prevention, and fall risk evaluation are important to minimize the risk of further fractures.
The treatment is not limited to repairing the bone: it also aims to quickly get the patient moving again and to preserve their autonomy. The strategy is adapted to age, general condition, previous autonomy and type of fracture.
WHEN TO CONSIDER SURGERY?
For a pertrochanteric or intertrochanteric fracture, surgery is generally considered early to stabilize the bone, relieve pain, and allow for early mobilization. The decision depends on the appearance of the fracture, the possibility of weight-bearing, and the patient's overall condition. Non-surgical management remains exceptional.
IN CASE OF A DISPLACED OR UNSTABLE FRACTURE
Surgery is generally indicated when bone fragments are displaced or when the fracture is unstable. Without fixation, the fracture risks further displacement and may not allow for reliable weight-bearing.
WHEN SUPPORT AND MOBILIZATION ARE IMPOSSIBLE
Significant pain, the inability to stand, or the lack of weight-bearing on the leg make prolonged immobilization difficult to endure, especially for an elderly person. Stabilizing the fracture allows for a quicker transition to a wheelchair, assisted walking, and rehabilitation.
AFTER ASSESSING THE GENERAL CONDITION
Age, associated illnesses, level of independence before the fall, current treatments, and anesthetic risks are taken into account before the procedure. In very rare situations, non-surgical management may be discussed when anesthesia or surgery presents a disproportionate risk.
REHABILITATION AND RESUMPTION OF ACTIVITIES
Recovery depends on the stability of the fixation, bone healing, muscle condition, and pre-fracture independence. It begins in the hospital and continues with appropriate rehabilitation, sometimes in a rehabilitation center or at home.
01 – STRAIGHTEN UP AND SIT DOWN
The first changes of position are made with the care team, taking into account pain, blood pressure and general condition.
02 – RESUME SUPPORT WITH AID
Walking begins with a walker or crutches when permitted. The level of weight-bearing is determined by the surgeon and physiotherapist.
03 – REGAIN STRENGTH AND BALANCE
Rehabilitation works on the hip and thigh muscles, transfers, balance and coordination in order to gradually regain a safer gait.
04 – RESUME DAILY ACTIVITIES
Movement within the home, stairs, washing and dressing are relearned or adapted according to the patient's abilities.
05 – PREVENTING ANOTHER FALL
The environment, footwear, vision, medications, balance, and bone fragility are reassessed. Prevention is an integral part of recovery.
Recovery depends on consolidation, general condition and autonomy, and not on an identical timetable for everyone.
A CARE APPROACH TAILORED TO EACH PATIENT
A pertrochanteric or intertrochanteric fracture is not treated solely based on the radiographic image. The decision takes into account the shape of the fracture, its stability, the quality of the bone, the patient's age, independence, and overall health.
Treatment involves pain management, fracture stabilization, prevention of immobilization complications, and progressive mobilization. Rehabilitation is tailored to each individual's abilities and recovery goals.
After the acute phase, follow-up checks the scar, healing, hardware placement, gait, and progress in independence. Screening for osteoporosis and fall prevention also help reduce the risk of further fractures.
«"Rapidly stabilizing the fracture and gradually restoring the patient's mobility are two essential objectives of treatment."»
FREQUENTLY ASKED QUESTIONS
DO YOU WANT TO BETTER UNDERSTAND YOUR PAIN?
A clinical examination combined with appropriate imaging helps to determine the origin of symptoms and identify the most suitable treatments.
