Intertrochanteric femoral fracture

　　The causes of intertrochanteric femoral fracture are mostly due to indirect external force, such as sudden twisting of the lower limb, strong internal or external rotation when falling, or direct impact. Due to local osteoporosis and fragility, fractures are mostly comminuted. In elderly osteoporosis, sudden twisting of the lower limb and falling can easily cause fractures, and hip varus deformity can be caused due to the internal rotation of the trochanteric area.

　　The complications of intertrochanteric femoral fracture are mainly postoperative complications. In the past, traction conservative treatment was often used in treatment, which could enable most patients to achieve fracture healing, but long-term bed rest is prone to cause pulmonary infection, bedsores, urinary tract infection, and formation of lower limb venous thrombosis, with high disability and mortality rates.

　　In terms of surgery, patients who undergo internal fixation often have complications such as tension screw cutting off the femoral head and hip varus deformity.

　　Intertrochanteric femoral fracture refers to the fracture within the plane area from the base of the femoral neck to the subtrochanteric region, which is an extra-articular fracture. It is most common in the elderly over 65 years old, with more females than males. Due to the rich blood supply in the trochanteric area, fractures rarely fail to heal, but hip varus deformity is very likely to occur. Long-term bed rest in elderly patients can lead to many complications. The following introduces the symptoms and clinical signs of intertrochanteric femoral fracture.

　　1. Symptoms of intertrochanteric femoral fractures

　　(1) Patients are mostly elderly, and severe hip pain is caused by trauma.

　　(2) Hip joint movement is limited, unable to stand or walk.

　　(3) Non-displaced impacted fractures or stable fractures with less displacement have relatively mild symptoms.

　　2. Signs of intertrochanteric femoral fractures

　　(1) During the examination, it can be seen that the greater trochanter on the affected side is elevated, the affected hip is swollen, and there is local subcutaneous ecchymosis.

　　(2) The lower limb is externally rotated 90° with significant shortening and deformity.

　　(3) Local tenderness in the anterior hip is obvious, and the tenderness points are mainly in the greater trochanter.

　　(4) Tenderness over the greater trochanter.

　　(5) Lower limb percussion tenderness.

　　The above are the symptoms and clinical signs of intertrochanteric femoral fractures, which are very helpful for the diagnosis of the disease. If the above signs can be suspected as intertrochanteric femoral fractures, combined with CT or MRI examination, it can be diagnosed.

　　Intertrochanteric femoral fractures are mainly caused by traumatic factors, so attention should be paid to safety in production and life to avoid trauma, which is the key to preventing the disease. Otherwise, attention should be paid to the overall condition to prevent various life-threatening complications caused by bed rest after fracture, such as pneumonia, bedsores, and urinary tract infections. Patients also need to perform joint exercises early to prevent joint stiffness.

　　The auxiliary examination methods for intertrochanteric femoral fractures are mainly imaging examinations, including X-ray examination, CT examination, and MRI examination:

　　1. X-ray examination:

　　The routine examination for intertrochanteric femoral fractures usually uses X-ray examination, which can generally detect the condition of the fracture. However, in some special types of fractures, such as incomplete fractures and fatigue fractures, due to the fact that the fracture is not displaced and only has irregular fissures, the fracture cannot be displayed on X-ray films. In addition, X-ray films overlap the bone folds and soft tissue shadows of the greater and lesser trochanters, intertrochanteric line, spine, etc., making the fracture easy to miss.

　　2. CT examination:

　　CT significantly reduces the misdiagnosis rate of femoral neck base or intertrochanteric or subtrochanteric fissure fractures, and can display the continuity of bone cortex and the internal structure of bone断层 layers. However, due to the irregularity of the femoral neck base or intertrochanteric and subtrochanteric bones, interference from nutrient vessels, missed scanning planes, and other factors, it also causes certain difficulties in diagnosis.

　　3. MRI examination:

　　MRI scanning is significantly superior to X-ray and CT. In cases of incomplete fractures, fatigue fractures, and other fracture types that cannot be displayed by X-ray in femoral neck base or intertrochanteric or subtrochanteric fissure fractures, MRI examination has a significant advantage. X-ray cannot display minor fractures, while MRI shows bone marrow changes. It has high sensitivity. However, attention should be paid to minor injuries and local exudation that can cause similar fracture signal shadows. T1 and T2 fracture lines have low signal, and fat suppression can improve the diagnostic rate. But be aware of volume effect artifacts, which can be avoided by thin-section scanning and do not mistake the epiphysis for a fracture line.

　　The above are the common examination items for intertrochanteric femoral fractures. These examinations can make an accurate diagnosis. If this disease is present, it needs to be treated actively, and the occurrence of complications should be prevented actively.

　　Intertrochanteric femoral fractures are common in the elderly. Due to the rich blood supply in the greater trochanter, fractures rarely fail to heal, but they are very prone to hip varus. Elderly patients with long-term bed rest have more complications. During the longer recovery period, both the family members and the patients of patients with intertrochanteric femoral fractures should pay attention to the dietetic care.

　　9. Generally speaking, patients who have been injured for 1 to 2 weeks need light, easy-to-absorb, and digestible diets. They should be given more vegetables, fruits, fish soup, eggs, and soy products, and steamed or braised dishes should be preferred. They should eat less spicy, greasy, and fried foods. Especially, more honey and bananas can be eaten, as bedridden patients are more likely to have constipation symptoms. These foods can help defecate.

　　8. For patients with intertrochanteric femoral fractures who have been injured for 2 to 4 weeks, their bodies are no longer so weak, and their appetite and gastrointestinal function have recovered. At that time, it is appropriate to supplement nutrition, such as bone soup, fish, eggs, and animal liver. At the same time, more radishes, tomatoes, and other vegetables should be eaten, which can meet the needs of bone growth and promote wound healing.

　　7. In the following days, patients with intertrochanteric femoral fractures do not need to avoid certain foods anymore. For some critically ill patients and patients with other complications caused by intertrochanteric femoral fractures, diet cannot be generalized. It is necessary to make a reasonable arrangement according to the condition and medical advice.

　　6. After more than 5 weeks of intertrochanteric femoral fracture, patients can eat more high-nutrient foods and foods containing trace elements such as calcium, manganese, and iron. Animal liver, eggs, green vegetables, and wheat contain a lot of iron. Sea products, soybeans, etc., contain a lot of zinc, and oatmeal, egg yolks, etc., contain a lot of manganese. At the same time, soup, fish soup, and various bone soup can be added selectively, and red dates and goji berries can be added.

　　5. Foods that patients with intertrochanteric femoral fractures should not eat: in the early stage, avoid sour and spicy, dry and hot, and greasy foods. It is especially not advisable to take greasy and nourishing foods too early, such as bone soup, fatty chicken, braised fish, etc. In addition, fruit juice and sugar are also not suitable.

　　The above is the dietary requirements for patients with intertrochanteric femoral fractures. Scientific and reasonable diet will be beneficial to the recovery of fractures and will shorten the recovery time.

　　Fractures of the intertrochanteric femur are mostly found in elderly patients. First, attention should be paid to the overall condition to prevent various life-threatening complications such as pneumonia, bedsores, and urinary tract infections caused by bed rest after fracture. The purpose of fracture treatment is to prevent the occurrence of hip varus deformity, and the specific treatment method should be adopted according to the type of fracture, displacement, patient age, and overall condition, respectively.

　　1. Traction Therapy

　　Applicable to all types of intertrochanteric fractures. Especially suitable for patients with non-displaced stable fractures and severe visceral diseases who are not suitable for surgery. The advantage of traction is that it can control the external rotation of the affected limb, for type I and II stable fractures, traction for 8 weeks, then mobilize the joints, use crutches to walk on the ground, but the affected limb should not bear weight until 12 weeks after the fracture healing is firm to prevent the occurrence of hip varus.

　　The requirements for traction of unstable fractures are:

　　(1) The traction weight is about 1/7 of the body weight.

　　(2) Once the hip varus deformity is corrected, the traction weight should be maintained at 1/7 to 1/10 of the body weight to prevent the recurrence of hip varus deformity.

　　(3) The traction should be maintained for a sufficient period of time, generally more than 8 to 12 weeks, and traction is removed after the fracture healing is initially firm.

　　2. Closed Intercondylar Multiple Stryker Nail Internal Fixation

　　Firstly, tibial tuberosity traction is performed for reduction, and a systemic examination is performed. Surgery is performed on the fracture table within 3 to 7 days after the injury. Use 4 diameter 3.5mm Stryker nails for fixation similar to multiple Stryker nails for femoral neck fracture.

　　3. Nail-plate Internal Fixation

　　This method is suitable for various types of fractures in adults, and common internal fixations include DHS (Dynamic Hip Screw) and Charnley sliding compression nail, etc.

　　4. Ender Nail Fixation

　　A hole is drilled 2cm above the medial condyle of the femur, and the Ender needle is observed on the X-ray television fluorescent screen, passing through the fracture site to the lower 0.5cm under the articular surface of the femoral head. Make several nail ends fan-shaped or fish fork-like to fix the proximal bone block. Postoperative skin traction or anti-external rotation shoe is applied.

　　5. Gamma Nail Fixation

　　In the early 1990s, some countries adopted Gamma nails, which are locked intramedullary nails, obliquely穿过a through the neck of the femoral head with a coarse screw, because the main nail passes through the medullary cavity, from the biomechanical analysis, the force line is close to the center of the femoral head, therefore, the inner side of the Gamma nail of the femur can withstand greater stress, and achieve the purpose of early weight-bearing on the ground.

　　Treatment methods for intertrochanteric fractures of the femur, the specific methods for patients with intertrochanteric fractures need to be formulated by doctors in combination with specific conditions to determine the best treatment plan.