![]() ![]() The greater trochanter serves as an insertion site for the gluteus medius, gluteus minimus, obturator internus, piriformis, and site of origin for the vastus lateralis. The intertrochanteric aspect of the femur is located between the greater and lesser trochanters and is composed of dense trabecular bone. ![]() Intertrochanteric fractures are defined as extracapsular fractures of the proximal femur that occur between the greater and lesser trochanter. Outline interprofessional team strategies for improving care coordination and communication to improve outcomes with intertrochanteric femur fracture treatment.Outline the treatment options for intertrochanteric femur fractures, depending on patient population and fracture severity and location.Summarize the diagnostic approach for an evaluation and assessment of a patient presenting with a potential intertrochanteric femur fracture, including any indicated imaging studies and potential differentials.Describe the most common mechanisms of injury that can result in intertrochanteric femur fractures.This activity reviews the evaluation and treatment of intertrochanteric femur fractures and highlights the role of the interprofessional team in evaluating and treating patients with this condition. Understanding the pathophysiology as well as the proper treatment options will significantly decrease the risk of mortality and morbidity of this injury. The increased use of intramedullary nails for intertrochanteric hip fractures appears to be multifactorial, including the less invasive nature of the surgery and increased experience with the closed surgical technique.Intertrochanteric femur fractures are a very common injury seen in the elderly. Increased use of intramedullary nails compared with ORIF has not shown improved outcomes or decreased complications in patients with intertrochanteric hip fractures. Over the decade of the study, intramedullary nail usage increased 59.8% compared with ORIF. Patients who underwent intramedullary nailing during 2006 to 2007 had a lower adjusted risk of conversion to total hip replacement at 1 year (P=.037) compared with those who had ORIF. Patients treated with an intramedullary nail had a higher adjusted risk of pulmonary embolism at 90 days (P=.003) and a higher risk of mortality at 1 year (P<.001) compared with those treated with ORIF. Intertrochanteric hip fractures treated with an intramedullary nail during this period increased from 3.3% to 63.1% compared with ORIF. There were 9157 patients treated with intramedullary nails and 27,687 treated with compression screw and plate fixation. Patients followed for up to 1 year postoperatively were identified from the 5% nationwide sample of Medicare administrative claims data (1998-2007) using the corresponding International Classification of Diseases, 9th revision, Clinical Modification, codes 820.21 and 820.31. The authors hypothesized that the biomechanically stronger and less invasive intramedullary nail would have superior results and fewer complications compared with ORIF. The study evaluated the incidence of and complications associated with the use of an intramedullary nail vs open reduction and internal fixation (ORIF) with a sliding compression hip screw and plate in treating intertrochanteric fractures. ![]()
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