Intertrochanteric Femur Fracture Treatment I वृद्धावस्था में कूलह ( हिप) के फ्रैक्चर का इलाज I

#Intertrochanteric_Femur_Fracture Treatment I वृद्धावस्था में #कूलह_के_फ्रैक्चर_का_इलाज I

फीमर का इंटर-ट्रोकैनेटरिक क्षेत्र जांघ की हड्डी का ऊपरी विस्तारित हिस्सा होता है जो फीमर की गर्दन को फीमर के शाफ्ट से जोड़ता है।

50 वर्ष से अधिक उम्र के बुजुर्ग आबादी में इंटर-ट्रोकैनेटरिक फ्रैक्चर सबसे अधिक होता है।
इसका मुख्य कारण यह है कि इस उम्र में हड्डियां ऑस्टियोपोरोटिक हो जाती हैं।

Inter-trochanteric area of femur is the upper expanded part of thigh bone which connects the neck of femur to the shaft of femur

Inter-trochanteric fracture most commonly occurs in elderly population beyond 50 years age.
Its mainly because the bones get osteoporotic in this age.

A trivial trauma can cause fracture in inter-trochanteric region of femur.
Trivial trauma can be as trivial as taking a turn in bed to slip in bathroom or room.

You can prevent this mis-happening by few simple modification in home like -
Fitting handles near most commonly used areas of room and washroom
Good friction tiles which does not slip on being wet is a good option.
Keeping the washroom dry
Placing soft thick mats in room
Placing low bell in washroom and rooms in case of emergency
Well lit rooms and bathrooms


In case of a slip at home
Make the patient rested supine in bed
If the patient has pain in the hip and thigh region
The 1st clinical sign to look for is the direction of foot of the injured leg.
If the little toe is touching the bed or appears more externally rotated as compared to the normal side.
It’s time to seek assistance of a doctor.
After assessment and X-ray will diagnose Inter-trochanteric fracture

The goal of treating such fracture is to mobilize the patient as early as possible - because recumbency can lead to numerous problems
1. Systemic problems like flare up of diabetes, hypertension,
2. Hematological problems like deep vein thrombosis with pain and swelling in leg and calf the thrombus can dislodge and can be life threatening
3. Local problem like bed sore in pressure areas of gluteal, heel shoulder blades etc.
4. Most importantly - dependency on family members.

So the treatment of IT fracture is Operate only. There is hardly any role of conservative treatment in this injury.

The treatment of Inter-trochanteric fracture is based on classification of the fracture to simplify we ll classify it into in-stable fracture and stable fracture.

The gold standard treatment of stable fracture in past has been Dynamic Hip Screw and Proximal femoral Nail. The result of these surgery are good even today.
But there has been complications reported with these implants like - screw cut out, screw back-out, Loosening etc

So now the gold standard for both stable and unstable fracture is Proximal fomoral nail (PFN) - A2
This implant does not have a screw to fix the fracture rather it has a helical blade plate for fixation
The major advantage of this implant and surgery are
1. Is is a minimally invasive surgery with small cuts in the skin
2. Loss of blood is very less
3. Being an intra-medullary implant the patient can walk the very next day with the help of walker
4. Fixation is mechanically much better with lesser chances of cut out and back-out
5. Can be used in wide variety of fracture around this area

………………………………………………………………………………………………

Dr.Ankit Bhartia is an Orthopaedic Surgeon and Specializes in Arthroscopy and Arthroplasty Knee, Hip and Shoulder. Dr. Ankit has a vast experience in treating Sports injury like Ligament tear (ACL, PCL, MCL, LCL, MPFL), Cartilage injury and Meniscus tear of knee, Rotator-cuff tear of shoulder and Bankart lesion of shoulder, Ligament tear and cartilage Injury of the ankle. Dr. Ankit also specializes in Joint replacement of knee where we do both total Knee replacement as well as partial knee replacement.
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