A hip fracture is a break that occurs near the hip in the upper part of the femur or thigh bone. The thigh bone has two bony processes on the upper part - the greater and lesser trochanters. The lesser trochanter projects from the base of the femoral neck on the back of the thigh bone.
Subtrochanteric hip fracture is a break between the lesser trochanter and the area approximately 5 centimeters below the lesser trochanter.
Causes of subtrochanteric hip fracture include:
- Minor trauma in elderly patients with weak bones
- High-energy trauma in young people
- Long term use of bisphosphonates (medicine to treat certain bone diseases)
Signs and symptoms of subtrochanteric hip fracture include
- Pain in the groin or outer upper thigh
- Swelling and tenderness
- Discomfort while rotating the hip
- Shortening of the injured leg
- Outward or inward turning of the foot and knee of the injured leg
X-ray and magnetic resonance imaging (MRI) may be performed to diagnose the fracture.
Traction is an option to treat your condition if you are not fit for surgery. Skeletal traction may be applied under local anesthesia, where screws, pins and wires are inserted into the femur, and a pulley system bearing heavy weights is set up at the end of the bed. The heavy weights help in correcting the misaligned bones.
Surgical options include external fixation, intramedullary fixation or plate and screws.
External fixation is a temporary fixation and used for severe open fractures. Pins are inserted into each of the fractured fragment and supported with tubes close to the bone. The tubes are interconnected together with short tubes to provide more stiffness for the frame.
Intramedullary fixation involves managing the fracture with a long intramedullary nail (large screw) and additional interlocking screws at the lower end of the nail to prevent rotation of bones.
Plate with screws involves fixing the screws into the bone from the outer side of the femur and a plate to hold the fracture together. A large screw will be inserted through the femoral neck and head, and other screws will be inserted across the length of the plate.
As with any surgical procedure, surgery for a sub trochanteric fracture involves certain risks and complications including:
- Nonunion of fracture with pain
- Limp or limited hip rotation due to malunion
- Nail or screw fixation failure
- Wound infection