MANUAL MINORS
A subtrochanteric fracture is a femur fracture located just below the lesser trochanter, extending up to 5 cm distally from this point. These fractures typically occur due to high-energy trauma in younger individuals or due to bone fragility, as seen in patients with osteoporosis or those treated with bisphosphonates. This type of fracture presents a challenge due to its location, as the biomechanics of the area make stabilisation and healing difficult.
Diagnosis
The diagnosis is made based on a history of trauma or fall, typically with severe pain, inability to walk, and visible deformity of the affected leg. On physical examination, swelling, limb shortening, and external rotation are observed. The diagnosis is confirmed through femur X-rays, which show the location of the fracture. In some cases, a computed tomography (CT) scan may be necessary to assess the extent of the fracture and plan for surgical treatment.
Differential Diagnosis
Condition | Key Differentiation |
|---|---|
Intertrochanteric Fracture | Involves the area between the greater and lesser trochanter, without extending distally beyond the lesser trochanter. |
Femoral Neck Fracture | The fracture occurs in the upper part of the femur, closer to the femoral head. |
Femoral Shaft Fracture | Involves the femoral shaft, distal to the subtrochanteric area. |
Pelvic Fracture | Pelvic pain without direct involvement of the femur. |
Avascular Necrosis of the Femoral Head | Hip pain without fracture, with a history of femoral head collapse visible on MRI. |
Emergency Management
Initial emergency management includes stabilising the patient, providing adequate analgesia, temporarily immobilising the affected limb, and, if necessary, administering intravenous fluids.
Subtrochanteric fractures are often unstable, so temporary skin traction may be used to relieve pain and prevent further displacement before surgical intervention. Associated injuries, particularly in patients with high-energy trauma, should be evaluated and treated.
Definitive Treatment
Definitive treatment is surgical in nearly all cases. The most commonly used technique is internal fixation with a locked intramedullary nail, which provides stability and allows for early functional recovery.
In some cases, a plate with screws may be used, especially if the fracture is complex or if intramedullary nailing is not possible. Early rehabilitation with physiotherapy is essential to restore mobility, although weight-bearing on the affected limb may be initially restricted.
The prognosis depends on the stability of the fracture and the patient’s bone quality. Radiological follow-up is important to ensure proper healing and to detect complications such as non-union or malunion.
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