• Registration
  • Login
JETem
  • Home
  • About
    • Aim and Scope
    • Our Team
    • Editorial Board
    • FAQ
  • Issues
    • Current Issue
    • Ahead of Print
    • Past Issues
  • Visual EM
    • Latest Visual EM
    • Search Visual EM
    • Thumbnail Library
  • For Authors
    • Instructions for Authors
    • Submit to JETem
    • Photo Consent
    • Policies
      • Peer Review Policy
      • Copyright Policy
      • Editorial Policy, Ethics and Responsibilities
      • Conflicts of Interest & Informed Consent
      • Open Access Policy
  • For Reviewers
    • Instructions for JETem Reviewers
    • Interested in Being a JETem Reviewer?
  • Topic
    • Abdominal / Gastroenterology
    • Administration
    • Board Review
    • Cardiology / Vascular
    • Clinical Informatics, Telehealth and Technology
    • Dermatology
    • EMS
    • Endocrine
    • ENT
    • Faculty Development
    • Genitourinary
    • Geriatrics
    • Hematology / Oncology
    • Infectious Disease
    • Miscellaneous
    • Neurology
    • Ob / Gyn
    • Ophthalmology
    • Orthopedics
    • Pediatrics
    • Procedures
    • Psychiatry
    • Renal / Electrolytes
    • Respiratory
    • Toxicology
    • Trauma
    • Ultrasound
    • Wellness
    • Wilderness
  • Modality
    • Curricula
    • Innovations
    • Lectures
    • Oral Boards
    • Podcasts
    • Simulation
    • Small Group Learning
    • Team Based Learning
    • Visual EM
  • Contact Us

Acute comminuted intertrochanteric hip fracture

Samuel Kaplan, BS* and Jonathan Peña, MD*

*University of California, Irvine, Department of Emergency Medicine, Orange, CA

Correspondence should be addressed to Jonathan Peña, MD at jdpena@uci.edu 

DOI: https://doi.org/10.21980/J8QK9C Issue 3:2
OrthopedicsVisual EM
No ratings yet.

History of present illness:

A 69-year-old male presented to the emergency department (ED) with left hip pain after he was rear-ended on his bicycle by a vehicle traveling 10-15 miles per hour. He had normal vital signs. On exam, his left lower extremity was externally rotated and shortened with trochanteric point tenderness. His pelvis was stable. His lower extremity compartments were soft, and he had 2+ dorsalis pedis and posterior tibial pulses.

Significant findings:

Plain film of the left hip showed acute comminuted displaced intertrochanteric fracture (red arrows) of left femur with varus angulation (green lines) and no dislocation. Greater (blue arrow) and lesser (yellow arrow) trochanters are annotated for reference.

Discussion:

Intertrochanteric (IT) femur fractures comprise around 50% of all diagnosed hip fractures and are considered extracapsular. They most often occur in elderly, female, or osteopenic patients as a result of low-energy trauma, and one-year mortality rates range between 15% and 30%.1,2,3  Patients classically present with external rotation and shortening, and fractures are generally classified as unstable when the posteromedial cortex is disrupted.4,5 Anteroposterior (AP) and lateral pelvis radiographs are first-line while computed tomography (CT), magnetic resonance imaging (MRI), and bone scans are more sensitive secondary modalities.6 Since IT fractures involve vascular cancellous bone, they may cause significant blood loss into the thigh, which may lead to compartment syndrome. Avascular necrosis and malunion have also been described as sequelae of this fracture pattern.7 A thorough integumentary and neurovascular exam is important for any ED provider. Early orthopedics consultation is important because reduction and fixation or arthroplasty are indicated in the majority of operative candidates.4

Topics:

Hip fracture, intertrochanteric, comminuted, orthopedics.

References:

  1. Kenzora JE, McCarthy RE, Lowell JD, Sledge CB. Hip fracture mortality. Relation to age, treatment, preoperative illness, time of surgery, and complications. Clin Orthop Relat Res. 1984;186:45-56.
  2. Grisso JA, Kelsey JL, Strom BL, Chiu GY, Maislin G, O’Brien LA, et al. Risk factors for falls as a cause of hip fracture in women. The Northeast Hip Fracture Study Group. N Engl J Med. 1991;324(19):1326–1331. doi: 10.1056/NEJM199105093241905
  3. Schnell S, Friedman SM, Mendelson DA, Bingham KW, Kates SL. The 1-year mortality of patients treated in a hip fracture program for elders. Geriatr Orthop Surg Rehabil. 2010;1(1):6-14. doi: 10.1177/2151458510378105
  4. Brunner LC, Eshilian-Oates L, Kuo TY. Hip fractures in adults. Am Fam Physician. 2003; 67(3):537-542.
  5. Knobe M, Gradl G, Ladenburger A, Tarkin IS, Pape HC. Unstable intertrochanteric femur fractures: is there a consensus on definition and treatment in Germany? Clin Orthop Relar Res. 2013;471(9):2831–2840. doi: 10.1007/s11999-013-2834-9
  6. Foster, KW. Hip fractures in adults. In: Downey BC, ed. UpToDate. Waltham, MA: 2017. www.uptodate.com. Updated April 20, 2017. Accessed April 5, 2018.
  7. Baumgaertner MR, Oetgen ME. Intertrochanteric hip fractures. In: Browner BD, Jupiter JB, Levine AM, Trafton PG, eds. Skeletal Trauma: Basic Science, Management, and Reconstruction. 3rd Philadelphia, PA: Elsevier; 2003.
Icon

Intertrochanteric Hip Fracture - Case Report

1 file(s) 434 KB
Download
Icon

Intertrochanteric Hip Fracture - Images

1 file(s) 282 KB
Download
Issue 3:2X-Ray

Reviews:

No ratings yet.

Please rate this





Radial Nerve Palsy

13 Apr, 18

Type 1 Brugada Syndrome

13 Apr, 18
JETem is an online, open access, peer-reviewed journal-repository for EM educators

Most Viewed

  • Telemedicine Consult for Shortness of Breath Due to Sympathetic Crashing Acute Pulmonary Edema
  • Anticholinergic Toxicity in the Emergency Department
  • The Suicidal Patient in the Emergency Department Team-Based Learning Activity
  • Child Maltreatment Education: Utilizing an Escape Room Activity to Engage Learners on a Sensitive Topic
  • Acute Chest Syndrome

Visit Our Collaborators

About

Education

Learners should benefit from active learning. JETem accepts submissions of team-based learning, small group learning, simulation, podcasts, lectures, innovations, curricula, question sets, and visualEM.

Scholarship

We believe educators should advance through the scholarship of their educational work. JETem gives educators the opportunity to publish scholarly academic work so that it may be widely distributed, thereby increasing the significance of their results.

Links

  • Home
  • Aim and Scope
  • Current Issue
  • For Reviewers
  • Instructions for Authors
  • Contact Us

Newsletter

Sign up to receive updates from JETem regarding newly published issues and findings.

Copyright © 2016 JETem. All rights reserved.