Orthopedic Center with Orthopedist and Arthroplasty Services

What are subtrochanteric fractures?

The subtrochanteric fracture most often occurs in the proximal femur. 25% of all fractures that occur in the proximal region of the femur can be attributed to subtrochanteric fractures.

These fractures mainly affect both young people and adults, resulting in high-energy trauma with more complex fracture patterns. Another group that is disproportionately prone to these fractures is elderly women; they’re mainly affected by subtrochanteric fractures related to the use of bisphosphonates.

AGENDE SUA CONSULTA



To understand more about the subtrochanteric fracture (femur surgery), please continue reading the information below.

Features

There are certain characteristics of this subtrochanteric region of the femur that make it more prone to fractures. Since the muscular insertions in this region frequently experience pressure from other forces, it ends up becoming a place that withstands a lot of stress.

Caused by the iliopsoas muscle, flexion is the most common type of deformity, along with abduction (which occurs in the middle gluteus), and external rotation (which occurs through the external rotators) of the proximal fragment of the femur.

Adductors

The adductors, which are in the distal part of the femur, are linked to various deformities.

One of the challenges to bone consolidation after fractures is the difficulties arising from the subtrochanteric region’s precarious vascularization. This may be owing to the predominance of the cortical bone. As a result, there are higher rates of reoperation and failure of fixation in complex fractures that lack medial support.

Surgical treatment

Fracture Fixation

This surgical procedure involves stabilizing the misaligned or fractured bones with the help of implants, splints, or casts. However, fracture fixation may be difficult in this case since they are relatively small in size compared to the proximal fragment.

Fracture comminution (the bone breaking into more than two fragments) and bone fragility (resulting from osteoporosis) are significant contributors to fracture deformity in the healing process.

Related issues

The issues related to the small size of the proximal fragment and the fragility of the bones can be overcome with advanced fixation options.

One such way of aiding the healing process is using proximal femoral plates with latched screw options. These can provide stable fixation for injuries and help re-set the misaligned bones.

Femur surgery

This is the most viable option for healing and stabilizing a broken thighbone. By opting for femur surgery, some fracture patterns can be stabilized using the 95-degree angle plates. Plates with an angle of 135 degrees are unsuitable for stabilizing subtrochanteric femoral fractures since they are not designed to withstand the forces present in these fracture patterns

Comminuted fragments are often present in these fracture patterns and can be repaired with interfragmentary screws. By placing them in bone corridors that are separated from the nail or plate, the multiple splinters can be stabilized.

Managing the causal force

Contact forces, body weight, and stress are the leading causes of subtrochanteric fractures in the femur. These causal forces need to be adequately dealt with, otherwise the femur surgery may be performed in a position that leads to an inadequate reduction in them.

The abducted position of the proximal fragment will cause inadequate reduction if taken care of. Additionally, the distal fragment needs to be aligned with the flexed position of the proximal fragment. This helps you avoid flexion deformity in the fracture.

Working with your surgeon

As experienced surgeons who want to help you regain your quality of life, we strive to make the fracture reduction the best it can be. It’s important to remember that complete reduction may not be possible nor practical when there is considerable comminution present. This is also the case when the reduction maneuvers are going to damage the fragment’s vascularization.

Femur Surgery

In femur surgery, indirect reduction techniques are preferable when stabilizing these lesions. We may use traction through the fracture table or through an assistant while the patient is on the radiolucent table. The Universal Distractor can be used to apply the reduction forces that will encourage fracture reduction through the soft tissue envelope effect.

Kinast Study

According to a famous study carried out in 1989 by Kinast, it was demonstrated that the use of indirect reduction techniques ends up decreasing the need for bone grafts. Our commitment to the latest advancements and leading research in the field ensures we utilize the best techniques to ease you back to a healthy life.

Closed Fracture

When treating closed fractures that have a lot of comminution—in such a way that there are large empty spaces in the bones—bone grafting may be a viable alternative. The viability of this procedure depends on whether it can be performed using a non-traumatic femur surgery technique for the vascular supply of the proximal femur.

To schedule an appointment at the Arthroplasty clinic, contact us via WhatsApp click here.

AGENDE SUA CONSULTA



Nossa Estrutura

Unidade Higienópolis
Sala de espera com amplo espaço e conforto para a família que espera por uma consulta de ortopedia geral ou ortopedia infantil.

celular      +55 (11) 99452-6862
celular +55 (11) 99949-4566

Unidade Higienópolis
A clínica Artroplastias do ortopedista em São Paulo, Dr. Felipe possui sala para acolher o paciente e família.

    +55 (11) 99452-6862
celular +55 (11) 99949-4566

Unidade Higienópolis
Sala para um exame ortopédico completo, cujo objetivo é o diagnóstico preciso. A indicação de uma artroplastia de quadril se baseia no estudo clínico e radiográfico cuidadoso do paciente.

    +55 (11) 99452-6862
celular +55 (11) 99949-4566

Estamos online!