Femur, proximal: extraarticular fracture, trochanteric area pertrochanteric simple—31-A1

10.1055/b-0034-87634

Femur, proximal: extraarticular fracture, trochanteric area pertrochanteric simple—31-A1

Suthorn Bavonratanavech

Case description

A healthy, active, and independent 90-year-old man fell while riding his bicycle and sustained a stable trochanteric fracture of the left femur. He was unable to bear weight after the fall and came to the hospital 3 hours after the injury. He had no other injury.

Indication for MIPO

A stable intertrochanteric fracture of the left femur may be treated by simple implants, such as the DHS. In elderly patients with osteoporosis the new DHS design with dynamic hip blade provides better stability because the bone is impacted during insertion of the blade, instead of needing to remove the bone as with the original DHS design. It is advantageous to perform the internal fixation using a minimally invasive technique because the smaller incisions reduce soft-tissue damage. As most intertrochanteric fractures occur in elderly patients, a less invasive surgical technique has the advantage of reducing operating time and blood loss. There is less postoperative pain, which reduces the need for pain medication, leading to earlier rehabilitation and recovery. MIPO technique can be used in patients of any age for stable and unstable trochanteric fractures that can be satisfactorily reduced by closed reduction techniques, or used in conjunction with tools and implants as indirect reduction techniques.

a–b X-rays show a stable intertrochanteric fracture of the left femur.

Preoperative planning

In general the uninjured side can be used as the template to determine the length of the screw and side plate which is about 4–5 holes long. In most stable intertrochanteric fractures closed reduction with manual traction will reduce the fracture and can be maintained by a fracture table throughout the operative procedure.

Operating room setup

Anesthesia

General or regional anesthesia depends on the general condition and fitness of the patient.

Patient and image intensifier positioning, and closed reduction

In the case of displaced fractures, closed manipulation and reduction is required. After closed reduction by hip flexion followed by manual traction in extension and abduction with neutral rotation, the fracture reduction is maintained on a fracture table. The C-arm is positioned between the legs and image intensification shows the reduction in both AP and lateral views ( Fig 16.3-2 ).