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Extra capsular fractures which involve the femoral trochanters include intertrochanteric and subtrochanteric fractures. The intertrochanteric fracture is by far the most common and is classified according to the status of the lesser and greater trochanter. If neither of these is fractured, the fracture is termed a two part fracture. If either the lesser or greater is fractured, then the fracture consists of three parts. If both are fractured, the fracture is termed a four part fracture. These fractures generally result from a fall and typically occur in postmenopausal women.
Though all of these fractures are often referred to simply as hip fractures, the above distinctions between femoral neck fractures, intertrochanteric factors, and subtrochanteric fractures are important because the anatomy, prognosis, and management are different for these fracture types. Femoral neck fractures are frequently treated using a prosthesis or replacement device to substitute for the proximal femoral fragment, including the residual neck fragment with the devitalized femoral head.
Intertrochanteric fractures are treated using an engineered metallic fixation device (internal splintage device) designed to maintain the nondisplaced, minimally displaced, or postreduction fracture fragments in their anatomic, near-anatomic, or acceptable postreduction position. This stability assists in the healing of the fracture. In addition, postoperative care and rates of complications, including mortality and morbidity, vary for different fractures and different subcategories of intertrochanteric fractures.
The current treatment of intertrochanteric fractures is surgical intervention. Despite an acceptable healing rate with nonsurgical methods, surgical intervention for intertrochanteric fractures has replaced previous nonsurgical methods of prolonged bed rest, prolonged traction in bed, or prolonged immobilization in a full-body (spica) cast.Though healing rates for previous nonsurgical methods may have been acceptable, they were accompanied by unacceptable morbidity and mortality rates because of frequent nonorthopedic complications associated with prolonged immobilization or inactivity.
Source: 1) Medscape 2) Gentili.net / Musculoskeletal Radiology of Fractures