![]() The greater trochanter is abducted and externally rotated by the gluteus medius and short external rotators, whereas the shaft is displaced posteriorly and medially by the adductors and hamstrings. With capsular disruption, the displacement of the fracture fragments is dependent on the musculotendinous attachment to the respective fragments. The hip capsule is especially important in reduction of pertrochanteric fractures, and its continuity with the distal fragment is the soft tissue attachment on which a stable reduction is made possible. The main structural attachments to the proximal femur include the hip capsule and the musculotendinous insertions of the gluteus medius and minimus (greater trochanter), iliopsoas (lesser trochanter), piriformis and short external rotators (posterior intertrochanteric ridge), the oblique head of the rectus femoris (anterior capsule), and the vastus lateralis (lateral femur just distal to the greater trochanter). The structure of the femoral neck: a physical dissection with emphasis on the internal trabecular system. Cross section of the proximal femur showing Adams’ arch and the trabecular bone pattern in the femoral head and neck. 3 This is the region most affected in cases with posteromedial fracture comminution, which leaves only the anterior-medial cortex potentially stable for repair ( Fig. The well-vascularized pertrochanteric region is dependent on the structural integrity of a laminated cancellous bone arcade from the femoral head and epiphyseal scar, around Ward′s triangle, to the lesser trochanter, where the solid nature of the structure changes to a tubular construct with the origin of the femoral medullary canal the strong plate of bone posteriorly is named the calcar femorale in the English-language literature, but was first described as “Adams’ arch” after Robert Adams in the mid-1800s. The anatomy of the pertrochanteric region of the femur is quite variable in its combination of cortical and cancellous bone structure. Interestingly, pertrochanteric fractures make up 34% of all hip fractures. In the Hip Fracture Database Report of over 59,000 cases from 180 hospitals in England, Wales, Northern Ireland, and the Channel Islands from 2011 to 2012, extremely detailed data have been obtained for the demographics of hip fractures. ![]() The largest number of fractures will occur in women older than 65 years of age. Surprisingly, despite such attention, these fractures continue to have high mortality rates and outcomes that too often reflect permanent disability.īrown et al 1 provide estimates of the future incidence of these fractures in the United States and suggest two possible trends in frequency, yielding a conservative estimate of 458,000 fractures per year by 2050 and possibly as many as 1,037,000. They are of interest to the government, insurance companies, hospital administrators, surgeons, geriatricians, rehabilitation centers, and, most importantly, the patient, because they entail expensive treatments and vast time and resource dedication. RussellĮxtra-articular fractures of the proximal metaphyseal region of the hip, commonly referred to as intertrochanteric or pertrochanteric fractures, are the most common surgically treated adult long-bone injuries. ![]() Intertrochanteric Hip Fractures Thomas A.
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