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Introduction Bones form the skeleton of the body and allow the body to be supported against gravity and

to move and function in the world. Bones also protect some body parts, and the bone marrow is the production center for blood products

A bone fracture sometimes abbreviated FRX or Fx, is a medical condition in which there is a break in the continuity of the bone. A bone fracture can be the result of high force impact or stress, or trivial injury as a result of certain medical conditions that weaken the bones, such as osteoporosis, bone cancer, or osteogenesis imperfecta, where the fracture is then properly termed a pathological fracture. Although broken bone and bone break are common colloquialisms for a bone fracture, break is not a formal orthopedic term.

Intertrochanteric fractures are considered 1 of 3 types of hip fractures. The anatomic site of this type of hip fracture is the proximal, upper part of the femur or thigh bone. The proximal femur consists of the femoral head, femoral neck, and the trochanteric region. An intertrochanteric hip fracture occurs between the greater trochanter, where the gluteus medius and minimus muscles (hip extensors and abductors) attach, and the lesser trochanter, where the iliopsoas muscle (hip flexor) attaches.

Causes of fracture When outside forces are applied to bone it has the potential to fail. Fractures occur when bone cannot withstand those outside forces. Fracture, break, or crack all mean the same thing. One term is not better or worse than another. The integrity of the bone has been lost and the bone structure fails. Broken bones hurt for a variety of reasons including:
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The nerve endings that surround bones contain pain fibers and and these fibers become irritated when the bone is broken or bruised.

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Broken bones bleed, and the blood and associated swelling (edema) causes pain. Muscles that surround the injured area may go into spasm when they try to hold the broken bone fragments in place, and these spasms cause further pain. Often a fracture is easy to detect because there is obvious deformity. However, at times it is not easily diagnosed. It is important for the physician to take a history of the injury to decide what potential problems might exist. Moreover, fractures don't always occur in isolation, and there may be associated injuries that need to be addressed. Signs and Symptoms y y y y y y y Pain ( at the time of injury) Tenderness at the site Swelling Loss of function Deformity Crepitus discoloration

CLASSIFICATION OF FRACTURE According to communication to the environment  Closed/ simple fracture- with skin damage, intact  Open / compound fracture with skin damage According to completeness  Complete fracture- entire cross section separate into two  Incomplete fracture- breakage of part or portion of the bone According to Anatomical Position  Proximal 1/3 upper/ superior  Middle 1/3 - intermediate

 Distal 1/3 lower or inferior According to the line of breakage/ displacement  Transverse fracture- horizontal, perpendicular  Longitudinal fracture vertical  Oblique fracture diagonal, slanted  Spiral fracture- twisting/ torsion Other classification  Comminuted fracture bone breaks into pieces or fracture  Greenstick fracture bending of bones or breakage on a portion, incomplete  Impacted fracture bones are pushed together with other bones  Distraction fracture bones are pulled apart  Compression fracture- common in the spine, secondary to compressive forces Classification in relation to the joint  Intracapsular  Extracapsular  Intra articular Intertrochanteric fractures are considered 1 of 3 types of hip fractures. The anatomic site of this type of hip fracture is the proximal, upper part of the femur or thigh bone. The proximal femur consists of the femoral head, femoral neck, and the trochanteric region. An intertrochanteric hip fracture occurs between the greater trochanter, where the gluteus medius and minimus muscles (hip extensors and abductors) attach, and the lesser trochanter, where the iliopsoas muscle (hip flexor) attaches.Fractures of the femoral neck are proximal or cephalad to intertrochanteric fractures, andsubtrochanteric fractures are distal or below (sub) to the trochanters. These fracture types are discussed in other eMedicine articles.

Normal femur anatomy

Stable intertrochanteric fracture

Unstable intertrochanteric fracture

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. Complications included the following:


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Pulmonary complications of pneumonia resulting from inactivity. Pulmonary emboli from deep vein thrombosis (DVT) caused by immobilization of an extremity.

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Bedsores from prolonged bed rest. Loss of motion of the lower extremity joints and muscle atrophy due to prolonged immobilization.

Union of the fracture in an unacceptable position resulting in a deformity. (Known as a malunion, the fracture heals with unacceptable shortening, rotation, and/or angulation of the extremity, resulting in decreased mobility and subsequent handicap, impairment, and disability.)

A bone fracture can be diagnosed clinically, based on the history given and the physical examination performed by to view the bone suspected of being fractured.In situations where x-ray alone is insufficient, a computed tomograph (CT scan) may be performed. Currently, with a few exceptions, surgical intervention is used to treat essentially all intertrochanteric fractures and is described as open reduction and internal fixation (ORIF). Various surgical fixation devices are now available for the treatment of essentially all intertrochanteric fractures. Each device requires a careful match between the appropriate internal fixation device and the specific type of fracture. The correct surgical technique described by the developer of the device should also be used. Therefore, the optimal device is chosen after a precise diagnosis of the type of intertrochanteric fracture. The indications and contraindications of the technique must also be matched with the patient's activity level, degree of osteoporosis, and realistic expected outcome.To accomplish this match between technique and patient, at a minimum, technically adequate preoperative radiographs of the hip are necessary, including anteroposterior (AP) view of the pelvis and involved hip and true lateral view (cross-table technique). In some cases, a frog lateral view, a computerized axial tomography (CAT) scan, or even a reconstituted CAT scan may be necessary to define the fracture in sufficient detail to accurately plan the surgery. Gentle traction applied during the radiograph will help define the fracture, particularly if significant shortening occurred.

PATIENTS PROFILE NAME: Patient A ADDRESS: 36 MRT Ave, Purok I, Lower Bicutan, Taguig City AGE: 21 years old SEX: Male NATIONALITY: Filipino RELIGION: Roman Catholic

BIRTHDAY: December 13,1988 STATUS: Single ADMISSION DATE: November 6, 2010 WARD: Males Ward ATTENDING PHYSICIAN: Dr. Brabante DIAGNOSIS: Fx. Cl. Comp. Intertrochanteric Femur with subtroch Excess; Fx. Admitting History: Chief Complaint Fall History of Present Illness: Patient is an inmate in a Taguig Jail. He tried to escape so that he jumped in the building from 4th floor and landed to 2nd floor. Past Medical History: (-)HPN, (-)DM, (-)Allergy Family History: (+)HPN, (-)DM Personal & Social History: (-)Smoke, (-)Alcoholic drink, (+)Drugs use

LABORATORY EXAM:

Component Hemoglobin Mass Hematocrit Leuckocyte count Different count: -segmenters -Lymphocycytes -Monocyctes -Eosinohils Reticuloctyes

Result 134 0.35 15.60 0.84 0.08 0.07 0.01 192

Normal range 127-183g/l 0.37-0.54/l 4.5-10x10g/l 0.50-0.70 0.20-0.40 0.00-0.07 0.00-0.05 0.5-2.0% 150-400x10

Anatomy and Physiology The intertrochanteric area of the femur is distal to the femoral neck and proximal to the femoral shaft. It is the area of the femoral trochanters, the lesser and the greater trochanters. The intertrochanteric area can also be seen as the area where the femur changes from an essentially vertical bone to a bone angling at a 45 angle from the near-vertical to the acetabulum or pelvis. The femoral artery and nerve are anterior; the sciatic nerve is posterior. The attachments of the iliopsoas and gluteus medius can cause certain displacements, depending on the fracture patterns. These factors may make reduction difficult. The attachment of the gluteus maximus to the femoral shaft is a guide to the level of the lesser trochanter and helpful when placing a guidewire for the compression screw. The vastus lateralis overlies the lateral cortex of the proximal femur and must be elevated to apply a side plate. Function: The femur is the largest and strongest bone in the body. It is a long bone making up about one fourth of your height and is the attachment point for some powerful muscles. At the hip (proximally), the femur's ball-shaped head joins (articulates) with the pelvis in the acetabulum and is secured by a strong ligament (ligamentum teres) attached to the fovea captitis on the head. The head attaches out (laterally) to a short neck that then attaches to the vertical shaft of the femur. Because of the way the head of the femur attaches to the side of the shaft, the neck is the weakest point and most prone to a break. Where the neck meets the shaft of the femur you will find the greater trochanter on the outside (lateral) and the medial trochanter on the inside (medial) which are connected by the intertrochanteric line in front (anteriorly) and the intertrochanteric crest in the back (posteriorly). The trochanters are attachment points for the powerful muscles of the thigh and butt. More muscle attachment sites are found on the back side of the femur (posteriorly) the gluteal tuberosity which leads down the shaft to the ridge-like linea aspera. At the bottom (distally), the femur spreads into a wide base with the medial and lateral condyles joining (articulating) with the tibia. Between the condyles is the intercondylar notch. Outside of them are the lateral and medial epicondyles, which are attachment sites for more muscles. The patellar surface in the front (anteriorly) joins (articulates) with the kneecap (patella).

Pathophysiology

Fall

Tissue damage

Bone cannot stand to the body forces Caused breakage of bone

Nerve ending that surrounds bone contain pain fibers Fibers become irritated when bone is broken Series of bleeding may occur

It swells then it can cause pain

Muscle that surround the injured part go to spasm and can cause further pain

Resulting to immobilization of the injured part

Philippine Orthopedic Center

Fx. Cl. Comp. Intertrochanter Femur Right with subtroch Excess; Fx. Cl. Comp. Comm.

A Case Study

Submitted by: Dennis D. Dimaunahan BSN 3-C Lipa City Colleges Group11 Submitted to: Cherubin Lazaro RN. MAN.

November 18, 2010