Presentation
Fell down five steps. Presented with her left leg shortened and in external rotation, unable to weight-bear.
Patient Data
Pre and post-fixation
Pre-fixation: Left femur comminuted intertrochanteric fracture. Overlaying traction splint.
Post-closed reduction and internal fixation: Left intramedullary nail and lag-screw. Realignment achieved, no remodeling at this stage and comminuted fragments still visible.
Other findings: Fecal loaded rectum, viscera otherwise unremarkable. Spinal fixation.
Comminuted left intertrochanteric femoral fracture. Left hip joint is maintained. Significant soft tissue swelling around the fracture and within the anterior compartment of the thigh. No signs of active bleeding. No other fractures were identified.
Other findings: Multiple renal cysts bilaterally. No injury to the solid or hollow viscera. No injury to the great vessels.
Case Discussion
Intertrochanteric neck of femur fractures occur between the greater and lesser trochanters of the femur. Being extracapsular fractures, they have a strong blood supply from the medial and lateral circumflex arteries1. Thus, extracapsular fractures are at low risk of avascular necrosis but have a high risk of blood loss into the thigh as in this case. They carry a high risk of displacement and invariably should be treated with surgical fixation in ambulatory patients 2.
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