Ulmar B, Simon S, Eschler A, Mittlmeier T
Abteilung für Unfall-, Hand- und Wiederherstellungschirurgie, Klinik und Poliklinik für Chirurgie, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland,
Unfallchirurg. 2013 Dec;116(12):1097-112; quiz 1113-4. doi: 10.1007/s00113-013-2525-8.
Subtrochanteric femoral fractures are proximal femoral fractures which are located between the trochanter minor and an area of 3 cm below the minor trochanter on the femoral shaft. About 10-15% of all proximal femoral fractures correspond to this fracture site. Elderly or geriatric patients are generally affected and the injury is often the result of a fall in the home, while high-energy trauma is the cause in a small group of generally younger patients. Clinical evaluation of the affected extremity shows disability of axial weight-bearing and pain during compression and rotation of the hip joint. Basic diagnostics include conventional x-rays of the injured femur in the anterior-posterior and lateral planes. These subtrochanteric femoral fractures are almost always treated surgically due to the inherent high degree of instability. The main goals of surgical intervention are to achieve anatomic fracture reduction and primary full weight-bearing stability of the corresponding leg. Intramedullary interlocking nails are used for primary treatment, while extramedullary implants are often used in revision surgery. Early mobilization and intensive respiratory exercises are necessary to prevent early postoperative complications.
股骨转子下骨折是指位于小转子与股骨干小转子下方3厘米区域之间的股骨近端骨折。所有股骨近端骨折中约有10% - 15%属于此骨折部位。通常受影响的是老年患者，损伤往往是在家中跌倒所致，而一小部分相对年轻的患者则是由高能创伤引起。对患侧肢体的临床评估显示轴向负重功能障碍以及髋关节在受压和旋转时疼痛。基本诊断包括对受伤股骨进行前后位和侧位的传统X线检查。由于其固有的高度不稳定性，这些股骨转子下骨折几乎总是采用手术治疗。手术干预的主要目标是实现骨折解剖复位以及使相应的腿部获得初次完全负重稳定性。髓内交锁钉用于初次治疗，而髓外植入物常用于翻修手术。早期活动和强化呼吸锻炼对于预防术后早期并发症是必要的。
