Intertrochanteric Fractures Are the Most Common Extracapsular Fractures in the Elderly
Intertrochanteric fractures are the most common type of extracapsular hip fractures in the elderly population, accounting for approximately half of all proximal femoral fractures. 1
Types of Extracapsular Hip Fractures
Extracapsular hip fractures include:
- Intertrochanteric fractures (most common)
- Subtrochanteric fractures
- Reverse oblique fractures
Clinical Characteristics of Extracapsular Fractures
Extracapsular fractures have several important clinical features that distinguish them from intracapsular fractures:
- Greater blood loss (can exceed 1 liter) due to rich blood supply from cancellous bone 1
- More painful than intracapsular fractures due to greater periosteal disruption 1
- Higher degree of comminution correlates with increased blood loss 1
- Require different surgical approaches compared to intracapsular fractures 1
Treatment Approaches for Intertrochanteric Fractures
Treatment selection is critical for optimizing outcomes and reducing mortality and morbidity:
Stable Intertrochanteric Fractures (AO/OTA 31-A1 and A2)
- Sliding hip screw is the preferred treatment 1, 2
- Comparable outcomes between sliding hip screws and intramedullary nails for these fracture types 2
Unstable Intertrochanteric Fractures (AO/OTA 31-A3)
- Antegrade cephalomedullary nail is strongly recommended 1, 2
- Provides better biomechanical stability for reverse oblique fractures 2
Risk Factors for Complications
Awareness of risk factors for complications can help improve outcomes:
- High body mass index increases risk of implant cut-out 3
- Basicervical fractures have higher cut-out risk regardless of nail design 3
- Poor reduction in anteroposterior and lateral planes increases failure risk 3
- Implant position in the femoral head is critical for preventing cut-out 2
Surgical vs. Conservative Management
While conservative management with traction and bed rest for 6-8 weeks is technically possible, it is associated with:
Therefore, surgical fixation is almost invariably recommended for extracapsular hip fractures in the elderly.
Emerging Trends
Despite limited evidence supporting their broader use, there is an increasing trend toward using intramedullary devices for AO/OTA 31-A2 fractures 4. However, this practice:
- Is not supported by current guidelines 4
- Increases costs without demonstrated clinical benefit 4
- Should be carefully evaluated by healthcare centers 4
Conclusion
Understanding the prevalence and appropriate management of intertrochanteric fractures is essential for optimizing outcomes in elderly patients. Proper surgical technique and implant selection based on fracture pattern are the most important factors in reducing complications and improving functional recovery.