Intertrochanteric Fracture

Physical Therapy Videos - Hip and Pelvis

Basic Anatomy

An intertrochanteric fracture is a type of hip fracture or broken hip. The hip is made up of two bones—the femur, or "thigh bone," and the pelvis, or "socket." The hip is an important ball-in-socket joint that allows you to move your leg when walking. Hips that break between the bone bumps at the top of the thigh bone are said to have broken in the intertrochanteric area of the femur or hip.

Figure 1: Skeleton model showing the femur, or thigh bone, and how it contributes to the hip joint. Highlighted in red is the intertrochanteric area. This is the location where this type of broken hip occurs.

Figure 2: Normal x-ray showing the femur, or thigh bone, and how it contributes to the hip joint. As in Figure 1, highlighted in red is the intertrochanteric area. This is the location where this type of broken hip occurs.

Mechanism and Epidemiology

Almost half of all broken hips are intertrochanteric fractures. Although they can occur in young people after a high energy injury such as a car crash or fall from a roof, these breaks occur more commonly in older people. This is largely due to the weakening of our bones as we age. The typical reason for this break in an older person is a fall from standing position. The U.S. Centers for Disease Control and Prevention (CDC) reports that over 300,000 people are hospitalized for hip fractures each year.

Figure 3. X-rays showing three different examples of intertrochanteric fractures. The red arrows point to the breaks in the bone.

Initial Care

A broken hip hurts, and most people cannot walk on their leg after they have broken their hip. They are typically brought to an emergency room by ambulance. When people come to the hospital with pain in their hip area, they will get an x-ray of their hip to see if and where it is broken. They will also typically need pain medication. People with broken hips usually need surgery to stabilize the broken bone. They need to be admitted to the hospital, as well as seen by other doctors to evaluate any other medical conditions and make sure they are okay to undergo surgery. It is common for people who fall to also hit their heads. This may need to be evaluated with additional tests, particularly if they are on blood thinning medications. Your doctor wants to make sure your health is as good as it can be before you undergo surgery.

Operative Care

The best treatment for these injuries is surgery to stabilize the break in the hip. Typically, a metal implant is placed on or in the bone to hold the broken bone in the right position until the bone heals. The implant is placed through a cut in the skin on the outside of the patient’s hip. This is close to where a hip-pocket is on your pants.

Figure 4. X-rays showing two different intertrochanteric fractures after surgery. Image A shows screws and side-plate used to stabilize a broken hip. Image B shows an intramedullary short rod and screws. Both implants can be used and produce good results. Doctors may have a preference based on the injury pattern or their comfort level with the implants.

Postoperative Care

After surgery, patients typically need to use a walker, crutches, or a wheelchair. While the break is healing, the patient is typically instructed by their doctor to place as much weight on their broken hip as is comfortable. You will likely need physical therapy. Depending on your living situation, you may need to live at a rehabilitation or care facility until you are strong enough to go home. Occasionally a doctor may instruct a patient not to place any weight on their leg when it is healing. This decision is made on a case-by-case basis, and your doctor can explain why this would be necessary.

After surgery, it is very important to not just lie in bed. During the day you should sit up as much as you can. This is to keep you from getting pneumonia, bedsores, or blood clots, and to work on using the leg as much as possible. It is important to do this safely. That may mean with the help of nurses, family, physical therapy, and the use of a walker or cane.

Long Term

Occasionally patients limp after surgery. With physical therapy this may improve or go away. Your hip might get more tired or stiffer than before surgery. It is uncommon, but occasionally the plate, rod, or screws can bother a patient on the side of their hip. In rare cases, the bone does not heal or there is a complication like an infection. If this happens, another surgery may be needed. Even with successful surgery, you may need to use a walker or cane all the time. This may happen even if you were not using one before. The most important thing is to prevent another fall. A walker or cane may help give you more stability and protect you from falling again.