Question 1

What is an intertrochanteric hip fracture?

Accepted Answer

An intertrochanteric fracture is a broken hip bone in the area between the greater trochanter (bony bump you can feel on outer hip) and the lesser trochanter (smaller bony prominence on inner hip). This is part of the femur (thigh bone) just below the hip joint socket. It is the SECOND most common type of hip fracture (after femoral neck fractures which break inside the hip joint). Intertrochanteric fractures are EXTRACAPSULAR - meaning outside the hip joint capsule. This is important because they have excellent blood supply (unlike femoral neck fractures), so bone healing is very reliable (95%+ union rate). These fractures occur almost exclusively in elderly patients (average age 75-80) from simple falls from standing height. The thin osteoporotic bone breaks easily. In younger patients, intertrochanteric fractures only occur from high-energy trauma like car accidents.

Question 2

Why is surgery necessary? Can it heal with rest?

Accepted Answer

Surgery is essential for intertrochanteric hip fractures because: 1) These fractures are UNSTABLE - the fracture fragments move and shorten when bearing weight. Without surgical fixation, the fracture cannot heal in acceptable position. 2) Prolonged bed rest (3-6 months needed for non-operative healing) causes WORSE outcomes than surgery - mortality from bed rest complications (pneumonia, blood clots, pressure sores) is HIGHER than mortality from surgery. 3) Modern studies show even very frail elderly patients (90+ years, multiple medical problems) have BETTER survival with surgery than without. 4) Surgery allows IMMEDIATE mobilization (day 1-2 after surgery) - this prevents life-threatening complications of immobility. 5) Quality of life: without surgery, patients remain bed-bound or wheelchair-bound permanently. With surgery, 50-60% regain walking ability. NON-OPERATIVE treatment is only considered for terminal patients with life expectancy under 3 months, where goal is comfort care only. For all other patients, even very frail ones, surgery within 24-48 hours is standard of care.

Question 3

What is the difference between a dynamic hip screw and an intramedullary nail?

Accepted Answer

Both are standard surgical treatments, choice depends on fracture pattern: DYNAMIC HIP SCREW (DHS): Large screw inserted up into femoral head, attached to metal plate on side of femur. BEST for stable simple 2-part fractures (most common pattern). The screw SLIDES within the plate barrel allowing dynamic compression as patient walks - this helps healing. Advantages: gold standard for stable fractures, 95%+ success rate, well-established technique. Disadvantages: larger incision (10-15cm), more tissue dissection, not ideal for unstable complex fractures. INTRAMEDULLARY NAIL: Metal nail inserted down center of femur, with screw into femoral head. BEST for unstable fractures (reverse oblique pattern, comminuted multiple fragments, subtrochanteric extension). Advantages: minimally invasive (3-5cm incision), biomechanically stronger for unstable patterns, less blood loss. Disadvantages: technically harder, risk of anterior thigh pain (10-15%). CHOICE: Stable 2-part fractures - either device works well, but DHS often preferred (simpler, lower cost). Unstable complex fractures - nail clearly superior. Elderly with osteoporosis - some surgeons prefer nail. Ultimately both have excellent success rates when used appropriately.

Question 4

Can I walk immediately after surgery or do I need to wait?

Accepted Answer

You can and SHOULD walk with weight-bearing immediately after surgery for intertrochanteric fractures. This is DIFFERENT from femoral neck fractures (which sometimes have weight-bearing restrictions). For intertrochanteric fractures treated with DHS or intramedullary nail, FULL WEIGHT-BEARING is allowed from Day 1 post-op. The surgical fixation (screws and plate or nail) is strong enough to support your full body weight immediately. Early mobilization is crucial for preventing complications (pneumonia, blood clots, muscle wasting). Physiotherapists will get you standing and walking with a frame/walker on Day 1 or 2 after surgery. You will put your FULL weight on the operated leg - no restrictions. The pain and weakness in your hip will limit how much you can do initially, but there is NO risk of 'breaking the fixation' by weight-bearing. In fact, weight-bearing HELPS healing by compressing the fracture fragments together (dynamic compression). Patients who mobilize early have better outcomes than those who delay mobilization.

Question 5

What is the mortality rate and why is it so high?

Accepted Answer

One-year mortality after intertrochanteric hip fracture is 20-30% (1 in 4 to 1 in 3 patients die within a year). This high mortality is NOT because of surgical complications - surgery itself is safe (peri-operative mortality under 2%). The high mortality occurs because: 1) Hip fractures affect very frail elderly patients who ALREADY have serious medical conditions (heart disease, COPD, dementia, kidney disease) - the fracture tips them over the edge. 2) Medical complications after fracture: delirium, pneumonia, heart attack, blood clots, kidney failure. 3) Loss of independence after fracture leads to permanent institutionalization and decline. 4) Hip fracture is often a MARKER of end-of-life in very elderly frail patients, not the direct cause of death. IMPORTANT: Not all patients have 20-30% mortality risk. Risk varies by patient: FIT healthy 75-year-old living independently - mortality risk 5-10% at one year. FRAIL 90-year-old with dementia and heart failure in nursing home - mortality risk 50-60% at one year. Your individual risk depends on age, medical conditions, and pre-fracture mobility. Despite the statistics, many patients do well and regain good quality of life after hip fracture surgery.

Medical Disclaimer

Intertrochanteric Hip Fracture (Broken Hip Between Trochanters)

📖What is Intertrochanteric Hip Fracture (Broken Hip Between Trochanters)?

🔬What Causes It?

⚠️Risk Factors

You may be at higher risk if:

🛡️Prevention