Updated: 6/11/2022

Intertrochanteric Fractures

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  • Summary
    • Intertrochanteric Fractures are common extracapsular fractures of the proximal femur at the level of the greater and lesser trochanter that are most commonly seen following ground-level falls in the elderly population.
    • Diagnosis is made with orthogonal radiographs of the hip. MRI is most helpful to evaluate occult hip fractures.
    • Treatment is generally operative with sliding hip screw versus cephalomedullary nail depending on fracture stability. 
  • Epidemiology
    • Incidence
      • account for ~50% of hip fractures 
      • 150,000 intertrochanteric fractures per year in US
      • 500 per 100,000 population per year for elderly female
      • 200 per 100,000 population per year for elderly male
    • Demographics
      • age
        • average ~80 years old
          • typically older age than femoral neck fractures
      • female: male ratio between 2:1 and 8:1
    • Risk factors 
      • proximal humerus fractures increase risk of hip fracture for 1 year
      • osteoporosis
      • advancing age
      • increased number of comorbidities
      • increased dependency with ADLs
  • Etiology
    • Pathophysiology
      • mechanism
        • elderly
          • low energy falls in osteoporotic patients
        • young
          • high energy trauma
    • Associated conditions
      • osteoporosis
      • recurrent falls
        • dementia
        • parkinsons
        • unsteady gait
        • visual impairment
        • medications
  • Anatomy
    • Osteology
      • neck shaft angle 130 +/- 7 degrees
      • anteversion 10 +/- 7 degrees
      • intertrochanteric area exists between greater and lesser trochanters
      • calcar femorale
        • vertical wall of dense bone that extends from posteromedial aspect of femoral shaft to posterior portion of femoral neck
        • level of involvement helps determine stable versus unstable fracture patterns
      • radius of curvature of femur
        • average 114-120 cm
        • factors that decrease radius of curvature (increased bowing)
          • elderly
          • asian 
          • short stature
    • Muscles
      • deforming forces on proximal segment
        • flexion
          • iliopsoas
          • sartorius
          • rectus femoris
          • pectineus
        • external rotation
          • piriformis
          • superior gemellus
          • obturator internus
          • inferior gemellus
          • quadratus femoris
        • abduction
          • gluteus maximus
          • gluteus medius
          • gluteus minimus
          • tensor fascia lata
      • deforming forces on distal segment
        • adduction and shortening
          • adductor longus
          • adductor brevis
          • adductor magnus
          • gracilis
        • overall varus alignment
    • Blood supply
      • rich collateral circulation reduces risk of nonunion 
        • trochanteric anastomosis
          • ascending branch of medial circumflex femoral artery (MFCA)
          • ascending branch of lateral circumflex femoral artery (LFCA) 
          • deep branch of superior gluteal artery
          • inferior gluteal artery
        • transverse branch of LFCA and MFCA
        • periosteum and surrounding muscles 
    • Biomechanics
      • Ward's triangle
        • area of lowest BMD in femoral neck bordered by 3 main compressive/tensile trabeculae
          • primary compressive trabeculae
            • extends from medial femoral head along calcar and excellent support to proximal femur
            • vertically oriented with a triangular configuration
          • principal tensile trabeculae 
            • forms an arc through the superior cortex of the femoral head and neck
            • extends from greater trochanter to inferior aspect of femoral head below fovea
          • secondary compressive trabeculae
            • fan-like configuration crossing from greater trochanter to lesser and also comprises calcar
  • Classification
    • Stability  
      • most commonly used and reliable classification 
      • two types
        • stable
          • definition
            • intact posteromedial cortex
          • clinical significance
            • will resist medial compressive loads once reduced
        • unstable
          • definition
            • fracture will collapse into varus or shaft will displace medially 
          • examples
            • large or comminuted posteromedial cortex
              •  i.e. lesser trochanteric fragment 
            • reverse obliquity or transtrochanteric 
              • fracture line extending from medial cortex out through lateral cortex
            • subtrochanteric extension 
          • other considerations
            • lateral wall thickness
              • measured from 3 cm distal from innominate tubercle at 135 degrees to the fracture site
                • <20.5 mm suggest risk of postoperative lateral wall fracture
                  • should be treated with cephalomedullary nail (CMN) rather than sliding hip screw (SHS)
              • key role in stabilizing proximal femur by providing lateral buttress  
      • AO/OTA Classification
      • 31A -A1
      • peritrochanteric simple two part
      • intact lateral cortex
      • 31A-A2
      • pertrochanteric with separate posteromedial fragment
      • intact lateral cortex
      • 31A-A3
      • fracture extends through lateral and medial cortex 
      • Evans classification (based on post-reduction stability)
      • Stable fracture 
      • posteromedial cortex intact or minimal comminution
      • able to resist compressive loads
      • Unstable fracture
      • greater comminution of posteromedial cortex 
      • can be converted to a stable pattern if medial cortical opposition obtained
      • Reverse obliquity
      • unstable due to medial displacement of femoral shaft due to adductors
  • Presentation
    • History
      • mechanism of injury 
        • low-energy most common in elderly
        • higher-energy may be associated with other injuries
      • pre-injury functional status
        • predictor of postoperative functional status 
      • antecedent hip pain
        • presence of OA or pathological fracture 
      • history of anticoagulation 
        • factors into surgical timing 
      • list of comorbidites (ASA classification) 
    • Symptoms
      • acute onset of hip pain
      • inability to ambulate
    • Physical Exam
      • inspection 
        • shortened, externally rotated lower extremity
      • palpation
        • tenderness over greater trochanter
      • motion
        • pain with log roll and axial load
        • unable to perform active straight leg raise
      • assess thigh compartments
      • neurovascular assessment 
  • Imaging
    • Radiographs
      • recommended views
        • AP pelvis
        • AP hip
        • cross table lateral
        • full length femur
      • optional
        • traction internal-rotation view
          • improve accuracy of fracture classification with direct impact on surgical planning 
      • findings 
        • AP pelvis
          •  compare to contralateral hip and assess neck shaft angle
        • AP hip
          • defines fracture pattern 
        • cross-table lateral
          • helps assess for posterior cortex comminution
        • full length femur 
          • assess subtrochanteric extension
          • possibility of pathological fracture
          • estimate length of intramedullary nail
          • assess femoral bowing
          • assess canal diameter
    • CT 
      • indication 
        • second line imaging to evaluate for occult fracture 
          • no access or contraindication to MRI
      • views
        • thin, 1-2 mm slice cuts 
      • diagnostic accuracy 
        • sensitivity 86%
        • specificity 98%
    • MRI
      • indication
        • occult hip fracture 
          • AAOS recommendation: moderate strength 
        • isolated greater trochanteric fracture to evaluate for intertrochanteric extension
      • findings 
        • bone marrow edema STIR or fat-suppressed T2
        • line of decreased intensity on T1 coronal view corresponding with signal on T2 and STIR
      • diagnostic accuracy
        • sensitivity 
          • T1-weighted 100% (most sensitive) 
          • T2-weighted 84%
    • Bone scan
      • indication
        •  contraindication to MRI
          • rarely used
            • improved access to MRI and CT
            • delay in care
            • false negative up to 72 hours from injury
      • diagnosis accuracy
        • variable with sensitivity up to 98%
  • Treatment
    • Nonoperative
      • indications
        • nonambulatory patients
        • high risk for perioperative mortality
        • skin breakdown at surgical site
        • incomplete fractures
      • modalities
        • non-weight bearing with early mobilization from bed to chair
      • outcomes
        • high mortality rate
          • 84.4% at 1-year
        • higher rates of pneumonia, UTI, decubitus ulcers, and DVT
        • low risk of displacement with occult fracture 
    • Operative
      • intramedullary hip screw (cephalomedullary nail)
        • indications
          • stable fracture patterns
            • AAOS recommendation: strong for use of either SHS or CMN
          • unstable fracture patterns
            • AAOS recommendation: strong for use of CMN 
          • reverse obliquity fractures
            • AAOS recommendation: strong for use of CMN 
            • 56% failure rate when treated with SHS
          • subtrochanteric extension
            • AAOS recommendation: strong for use of CMN 
          • lack of integrity of femoral wall
            • associated with increased displacement and collapse when treated with SHS
            • increased risk of lateral wall fracture with decreasing lateral wall thickness
        • technique
          • short CMN
          • long CMN
        • outcomes
          • stable fracture pattern 
            • similar clinical and radiographic outcomes for SHS vs CMN 
          • unstable fracture pattern 
            • lower reoperation rate with CMN  
          • CMN use has significant increased over last decade
      • open reduction and internal fixation (ORIF)
        • indications
          • stable fracture pattern
            • AAOS recommendation: strong for use of either SHS or CMN 
        • techniques
          • sliding hip compression (SHS) screw (most common)
          • proximal femur locking plate
          • 95 degree blade plate (rarely used) 
        • outcomes
          • similar outcomes for stable fracture patterns when compared to CMN
      • arthroplasty
        • indications (rare) 
          • salvage for failed internal fixation
          • severely comminuted fractures
          • preexisting severe degenerative hip arthritis
          • severely osteoporotic bone that is unlikely to hold internal fixation
  • Techniques
    • Intramedullary hip screw (cephalomedullary nail) 
      • pros
        • biologically friendly with potentially closed technique
        • less estimated blood loss (EBL)
        • can be used in unstable fracture patterns
        • decreased bending strain on implant
          • load sharing device with shorter lever arm on implant
          • intramedullary buttress limits shaft medialization  
      • cons
        • periprosthetic fracture
        • higher implant cost than sliding hip screw
        • violation of hip abductors for insertion
      • approach
        • supine on fracture table 
        • lateral decubitus on radiolucent table
      • technique
        • short vs long CMN
          • controversial 
            • AAOS recommendation: limited  
          • short CMN
            • advantage
              • ease of use
              • decreased OR time
              • decreased EBL
              • lower implant cost
          • long CMN
            • advantage
              • theoretical benefit of protecting entire femur
            • disadvantage
              • increased OR time
              • increased EBL
              • increased radiation exposure
              • possible mismatch of implant bow and femur
          • outcomes 
            • similar functional outcomes, peri-implant fracture, and cutout rate 
              • short nail can tolerate up to 3 cm of subtrochanteric extension
        • lag screw versus helical blade
          • controversial 
          • lag screw
            • proven track record
            • femoral head rotation during insertion
          • helical blade 
            • theoretical benefit of compacting cancellous bone around blade during insertion
              • avoids removal of bone with reamer
            • biomechanical studies showing higher cutout resistance
      • complication
        • lag screw or helical blade cutout
        • anterior perforation of femur
        • perimplant fracture 
    • Open reduction and internal fixation
      • Sliding hip compression screw
        • technique
          • must obtain correct neck-shaft relationship
          • lag screw with tip-apex distance <25 mm is associated with reduced failure rates
          • 4 hole plates show no benefit clinically or biomechanically over 2 hole plates
        • pros
          • allows dynamic interfragmentary compression
          • lower implant cost
          • no violation of hip abductors
        • cons
          • open technique
          • increased blood loss
          • not advisable in unstable fracture patterns
            • excessive fracture collapse
            • limb shortening
            • medialization of shaft
          • anterior spike malreduction in left-sided, unstable fractures due to screw torque
            • place derotational wire or screw prior to lag screw insertion
      •  proximal femoral locking plate
        • indication
          • infrequently used
            • consider in young patient with unstable fracture
        • pros 
          • allow for intraoperative fracture compression 
          • avoid excessive postoperative fracture compression
          • maintain limb length
          • avoid shaft medicalization 
        • cons
          • limited evidence
          • highly dependent on surgeon experience 
          • must obtain anatomic reduction 
    • Arthroplasty
      • technique
        • long stem with calcar-replacing prosthesis often needed
        • must attempt fixation of greater trochanter to shaft
      • pros
        • possible early return to unrestricted weight bearing
        • not reliant on internal fixation in osteoporotic bone
      • cons
        • increased blood loss and OR time
        • increased cost
        • may require prosthesis that some surgeons are less familiar with
  • Complications
    • Implant failure and cutout
      • incidence
        • occurs in 4-20%
        • usually occurs within first 4 months
      • risk factors
        • older age
        • osteoporosis
        • fracture type
        • quality of reduction 
        • tip-apex distance (TAD)
          • sum of distances from tip of lag screw to apex of femoral head on AP and lateral
            • after adjusting for magnification
          • goal TAD <25mm 
          • TAD >45 mm associated with 60% failure rate
      • treatment
        • young
          • corrective osteotomy and/or revision open reduction and internal fixation
        • elderly or articular injury from screw cutout
          • total hip arthroplasty
    • Nonunion and malunion 
      • incidence
        • <2%
          • uncommon due to good blood supply
        • leads to varus collapse and screw cutout 
      • diagnosis
        • hip pain with persistent radiolucent defect at fracture site 4-7 months after surgery
        • CT scan may help confirm diagnosis
        • rule out infection 
      • treatment
        • valgus intertrochanteric osteotomy + bone grafting
        • arthroplasty 
          • screw cutout has damaged hip joint
    • Peri-implant fracture
      • incidence 
        • 1-3% at 1 year
        • no significant difference between short and long CMN
        • short CMN typically fracture just distal to tip of nail
        • long CMN typically fracture more around the rod (as opposed to the tip) 
      • risk factors 
        • distal interlocking screw protective against fracture 
      • treatment
        • short CMN
          • distally inserted lateral femoral plate with cables
          • revise to long CMN
        • long CMN
          • closed reduction and insertion of distal locking screw
          • distal femoral plating (fracture distal to tip)
    • Anterior perforation of the distal femur
      • incidence
        • mostly seen with insertion of long CMN
        • decreased with improvements in nail radius of curvature to better match patient anatomy
      • risk factors
        • mismatch of the radius of curvature of the femur (shorter) and implant (longer)
        • posterior starting point on the greater trochanter
    • Postoperative anemia and transfusions
      • blood transfusion
        •  >30% postoperative transfusion rate
        • AAOS moderate recommendation 
          • transfusion threshold no higher than 8g/dL in asymptomatic postop hip fracture
      • transexamic acid (TXA) 
        • AAOS strong recommendation for use 
        • decrease EBL 
        • decrease postoperative blood transfusion 
  • Prognosis
    • Mortality 
      • 15-30% mortality risk in the first year following fracture
      • 84.4% at one year with nonoperative treatment 
    • Factors that increase mortality
      • male gender (25-30% mortality) vs female (20% mortality)
      • higher in intertrochanteric fracture (vs femoral neck fracture)
      • operative delay of >2 days
      • age >85 years
      • 2 or more pre-existing medical conditions
      • ASA classification (ASA III and IV increases mortality)
    • Factors that decrease mortality
      • Surgery within 48 hours decreases 1 year mortality
        • AAOS moderate recommendation for hip fracture surgery pithing 24-48 hours of admission
      • early medical optimization and co-management with medical hospitalists or geriatricians 
        • AAOS strong recommendation for use of interdisciplinary care teams
    • Loss of independence 
      • community-dwelling ambulators at 1-year 
        • 41% maintain pre-injury ambulatory status
        • 40% more dependent on assistive devices
        • 12% became household ambulators
        • 8% became nonfunctional ambulators
      • One-third general rule
        • 1/3 regain function
        • 1/3 lose one level of independence
        • 1/3 mortality rate  

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(SBQ18TR.2) What is the most cost-effective implant indicated for the injury shown in Figures A and B, assuming the hospital purchases the implants at-cost from the manufacturer?

QID: 211122
FIGURES:
1

Long cephalomedullary nail

2%

(25/1582)

2

Short cephelomedullary nail

9%

(137/1582)

3

Sliding hip screw

76%

(1203/1582)

4

Hemiarthroplasty

1%

(21/1582)

5

Cannulated screws

11%

(175/1582)

L 2 A

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(OBQ18.206) An 87-year-old female sustained the injury shown in Figure A. Which of the following is/are factor(s) that increase the risk of perforation of the anterior cortex during surgical treatment with a long cephalomedullary nail?

QID: 213102
FIGURES:
1

Radius of curvature mismatch between the bone and the implant

2%

(38/2016)

2

Anterior starting point on the greater trochanter

1%

(27/2016)

3

Posterior starting point on the greater trochanter

3%

(56/2016)

4

Answers 1 and 2

18%

(357/2016)

5

Answers 1 and 3

75%

(1515/2016)

L 4 A

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(OBQ18.240) A 78-year-old patient presents with right hip pain and inability to bear weight after an unwitnessed fall at a nursing home. Figures A and B are the radiographs of the hip and pelvis. Which statement is true regarding the treatment of these injuries?

QID: 213136
FIGURES:
1

Smaller lateral wall thickness favors sliding hip screw constructs

2%

(37/2288)

2

Unstable fractures are best treated with sliding hip screw constructs

2%

(37/2288)

3

Avoiding distal locking screws in intramedullary implants protects against refracture

1%

(31/2288)

4

Stable fractures have no differences in outcomes between sliding hip screws and intramedullary implants

89%

(2027/2288)

5

Implant stability has a greater impact on outcomes rather than reduction quality

3%

(75/2288)

L 1 A

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(OBQ18.239) An 82-year-old female sustains the fracture shown in Figure A as the result of a ground level fall. Which of the following has been shown to be a reliable predictor of postoperative lateral wall fracture for this injury after treatment with a sliding hip screw?

QID: 213135
FIGURES:
1

Reverse obliquity fracture pattern

19%

(375/1996)

2

Lateral wall thickness

62%

(1230/1996)

3

Previous contralateral hip fracture

1%

(27/1996)

4

DEXA T-score <-2.0

6%

(110/1996)

5

Calcar comminution

12%

(234/1996)

L 1 A

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(OBQ13.2) A 86-year-old man slips on the ice and falls sustaining the injury shown in Figure A. He has Type 2 diabetes mellitus, atrial fibrillation, coronary artery disease, end-stage renal disease on dialysis and chronic obstructive lung disease. All of the following variables are associated with increased mortality at one year after injury EXCEPT?

QID: 4637
FIGURES:
1

Intertrochanteric fracture

5%

(205/4531)

2

Two or more pre-existing medical conditions

1%

(61/4531)

3

Age of eighty-five years or more

2%

(76/4531)

4

Male gender

10%

(452/4531)

5

Operative fixation within 48 hours

82%

(3719/4531)

L 2 B

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(OBQ11.172) Which of the following methods accurately describes the measurement of tip-apex-distance as it relates to placement of a lag screw in the femoral head?

QID: 3595
1

Summation of the distance between the end of the screw and the apex of the femoral head on AP and lateral radiographs

95%

(3436/3629)

2

Distance from the acetabular teardrop to the tip of the screw on an AP radiograph of the hip

1%

(52/3629)

3

Multiplication of the distance between the end of the screw and the apex of the femoral head on AP and lateral radiographs

1%

(47/3629)

4

Distance from the center of the lesser trochanter to the tip of the screw on an AP hip radiograph

1%

(32/3629)

5

Summation of the distance between the tip of the greater trochanter and end of the screw on AP and lateral hip radiographs

1%

(42/3629)

L 1 B

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(OBQ11.189) Which of the following deformities is most likely to occur with dynamic hip screw fixation of unstable left sided standard obliquity hip fractures?

QID: 3612
1

Posterior spike displacement of the proximal fragment

8%

(167/2172)

2

Anterior spike displacement of the proximal fragment

63%

(1359/2172)

3

Lateral displacement of the proximal fragment relative to the distal fragment

11%

(230/2172)

4

Shortening of the proximal fragment relative to the distal fragment

4%

(93/2172)

5

Medial displacement of the proximal fragment in relation to the distal fragment

14%

(310/2172)

L 3 C

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(OBQ10.17) A 74-year-old female falls from a standing height and sustains the fracture shown in Figure A. The occurrence of this injury most increases her risk of subsequently sustaining which of the following fractures in the future?

QID: 3105
FIGURES:
1

Sacral fracture

2%

(39/2007)

2

Hip fracture

64%

(1292/2007)

3

Distal radius fracture

16%

(331/2007)

4

Distal fibula fracture

1%

(12/2007)

5

Distal humerus fracture

16%

(328/2007)

L 2 D

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(SBQ09TR.45.1) Which of the following is an advantage of sliding hip screws compared to cephalomedullary nails for the treatment of appropriate intertrochanteric femur fractures?

QID: 211031
1

Decreased risk of deep venous thrombosis

1%

(20/2432)

2

Biomechanically advantageous under physiologic loading

14%

(351/2432)

3

Decreased blood loss

10%

(247/2432)

4

Decreased risk of nonunion

2%

(57/2432)

5

None of the above

72%

(1743/2432)

L 2 C

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(OBQ09.233) Which of the following statements is true regarding treatment of intertrochanteric hip fractures with an intramedullary nail versus a sliding hip screw?

QID: 3046
1

The use of intramedullary nail has increased in the last ten years

84%

(799/948)

2

The use of sliding hip screws has increased in the last ten years

4%

(37/948)

3

Medicare reimbursement is more for a sliding hip screw

1%

(11/948)

4

Intramedullary nails have demonstrated superior outcomes in randomized-controlled studies

8%

(74/948)

5

Sliding hip screw is superior for treatment of reverse obliquity intertrochanteric fractures

3%

(24/948)

L 2 D

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(OBQ09.222) A patient with an intertrochanteric hip fracture undergoes reduction and dynamic hip screw application. The post-operative radiographs demonstrate that the lag screw is superior in the femoral head with a tip-apex distance of 40 millimeters. This patient is at increased risk of what complication?

QID: 3035
1

lag screw cutout

96%

(1528/1590)

2

osteonecrosis

1%

(13/1590)

3

osteoarthritis

1%

(13/1590)

4

peri-prosthetic fracture

1%

(14/1590)

5

lag screw breakage

1%

(18/1590)

L 1 B

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(OBQ09.3) Which of the following factors has been shown to be the strongest predictor of screw cutout of a dynamic compression hip screw used for an intertrochanteric femur fracture?

QID: 2816
1

Age of the patient

1%

(26/3211)

2

Intrinsic stability of the fracture

4%

(142/3211)

3

Tip-apex distance

92%

(2945/3211)

4

Quality of reduction

2%

(77/3211)

5

Angle of the sideplate

0%

(13/3211)

L 2 B

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(OBQ08.138) An 82-year-old female sustains an intertrochanteric hip fracture and is treated with a sliding hip screw. What is the most appropriate definitive step in treating the failure seen in figure A?

QID: 524
FIGURES:
1

Non-weight bearing

0%

(4/802)

2

Valgus proximal femoral osteotomy

7%

(53/802)

3

Total hip arthroplasty

82%

(654/802)

4

Revision open reduction and internal fixation

10%

(84/802)

5

Proximal femoral resection

0%

(4/802)

L 2 D

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(OBQ07.246) A 72-year-old male sustains the injury shown in Figure A as a result of a fall from a ladder. Which of the following factors has been shown to be associated with increased collapse or sliding displacement?

QID: 907
FIGURES:
1

Use of a long intramedullary device

1%

(8/938)

2

Use of a short intramedullary device

6%

(59/938)

3

Use of external fixation

3%

(24/938)

4

Postoperative weight bearing status

6%

(60/938)

5

Intraoperative fracture of the lateral femoral wall

84%

(785/938)

L 2 C

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(OBQ07.153) Anterior perforation of the distal femur from antegrade femoral nailing has been attributed to what factor?

QID: 814
1

Non-anatomic reduction

2%

(62/2899)

2

Mismatch of the radius of curvature of implant and bone

91%

(2643/2899)

3

Usage of too large an implant

2%

(58/2899)

4

Lateral patient positioning

1%

(19/2899)

5

Lateral proximal starting point

4%

(107/2899)

L 1 B

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(OBQ07.86) Which of the following is not an appropriate implant for treatment of the fracture seen in Figure A?

QID: 747
FIGURES:
1

Cephalomedullary nail

7%

(179/2450)

2

External fixation

8%

(198/2450)

3

Proximal femoral locking plate

2%

(60/2450)

4

95 degree blade plate

1%

(36/2450)

5

Sliding hip screw

80%

(1971/2450)

L 2 C

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(OBQ06.157) Which of the following is a recognized predictor of mortality after hip fracture?

QID: 343
1

American Society of Anesthesiologist (ASA) classification

73%

(997/1372)

2

Post-operative weight bearing status

23%

(322/1372)

3

Fracture comminution

2%

(31/1372)

4

Fixation device used

0%

(6/1372)

5

Type of anesthetic used

1%

(13/1372)

L 2 D

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(OBQ05.262) When treating a stable 2-part intertrochanteric hip fracture with a sliding hip screw construct, what is the minimum number of screw holes that are needed in the side plate for successful fixation?

QID: 1148
1

One

2%

(22/925)

2

Two

80%

(740/925)

3

Three

13%

(121/925)

4

Four

4%

(35/925)

5

Five

0%

(1/925)

L 2 C

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(OBQ05.210) All of the following implants offer adequate fracture fixation of the injury shown in Figure A EXCEPT:

QID: 1096
FIGURES:
1

Trochanteric entry point cephalomedullary nail

3%

(72/2449)

2

Piriformis fossa entry point cephalomedullary nail

3%

(70/2449)

3

Dynamic hip screw

85%

(2070/2449)

4

Fixed angle blade plate

2%

(51/2449)

5

95 degree dynamic condylar screw

7%

(179/2449)

L 1 B

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(OBQ05.161) A 55-year-old male is involved in a motor vehicle accident and sustains the injury seen in Figure A. What is the most appropriate treatment for this type of injury?

QID: 1047
FIGURES:
1

Total hip arthroplasty

1%

(11/1492)

2

Bipolar hemi-arthroplasty

1%

(9/1492)

3

Sliding hip screw

3%

(43/1492)

4

Percutaneous screw fixation

1%

(8/1492)

5

Cephalomedullary nail fixation

95%

(1416/1492)

L 1 B

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EXPERT COMMENTS (60)
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