Intertrochanteric Fractures — AO/OTA

Intertrochanteric fractures are extracapsular fractures of the proximal femur occurring between the greater and lesser trochanters. These fractures are extremely common in the elderly population and are strongly associated with osteoporosis. They account for nearly half of all hip fractures and represent a major cause of morbidity and mortality in older adults.

In younger individuals, intertrochanteric fractures usually occur due to high-energy trauma such as road traffic accidents or falls from height. In contrast, elderly patients often sustain these fractures following low-energy mechanisms such as a simple fall from standing height.

Because these fractures occur outside the hip joint capsule, the blood supply to the femoral head is generally preserved, and the risk of avascular necrosis is much lower compared with femoral neck fractures. Modern treatment focuses on early surgical stabilization to allow early mobilization and reduce complications associated with prolonged immobilization.

The intertrochanteric region lies between the greater and lesser trochanters of the femur. This area serves as the attachment site for several powerful muscles that influence fracture displacement.

• Greater trochanter – insertion of gluteus medius and minimus
• Lesser trochanter – insertion of iliopsoas
• Intertrochanteric line – anterior ridge connecting trochanters
• Intertrochanteric crest – posterior ridge between trochanters

Muscle forces acting on the proximal femur contribute to displacement patterns in intertrochanteric fractures. The iliopsoas tends to flex and externally rotate the proximal fragment, while the gluteal muscles abduct the greater trochanter.

• Common in elderly patients with osteoporosis
• Represents about 50% of hip fractures
• Higher incidence in women
• Incidence increases with age

• Fall directly onto the greater trochanter
• Low-energy trauma in elderly patients
• High-energy trauma in younger individuals
• Direct impact to the lateral hip

In osteoporotic bone, even minor trauma may produce complex fracture patterns with comminution of the posteromedial cortex.

The AO/OTA classification is commonly used to categorize intertrochanteric fractures based on fracture pattern and stability.

Fracture stability is a key factor in determining the appropriate surgical fixation method.

• Severe hip pain
• Inability to bear weight
• Shortened and externally rotated limb
• Swelling around hip
• Tenderness over greater trochanter

Patients typically present after a fall and are unable to stand or walk due to severe pain.

• AP pelvis radiograph
• Lateral hip radiograph
• CT scan for complex fractures

Radiographs typically demonstrate the fracture pattern and displacement of fragments.

The primary goal of treatment is early mobilization and restoration of function. Most intertrochanteric fractures are treated surgically.

• Early surgery within 24–48 hours
• Stable internal fixation
• Early mobilization
• Prevention of complications

• Implant failure
• Malunion
• Nonunion
• Deep vein thrombosis
• Pressure sores

• Extracapsular fracture of proximal femur
• Most common in elderly osteoporotic patients
• AO classification type 31-A
• PFN preferred for unstable fractures