Tip-apex distance shoulde be equal to or less than 25mm (tip apex distance = the sum of the distance from the tip of the lag screw to the apex of the femoral head on the AP and lateral Xrays) (Baumgaertner MR, JBJS 1995 77:1058). Stable fracture (posteromedial cortex intact/minimal comminution): 2-hole DHS.Intertrochanteric Femur Fx Classification / Treatment Bone scans may not be positive for up to 3 days after fracture Consider bone scan if MRI is not available. MRI: indicated for suspected hip fracture not seen on xray.AP in 15° of internal rotation are best to demonstrate non-displaced fractures. AP pelvis, cross-table lateral hip, AP hip.Document any pre-existing sacral or heel decubitus ulcer.Lower extremity is shortened and externally rotated with displaced fractures.Intertrochanteric Femur Fx Clinical Evaluation Hip adductors insert distal to the fracture causing adduction and varus deformity.Short external rotators often remain intact, externaly rotating the proximal fragment.Gluteus medius and minimus insert on the greater trochanter and produce varus deformity at the fracture site and shorten the limb.iliopsoas inserts on the lesser trochanter and flexes, externally rotates, and shortens the limb.IT fractures occur between the greater and lesser trochanters.Non-op treatment/delayed surgical treatment = decubiti, UTI, joint contractures, pneumonia, DVT/PE, high mortality rate. Hip fractures in young patients are associated with high-energy trauma (MVA, fall from height).
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