The subtrochanteric region is a part of the thigh bone (femur). It is the area proximally 10 cm from the top of the femur bone. This area is important because there are a lot of muscles attached to the bone here. Any fractures that occur in this area will often result in the muscles pulling the fracture ends away from each other.
If the bone ends are not in contact, fracture healing cannot occur. The femur is an important part of the leg, and is crucial to allowing walking, and sitting. If the fracture is not allowed to heal with the bone placed in a good position, patients may find themselves wheelchair-bound indefinitely.
A subtrochanteric fracture is a serious injury that often results from an accident (trauma). Examples of such accidents include falls from height and car accidents. Occasionally, elderly patients with very poor bone quality, may suffer a subtrochanteric fracture after a minor injury, such as a fall from a standing height. The use of anti-osteoporotic medications for a long time may also predispose patients to subtrochanteric fractures.
Patients who have sustained a subtrochanteric fracture are often in severe pain, with the leg grossly deformed and held at a weird angle. There may also be accompanying bleeding especially if there is a break in the skin.
Patients will often be unable to stand, much less put weight on the affected leg. There may also be other injuries sustained, especially to the leg on the same side of the injury, and to the lower back.
Patients who have sustained a leg injury will usually be assessed with a clinical interview with regards to the mechanism of their leg injury. Additional questions will be asked with regards to bleeding, the presence of an open wound, and numbness of the affected leg. Questions will also be asked about pain elsewhere in the body.
Based on the information gleaned during the medical interview, a focused clinical examination will be conducted where the patient’s affected leg will be examined. A neurological and vascular examination of the leg may also be conducted.
Plain X-rays are usually sufficient to diagnose subtrochanteric fractures. Occasionally, computerised tomography (CT) scans may be necessary to delineate the exact fracture pattern.
Surgical treatment of subtrochanteric fractures is strongly recommended. As mentioned previously, subtrochanteric fractures heal poorly, and immobility/prolonged bed rest can have disastrous effects on patients.
Non-surgical treatment is usually reserved only for patients with other severe medical conditions, who may be at risk of death during the surgery to fix the fracture.
Subtrochanteric fracture fixation is usually carried out with intramedullary nailing, where the fracture is reduced and held in place with a metal rod placed within the bone itself. This is a minimally invasive operation, and wounds from the surgery usually go on to heal within 2 weeks.
Following the surgery, patients will be allowed to put weight on the affected leg but may require a set of crutches to aid in walking. Sutures placed during surgery will usually be removed 2 weeks after surgery.
Rehabilitation and recovery
Patients who have undergone surgery to repair their subtrochanteric fracture will usually be referred for a course of physiotherapy for the lower limbs. During rehabilitation, they will be trained to walk on the affected leg. Strengthening exercises will also be taught to the muscles around the hip.
In general, subtrochanteric fractures take 3 to 6 months to fully heal. Thereafter, most patients will be able to return to sport/exercise. In the case of fractures occurring due to prolonged use of osteoporotic medications, the fractures may take up to a year or more to heal.
For an assessment of your condition, please book an appointment with Dr. Yong Ren.
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