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Radiographic Findings of Intertrochanteric Frx

- See:
      - Classification
      - Singh index
      - Unstable Intertrochanteric Fractures

- AP view (internal rotation);
    - allows determination of frx obliquity & bone quality;
    - if hip is in external rotation, greater troch rotates posteriorly & will overlie part of the fracture line;
    - determine size, location, & comminution posterior frx fragments, which determines fracture (in)stability;
    - in some cases the lesser trochanter will be fractured w/o comminution but more often there will be associated comminution which makes the frx unstable;

- Lateral:
    - in some cases, an unstable frx pattern may be missed due to an inadequate lateral radiograph, which interferes w/ assessment of size postero-medial comminution and presence of coronal split in the greater troch (4 part frx);

           - diagram of 4 part fracture:

- 5Ps Hip Fracture: Pathologic Hip Fractures:
    - ability of severely osteoporotic bone to bear substantial segment of load is impaired even when collapsible device is used properly.
    - consider placing Sliding Screw more inferiorly in osteoporotic bone;
    - purchase of cortical-bone screws thru side-plates may also be impaired in osteoporotic bone & may result in plate pulling away from shaft;
          - this may be corrected by use of either longer plate & more screws;
    - osteoporotic frxs must be protected w/ limited wt bearing postop;

- Fracture Geometry and Stability: (See Classification)
    - w/ cortical instability on one side of frx owing to cortical overlap or destruction, frx tends to collapse in direction of instability;
    - it is important prior to reduction to distinguish between Unstable and Stable Frx intertroch fractures

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