Displacements of trochanteric fractures and their influence on reduction.

The management of trochanteric fractures of the femur presents fewer problems than that of transcervical fractures. Union is often well advanced at twelve to fourteen weeks, by which time most patients are permitted to bear weight through the injured hip; the functional end-result is generally good, providing there is reasonable anatomical alignment of the fragments. Most surgeons use internal fixation in the management of this injury, and the greater part of the literature is concerned with the merits of various fixation devices and the complications resulting from their use. A clear description ofthe dynamics ofthe displacement of the fragments was given by Horn and Wang (1964), based on the level of the fracture and the relevant muscle anatomy. This information helps to indicate the methods of reduction that should be employed. Although an imperfect reduction does not materially alter the eventual function of the hip it does increase the difficulties of fixation. In such circumstances fixation of the fracture is not sound and the risk of complications such as bending and breaking of the nail-plate and extrusion of the nail is considerably increased. This paper describes the detailed radiographic appearances of the displaced fragments and their relevance in achieving more precise reduction. Crack fractures and those with only slight displacement present no problems and are not considered in this discussion.