Intertrochanteric Fracture

An intertrochanteric fracture is a break across the upper part of your thigh bone, between the two bony bumps you can feel on the outside of the hip — just below where the bone angles into the joint. Like the more well-known femoral neck fracture, these usually happen to older women with osteoporosis after a ground-level fall. They're classified as stable or unstable based on whether the broken pieces can support load after they've been fixed back together.

Important difference from femoral neck fractures: the blood supply to the ball of the hip is almost never threatened here, so the standard surgery is to FIX the bone (with screws or a long rod) rather than to REPLACE it. Hip replacement is rarely needed for an intertrochanteric fracture.

The injury is usually obvious: a fall (often from standing height in an older adult) followed by immediate inability to put weight on the leg. The affected leg looks shorter than the other and is rotated outward — the foot points to the side rather than straight ahead. Pain is severe in the groin and upper thigh, and any attempt to move the hip causes it to spike.

Swelling and bruising develop quickly around the upper thigh and hip. In frail or elderly patients, the fracture can sometimes be difficult to detect on its own — complaints may be vague hip or knee pain after a stumble — so any older adult who can't walk after a fall needs X-rays of the hip. Because these fractures happen overwhelmingly in people with weakened bone (osteoporosis), they often follow only minimal trauma.

The presentation looks just like a femoral neck fracture: can't bear weight, the affected leg looks shorter and rotated outward, and there's pain in the upper thigh and groin. Standard pelvis and hip X-rays confirm the diagnosis. A CT scan is added for shattered or complex fracture patterns to plan the fixation.

Surgical fixation is the standard treatment for nearly every intertrochanteric fracture in patients who can tolerate surgery. Early fixation (within 24 to 48 hours of the injury) improves outcomes — getting you up and moving as soon as possible is critical to overall recovery.

External patient-education references and related OSI pages for additional background:

• Britannica — Bone disease (fractures)
• Britannica — Hip (anatomy)
• AAOS OrthoInfo — patient education library
• OSI glossary — orthopedic terminology in plain language