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Subtrochanteric and Femoral Shaft Fracture
MK Jesse, MD; Julia R. Crim, MD; Adam C. Zoga, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Synonyms

                • Proximal femoral shaft fracture
              • Definitions

                • Subtrochanteric fracture: ≤ 5 cm below lesser trochanter
                • Femoral shaft fracture: > 5 cm distal to lesser trochanter
                • Segmental fracture: shaft fractured in 2 locations, isolating segment of bone between 2 fracture lines
                • Intercalated segment: portion of bone isolated between 2 fracture lines in segmental fracture
                  • Intercalated segment often has impaired vascularity
                • Bisphosphonate fracture: fracture related to failure of bone remodeling in patients on long-term bisphosphonate therapy
                  • Also designated atypical femur fracture

              IMAGING

              • General Features

                • Radiographic Findings

                  • CT Findings

                    • MR Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          • Reporting Tips

                                            Selected References

                                            1. Marshall RA et al: Imaging features and management of stress, atypical, and pathologic fractures. Radiographics. 38(7):2173-92, 2018
                                            2. Hak DJ et al: Ipsilateral femoral neck and shaft fractures: current diagnostic and treatment strategies. Orthopedics. 38(4):247-51, 2015
                                            3. Probyn L et al: Bilateral atypical femoral fractures: how much symmetry is there on imaging? Skeletal Radiol. 44(11):1579-84, 2015
                                            4. Ekström W et al: Quality of life after a subtrochanteric fracture: a prospective cohort study on 87 elderly patients. Injury. 40(4):371-6, 2009
                                            5. Goh SK et al: Subtrochanteric insufficiency fractures in patients on alendronate therapy: a caution. J Bone Joint Surg Br. 89(3):349-53, 2007
                                            6. Kregor PJ et al: Unstable pertrochanteric femoral fractures. J Orthop Trauma. 19(1):63-6, 2005
                                            7. Haidukewych GJ et al: Nonunion of fractures of the subtrochanteric region of the femur. Clin Orthop Relat Res. (419):185-8, 2004
                                            8. Tornetta P 3rd: Subtrochanteric femur fracture. J Orthop Trauma. 16(4):280-3, 2002
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Pathology

                                                    • Clinical Issues

                                                      • Diagnostic Checklist

                                                        TERMINOLOGY

                                                        • Synonyms

                                                          • Proximal femoral shaft fracture
                                                        • Definitions

                                                          • Subtrochanteric fracture: ≤ 5 cm below lesser trochanter
                                                          • Femoral shaft fracture: > 5 cm distal to lesser trochanter
                                                          • Segmental fracture: shaft fractured in 2 locations, isolating segment of bone between 2 fracture lines
                                                          • Intercalated segment: portion of bone isolated between 2 fracture lines in segmental fracture
                                                            • Intercalated segment often has impaired vascularity
                                                          • Bisphosphonate fracture: fracture related to failure of bone remodeling in patients on long-term bisphosphonate therapy
                                                            • Also designated atypical femur fracture

                                                        IMAGING

                                                        • General Features

                                                          • Radiographic Findings

                                                            • CT Findings

                                                              • MR Findings

                                                                • Imaging Recommendations

                                                                  DIFFERENTIAL DIAGNOSIS

                                                                    PATHOLOGY

                                                                    • General Features

                                                                      • Staging, Grading, & Classification

                                                                        CLINICAL ISSUES

                                                                        • Presentation

                                                                          • Demographics

                                                                            • Natural History & Prognosis

                                                                              • Treatment

                                                                                DIAGNOSTIC CHECKLIST

                                                                                • Consider

                                                                                  • Image Interpretation Pearls

                                                                                    • Reporting Tips

                                                                                      Selected References

                                                                                      1. Marshall RA et al: Imaging features and management of stress, atypical, and pathologic fractures. Radiographics. 38(7):2173-92, 2018
                                                                                      2. Hak DJ et al: Ipsilateral femoral neck and shaft fractures: current diagnostic and treatment strategies. Orthopedics. 38(4):247-51, 2015
                                                                                      3. Probyn L et al: Bilateral atypical femoral fractures: how much symmetry is there on imaging? Skeletal Radiol. 44(11):1579-84, 2015
                                                                                      4. Ekström W et al: Quality of life after a subtrochanteric fracture: a prospective cohort study on 87 elderly patients. Injury. 40(4):371-6, 2009
                                                                                      5. Goh SK et al: Subtrochanteric insufficiency fractures in patients on alendronate therapy: a caution. J Bone Joint Surg Br. 89(3):349-53, 2007
                                                                                      6. Kregor PJ et al: Unstable pertrochanteric femoral fractures. J Orthop Trauma. 19(1):63-6, 2005
                                                                                      7. Haidukewych GJ et al: Nonunion of fractures of the subtrochanteric region of the femur. Clin Orthop Relat Res. (419):185-8, 2004
                                                                                      8. Tornetta P 3rd: Subtrochanteric femur fracture. J Orthop Trauma. 16(4):280-3, 2002