This is a fracture at or below the lesser trochanter. It is relatively uncommon. Given enough force, it may occur at any age, but in practice, most arise as a pathological fracture in an elderly person following comparatively minor injury.
The leg is usually shortened and externally rotated. Blood loss may be extensive - more than with a femoral neck or other trochanteric fracture - with the thigh markedly swollen. Movement is painful.
Transverse, oblique or spiral fractures may occur. Many are comminuted.
Treatment is usually by open reduction and internal fixation. An intramedullary nail secured with locking screws into the femoral head and neck is often successful. Cementing may be required to improve stability if there is a large osteolytic defect.
Mal-union or non-union may be treated by bone grafting.
Patients whose health is too poor for surgery can be given pain relief by traction in a Thomas splint.
Last reviewed 01/2018