Intertrochanteric Hip Fracture: Tips from Physical Therapist!

What does a intertrochanteric fracture look like?

Even though you probably had never heard this name before experiencing it, intertrochanteric fractures are quite common.

Especially in individuals over the age of 65: the average age of people with a intertrochanteric fracture is 80 years old (Ghanem 2021).

Half of all hip fractures are intertrochanteric fractures.

Source: Selim 2020

Definition and classification of a interchanteric fracture

What do we mean by a ‘intertrochanteric fracture’?

It’s simply a fracture at a location on the upper part of the femur called the trochanteric region.

It’s just below the femoral neck.

There are different types of intertrochanteric fractures.

And different classifications. But that doesn’t matter much for everything related to rehabilitation: no matter the location and the specific type of fracture, the treatment follows the same broad guidelines.

The two main types of intertrochanteric fractures are:

• Stable fractures: The bone is only broken into 2 parts.
• Unstable fractures (40%): The bone is broken into 3 or 4 pieces.

Normally, you can find the type of fracture you have mentioned in your X-ray report, emergency room visit, or hospitalization.

X-ray of a intertrochanteric fracture

Want to see what a intertrochanteric fracture looks like? Well, here’s an X-ray of someone who has this type of fracture:

The X-ray (or another imaging method, like a CT scan) confirms the diagnosis of the fracture and provides more information about the specific type: is it stable or unstable?

The X-ray above shows a fairly significant and unstable fracture. It’s likely that your own fracture is less severe.

Below is a intertrochanteric fracture seen on a CT scan. It’s simpler than the previous one, with no displacement. This means that the two bone parts separated by the fracture line are almost in close proximity.

Sometimes, there are also intertrochanteric fissures, where the fracture line is even more discreet.

What is the treatment for a intertrochanteric fracture?

As always in trauma cases, the treatment will depend on several factors:

• Your overall health before and after the fracture, any preexisting medical conditions, and your level of independence.
• The type of fracture.
• The medical and surgical team you encounter.

When multiple treatment options are available, the surgical team may sometimes seek your input (or that of your loved ones) regarding your own assessment of the risk-benefit balance, based on the information they provide.

Surgery for a intertrochanteric hip fracture

Surgery is often necessary in the case of a intertrochanteric fracture, even in individuals over 90 years old (Ghanem 2021).

The operation often takes place within 24 hours after the fracture to minimize the risk of complications. However, in individuals over 90 years old, waiting does not increase the risk of complications (Ghanem 2021).

A trauma-orthopedic surgeon, often specializing in lower limb injuries, performs the surgery.

The goal of the operation is to:

• Reduce the fracture: correctly realign the bone fragments.
• Stabilize the fracture: ensure everything stays in place and facilitates healing, even when you start moving again.

To achieve this, various materials are used and placed in the femur.

These materials are designed to be highly resistant and compatible with the body.

They are typically made of materials suitable for internal use, such as iron, cobalt, titanium alloys, and steel.

Most commonly, osteosynthesis materials are used, such as:

• A DHS plate and screws.
• A gamma nail, also called an intramedullary femur nail.
• Less commonly, a hip replacement may be used. In this case, the materials are often polyethylene (a very hard plastic), ceramic, or certain metals like cobalt-chrome or titanium.

You will know the specific hardware used by reviewing the report from your surgery.

After the operation, you typically stay in the hospital for a few days.

Unless there are specific circumstances, weight-bearing on the operated leg is often allowed right away, as is moving the hip for daily activities.

Without surgery: conservative treatment

Less commonly, surgery may not be necessary.

In such cases, you will receive specific instructions to promote healing:

• Bed rest with the application of traction.
• Minimal to no weight-bearing for several weeks.
• Wearing a Zimmer splint to limit hip movement.

Read this other article to learn more about whether walking is allowed or not after a hip fracture.

What rehabilitation is needed after a intertrochanteric fracture?

Regardless of whether you go to a rehabilitation center, a private practice, or receive rehabilitation at home, the care is similar.

In general, the rehabilitation and recovery period is divided into 2 phases:

1. The first few weeks after the fracture, up to the follow-up X-ray. The goal is to encourage healing by staying active without increasing pain or putting too much stress on the joint.
2. The months following the follow-up X-ray: you gradually resume all your pre-fracture activities.

Physical therapists are among the professionals who can assist you during either or both of these phases.

In France, physical therapy sessions are often prescribed after a pertrochanteric fracture, especially if you have difficulty moving independently. They are covered by health insurance and private health plans.

What are the goals of rehabilitating a intertrochanteric fracture?

The general objectives of physical therapy sessions are:

• Gradually help you regain the ability to perform all your daily activities, walk without a walker or crutches.
• Ensure that your living environment and lifestyle are adapted to prevent the type of accident that led to the femur fracture from recurring. If necessary, implement actions to prevent the risk of falling.
• Monitor the gradual reduction of pain, swelling, and hematoma.

The role of the physical therapists accompanying you is to define more specific and personalized goals with you. These goals should be realistic and tailored to your lifestyle and preferences.

Exercises after a intertrochanteric fracture?

Are there specific exercises to do after a intertrochanteric fracture?

I know that for some people, physiotherapy equals massage, or physiotherapy equals exercises. Of course, that’s a bit of an oversimplification.

I see things a bit differently: the goal is to regain your abilities. For this, it is not necessarily necessary to do specific exercises.

If you remain active throughout the day:

• By gradually increasing your walking, both indoors and outdoors.
• By going up and down stairs.
• By doing household chores.
• By varying your positions throughout the day (lying down, semi-reclined, sitting, standing),

doing exercises becomes secondary!

In my opinion, it’s better to stay active throughout the day rather than doing 10 minutes of daily exercise and not thinking about it for the rest of the day.

That’s why I sometimes give exercises to my patients after a pertrochanteric fracture (especially if they request them), but I don’t consider it the main focus of rehabilitation.

The main focus is to reassure you and help you stay active in your daily life, in a way that is adapted to your level, your environment, and your goals.

How long does the rehabilitation of a trochanteric fracture last?

Again, the goal of the physical therapists who are treating you is to identify with you the ideal duration of rehabilitation and physical therapy supervision in your case.

This depends on your health status, your goals, your concerns, your desire for independence, and your availability in terms of time.

Some people do not have any physical therapy sessions after a intertrochanteric fracture.

Others may go to the physical therapist 2 or 3 times a week for months. (I’m not sure if this is the case in countries where physical therapy is not as well financially supported by the government and insurance companies.)

On average, I would say that the duration of rehabilitation for a trochanteric fracture is a few weeks. Often, it stops at the time of the follow-up X-ray if it started right after hospital discharge.

How long do the pains last after a trochanteric fracture?

Whether you have undergone surgery or not, your tissues (bone, skin, muscles, etc.) are somewhat damaged after a trochanteric fracture.

They need time (several weeks to several months) to heal, to consolidate, and return to their pre-injury state.

For this, your body automatically reacts. Your immune system (defense system) triggers inflammatory responses at the hip.

This inflammation causes:

• Accumulation of fluids in various layers of tissues. This often leads to swelling around the hip after a trochanteric fracture.
• Pain.
• Redness and warmth at the hip.
• One or more hematomas and bruises.

This inflammation is a necessary step, and in the medium to long term, it is beneficial!

It helps repair damaged tissues. It transports all the necessary substances to the injured area through fluids, facilitating the natural healing of damaged structures as quickly as possible.

These pains can last for a few days, a few weeks, and sometimes a few months after a intertrochanteric fracture. They gradually improve over time.

One of the best ways to relieve these pains? Stay as active as possible.

Physical activity has direct and indirect positive effects on limiting these pains.

What is the total healing time for a intertrochanteric fracture?

Here are some data on the progression in the days, weeks, and months following a trochanteric fracture.

Some people recover much faster than others. That’s why these are average data, a range. You may fall into one of the extremes or even outside of it!

It is very difficult to predict in advance how you will recover.

Recovery Milestones	Timeframes
Disappearance of hip and thigh pain	Decrease from the first days post-surgery/post-fracture
Complete or partial disappearance 1 to 12 months after surgery
Resumption of walking with assistive devices (canes, walker) for a few meters	The day after surgery or within a few days at most
Resumption of walking with assistive devices for more than 500 meters	1 to 3 weeks after surgery if there were no walking difficulties before surgery
Resumption of walking without any assistive devices	1 to 4 months
Resumption of all daily activities without assistance (household chores, cooking, shopping, etc.)	2 to 5 months
Resumption of driving	1 to 3 months
Return to sports	3 to 12 months, depending on the sport and prior activity level

Generally, individuals with unstable and complex trochanteric fractures take longer to recover. However, as time passes, the difference diminishes (Gleich 2021).