Bilateral intertrochanteric fracture: Definition, Uses, and Clinical Overview

Posted on February 27, 2026 | by drhip

Bilateral intertrochanteric fracture Introduction (What it is)

Bilateral intertrochanteric fracture means there are breaks in the upper thigh bones (femurs) near both hips.
The fractures occur in the “intertrochanteric” region, which is between two bony prominences called the greater and lesser trochanters.
It is most often discussed in emergency care, orthopedic trauma, and geriatric fracture care.
Clinicians use the term to describe the injury pattern and guide imaging, stabilization, and treatment planning.

Why Bilateral intertrochanteric fracture used (Purpose / benefits)

In orthopedics, precise fracture terminology is used to communicate what broke, where it broke, and what that implies for stability and treatment options. The label Bilateral intertrochanteric fracture serves several practical purposes:

Clarifies location and biomechanics. Intertrochanteric fractures involve a weight-bearing area where the hip’s powerful muscles attach, which affects how fracture fragments shift and how fixation may be chosen.
Signals higher functional impact. Because both hips are involved, standing, walking, transfers (bed to chair), and basic mobility can be significantly limited compared with a one-sided fracture.
Guides imaging and surgical planning. The term helps teams anticipate the need for full-length femur imaging, evaluation of both sides, and planning for fixation strategy (and sometimes staging).
Supports consistent documentation. Clear terminology improves communication among emergency clinicians, radiologists, surgeons, anesthesiologists, physical therapists, and inpatient teams.
Frames risk and recovery discussions. Bilateral injuries often require more coordinated rehabilitation planning and closer monitoring for complications, though specifics vary by clinician and case.

Indications (When orthopedic clinicians use it)

Orthopedic clinicians use the term Bilateral intertrochanteric fracture when the clinical exam and imaging support fractures on both sides in the intertrochanteric region, such as:

A fall or trauma followed by pain in both hip areas and inability to bear weight
Known or suspected fragility fracture pattern (low-energy fall) involving both hips
High-energy trauma (for example, a motor vehicle collision) with bilateral hip/thigh pain
Polytrauma scenarios where bilateral femur involvement is suspected during a systematic trauma evaluation
Cases where initial imaging of one hip is positive and symptoms or exam suggest injury on the other side
Situations where clinicians need to distinguish intertrochanteric fractures from femoral neck, subtrochanteric, or pelvic fractures

Contraindications / when it’s NOT ideal

A “contraindication” fits procedures more than diagnoses, but there are situations where the label Bilateral intertrochanteric fracture or a typical intertrochanteric-fracture management pathway is not the best match, including:

Different fracture location: femoral neck (intracapsular) fractures, subtrochanteric fractures, femoral shaft fractures, or pelvic/acetabular fractures may require different classification and treatment approaches.
Periprosthetic fractures: fractures around a hip implant (after a prior hip replacement) are categorized differently and often use different fixation or revision strategies.
Pathologic fractures: fractures through bone weakened by tumor, infection, or certain metabolic bone disorders may need additional diagnostic workup and different stabilization planning.
Atypical fracture patterns: some femur fractures have distinctive imaging features and may be managed differently; classification can vary by clinician and case.
Medical instability affecting timing/approach: severe cardiopulmonary instability, active infection, or other acute medical issues can change timing, anesthesia planning, or whether surgery is staged; decisions vary by clinician and case.
Imaging uncertainty: poor-quality imaging or overlapping injuries (for example, multiple fracture sites) may require additional views or advanced imaging before final classification.

How it works (Mechanism / physiology)

A bilateral intertrochanteric fracture is not a device or medication, so it does not have a “mechanism of action.” Instead, it has a mechanism of injury and a set of biomechanical consequences.

Relevant hip anatomy (plain language, clinically accurate)

The femur is the thigh bone. Its upper end forms the “ball” portion of the hip joint.
The femoral head (ball) sits in the acetabulum (socket of the pelvis).
The femoral neck connects the head to the rest of the femur.
The intertrochanteric region lies just below the neck, between the greater trochanter and lesser trochanter—two prominent bony areas where major muscles attach.
Strong muscle groups (including parts of the gluteal muscles and iliopsoas) pull on these trochanters. After a fracture, these pulls can contribute to fragment displacement.

Mechanism of injury and why stability matters

In older adults, intertrochanteric fractures often occur after a low-energy fall onto the side, especially when bone strength is reduced (for example, osteoporosis).
In younger patients, they can occur after high-energy trauma, and the fracture may be more complex.
The intertrochanteric area is outside the hip joint capsule (an extracapsular region). This influences bleeding patterns, fracture healing environment, and typical treatment options compared with intracapsular femoral neck fractures.
Fractures are often described as stable or unstable based on fragment pattern, comminution (multiple pieces), and whether the bone can resist collapsing into varus (an inward angulation) under load.

Onset, duration, and reversibility

The onset is immediate at the time of injury, typically with acute pain and loss of function.
Without stabilization and healing, the mechanical problem persists. The “duration” depends on injury severity, treatment strategy, and healing capacity.
“Reversibility” applies mainly to function: with fracture healing and rehabilitation, mobility can improve, but outcomes vary by clinician and case.

Bilateral intertrochanteric fracture Procedure overview (How it’s applied)

A bilateral intertrochanteric fracture is a diagnosis rather than a single procedure. Below is a high-level overview of how clinicians typically evaluate and manage it from presentation through follow-up. Specific steps vary by clinician and case.

1) Evaluation and exam

History of the event (fall, collision, twisting injury) and symptoms in both hips/thighs
Physical exam focusing on pain location, limb position, swelling/bruising, and ability to move
Neurovascular checks (sensation, pulses, and limb perfusion)
Review of medications and conditions that may affect bleeding risk, anesthesia planning, or bone health

2) Imaging and classification

X-rays of both hips and femurs are commonly used to confirm location and pattern
Additional views may be added to better define fracture lines and stability
CT or other imaging may be considered when fracture pattern is unclear or complex; use varies by clinician and case

3) Preparation and stabilization planning

Pain control and positioning to minimize discomfort
Assessment for other injuries (especially in high-energy trauma)
Medical evaluation for operative readiness and anesthesia planning when surgery is considered
Planning fixation type and sequencing (single-stage vs staged), which varies by clinician and case

4) Intervention (general categories)

Surgical fixation is commonly used for intertrochanteric fractures to stabilize the bone and support mobilization, though exceptions exist.
Common fixation strategies include intramedullary devices (placed inside the bone canal) or plate-based systems on the outside of the bone; selection depends on fracture pattern and surgeon preference.

5) Immediate checks after treatment

Post-treatment imaging to confirm alignment and hardware position (when surgery is performed)
Monitoring for bleeding, blood pressure changes, and pain control needs
Early mobility assessment and initiation of rehabilitation planning

6) Follow-up and recovery monitoring

Repeat assessments to monitor healing, function, and potential complications
Physical therapy progression and mobility support planning
Evaluation of contributing factors such as bone health and fall risk; specifics vary by clinician and case

Types / variations

Clinicians describe bilateral intertrochanteric fractures using pattern-based terms that help communicate stability and plan fixation. Common variations include:

Stable vs unstable patterns: Stability is based on how the fracture is expected to behave under load and how much structural support is lost.
Comminuted fractures: The bone is broken into multiple pieces, often increasing instability.
Displaced vs minimally displaced: Displacement refers to how far fragments have shifted from their normal alignment.
Reverse obliquity patterns: A specific fracture line orientation that can behave differently under weight-bearing and may influence fixation choice.
With subtrochanteric extension: The fracture line extends below the trochanters into the upper femoral shaft region.
Open vs closed fractures: “Open” means the fracture communicates with the outside through a wound; this is less common in low-energy hip fractures but can occur in high-energy trauma.
Traumatic vs fragility fractures: Traumatic (high-energy) injuries differ in associated injuries and patient profile compared with fragility (low-energy) fractures.
Associated injuries: In bilateral cases, clinicians may also look for concurrent pelvic fractures, spine injuries, or upper extremity fractures from the same fall or collision.

Pros and cons

Because this is a diagnosis rather than a treatment, the “pros and cons” are best understood as the advantages and drawbacks of recognizing and classifying the injury accurately and managing it through standard orthopedic pathways.

Pros

Enables clear communication of fracture location and expected biomechanical issues
Helps guide imaging choices and whether additional studies are needed
Supports faster coordination between emergency care, orthopedics, anesthesia, and rehabilitation teams
Improves planning for mobility needs because both hips are affected
Helps anticipate fixation options based on stability and fracture pattern
Standard terminology supports consistent documentation and follow-up comparisons

Cons

The term alone does not capture all factors that affect outcomes (bone quality, comorbidities, other injuries)
Bilateral involvement often increases complexity in rehabilitation planning and care logistics
Classification can vary with imaging quality and clinician interpretation
“Intertrochanteric” can be confused with nearby fracture types, which may have different treatment considerations
Recovery expectations are less straightforward than with a single-sided fracture
Complication risks depend on many variables and cannot be predicted from the term alone

Aftercare & longevity

Aftercare following a bilateral intertrochanteric fracture focuses on supporting healing, restoring mobility, and reducing the chance of complications. Because this is informational only, details such as exact activity level, weight-bearing status, and therapy progression are determined by the treating team and vary by clinician and case.

Factors that often affect recovery course and longer-term function include:

Fracture pattern and stability: More complex or unstable patterns may require more protective rehabilitation strategies.
Fixation choice and surgical goals: Hardware type and construct strategy influence permitted activity and follow-up imaging needs; device performance can vary by material and manufacturer.
Bone quality: Lower bone density can affect fixation purchase and fracture healing dynamics.
Bilateral involvement: With both sides injured, mobility aids, transfers, and self-care planning are typically more demanding.
Comorbidities: Conditions such as anemia, diabetes, kidney disease, or cardiopulmonary disease can influence overall recovery tolerance and complication risk.
Pain control and sleep: Comfort and the ability to participate in rehabilitation can affect progress.
Rehabilitation participation: Consistency with therapy and safe mobility practice often matters, while specifics depend on the care plan.
Nutrition and general health: Overall health status can influence healing capacity.
Follow-up schedule and imaging: Monitoring can detect alignment changes, delayed healing, or hardware issues early.

“Longevity” in this context generally refers to the durability of the outcome—maintaining function and avoiding re-injury or hardware-related problems—rather than a fixed time period. Long-term results depend on fracture healing quality, alignment, muscle strength recovery, and fall-risk environment, among other variables.

Alternatives / comparisons

A bilateral intertrochanteric fracture is a serious structural injury, so “alternatives” usually refer to different management strategies rather than replacing the diagnosis itself. Options can differ depending on stability, patient health, and goals of care, and they vary by clinician and case.

Common comparisons include:

Surgical fixation vs nonoperative management:
Surgical fixation is commonly used to stabilize the fracture and support mobilization.
Nonoperative approaches may be considered in select situations (for example, when surgery is not feasible due to medical factors), but they may involve prolonged immobility and different risk tradeoffs.
Intramedullary fixation vs plate-based fixation:
Intramedullary nails are placed within the femur’s canal and are often used for many intertrochanteric patterns.
Sliding hip screw/plate constructs are external devices that can be appropriate for some patterns.
Choice depends on fracture anatomy, surgeon preference, and patient factors.
Single-stage bilateral surgery vs staged procedures:
Some patients may have both sides addressed during one operative session, while others may undergo staged treatment.
This depends on medical stability, injury complexity, and perioperative considerations.
X-ray vs CT (imaging comparison):
X-rays are the first-line tool for identifying and classifying many hip fractures.
CT may be used when the fracture pattern is complex, subtle, or when surgical planning requires more detail.

Bilateral intertrochanteric fracture Common questions (FAQ)

Q: Is a bilateral intertrochanteric fracture the same as a “broken hip”?
It is a type of “broken hip,” but “broken hip” is a broad phrase. Intertrochanteric fractures occur just below the femoral neck, between the trochanters. “Bilateral” means both hips are involved.

Q: What does intertrochanteric mean in simple terms?
It refers to the part of the upper femur between two bony bumps called the greater and lesser trochanters. These bumps are important because several strong hip muscles attach there. That muscle pull can influence how the fracture shifts.

Q: How is it diagnosed?
Diagnosis typically starts with symptoms, exam, and X-rays of the hips and femurs. Additional imaging may be used if the fracture pattern is unclear or complex. The final classification may be refined after reviewing full imaging and clinical context.

Q: Does it always require surgery?
Many intertrochanteric fractures are treated with surgical stabilization, but “always” is not accurate. Decisions depend on medical fitness, fracture stability, functional goals, and overall risk assessment. The best approach varies by clinician and case.

Q: How painful is it, and how long does pain last?
Pain is usually significant at the time of injury and commonly limits standing and walking. Pain typically changes over time with stabilization, healing, and rehabilitation, but the timeline varies. Factors include fracture severity, associated injuries, and individual pain sensitivity.

Q: How long does recovery take?
Recovery is highly individual and depends on fracture pattern, treatment type, rehabilitation participation, and baseline health. Bilateral involvement can make early mobility more challenging than a one-sided fracture. Clinicians often describe recovery in phases rather than a single fixed endpoint.

Q: Will I be allowed to put weight on my legs right away?
Weight-bearing status depends on fracture stability, fixation construct (if used), bone quality, and surgeon preference. Some patients may be allowed earlier weight-bearing than others, and some may need restrictions. This varies by clinician and case.

Q: When can someone drive or return to work after this injury?
Driving and work timelines depend on pain control, ability to sit and move safely, reaction time, medication effects, and functional strength. Job demands matter—desk work differs from manual labor. Clearance criteria vary by clinician and local regulations.

Q: What is the cost range for evaluation and treatment?
Costs can range widely due to factors such as emergency care, imaging, hospitalization length, surgical implants, rehabilitation setting, and insurance coverage. Bilateral injuries may involve more resources than unilateral injuries. Exact costs vary by region, facility, and payer.

Q: Are there long-term issues after healing?
Some people return close to baseline function, while others have persistent stiffness, weakness, gait changes, or need ongoing mobility support. Long-term outcomes relate to healing alignment, muscle recovery, and general health factors such as bone strength. Risks and expected function vary by clinician and case.