Case report 808: Avulsion fracture of the greater trochanter

The incidence and management of Isolated Greater Trochanteric Fractures - A systematic review of 166 cases

BACKGROUND

Isolated fractures of the greater trochanter are unusual injuries with a wide spectrum of presentation, investigations and management strategies.

AIMS

The objective of this study was to evaluate the incidence and treatment protocols used in the management of Isolated Greater Trochanteric Fractures (IGTF).

METHODS

A systematic literature review of the PubMed and Central Register of Controlled Trials (Cochrane) databases by using the search term 'greater trochanter fracture and hip fracture' was conducted for Randomised Controlled Trials (RCT's), including prospective and retrospective non-experimental studies.

RESULTS

The search yielded 15 studies meeting our inclusion criteria encompassing 166 patients with Isolated Greater Trochanteric Fractures (IGTF). Most of the reports were observational studies due to paucity of coverage on this topic in literature. Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) were the common modalities used to diagnose these injuries. Most of the patients were managed with non-operative methods.

CONCLUSION

This systematic review analyses the consensus of treatment of IGTF based on evidence-based practice. When the IGTF is identified, the majority of studies advocate conservative management to surgery for such cases. Furthermore, large cohort studies with clearly documented outcome follow up are required to establish objective treatment guidelines for IGTF.

Treatment strategy for elderly patients with the isolated greater trochanteric fracture

Background:

The objective of this study was to evaluate the risk of femur intertrochanteric fracture associated with femur trochanter major fractures in patients over 65 years of age with magnetic resonance examination for better diagnosis and treatment.

Methods:

Thirty-one patients who had incomplete femur intertrochanteric fracture diagnosed were included in the study. Patients were classified according to the length of the fracture line crossing the intertrochanteric border. Fracture patterns were described on magnetic resonance imaging coronal views. Group A, pattern 1, greater trochanteric fracture extends to intertrochanteric region with both cortices; Group B, pattern 2, fracture has characteristics of pattern 1 fracture including diametaphysis fracture line; Group C, pattern 3, greater trochanteric fracture only has extending superolateral cortex fracture line of intertrochanteric region; and Group D, pattern 4, fracture has characteristics of pattern 1 fracture and including superior extension to the baso-cervical line. Surgical treatment with dynamic hip screw was applied to all patients with intertrochanteric extension after magnetic resonance examination.

Results:

This study included 16 women (80.3 ± 6.7 years) and 15 men (76.9 ± 10.94 years). Group A had 11 patients, group B had 8 patients, group C had 6 patients, and group D had 6 patients. Ambulation was initially prescribed for these patients 1 day after the surgery. The average surgery durations of the A, B, C, and D patterns were 44.54 ± 7.56, 49.37 ± 12.65, 49.16 ± 3.76, and 44.16 ± 5.84 min, respectively. No statistically significant differences were observed among the four patterns (P = 0.404).

Conclusion:

Surgical treatment of the greater trochanteric fracture which is considered an indicator of occult intertrochanteric fracture is a good choice for the treatment because of the procedure safety and early mobilization after the surgery

MRI of Seemingly Isolated Greater Trochanteric Fractures

OBJECTIVE

The objective of this article is to show that greater trochanteric fractures commonly perceived on routine radiographs as isolated are often neither isolated nor minor and that MR images can serve as a basis for more informed treatment by revealing the actual extent of such fractures in acute posttraumatic settings.

CONCLUSION

A pitfall in diagnosing seemingly isolated greater trochanteric fractures on routinely used imaging techniques lies in the fact that the injuries usually involve a large anatomic area. In our experience, MRI more accurately defines the true geographic extent of greater trochanteric fractures sustained through acute trauma than do radiography and bone scintigraphy and thus could provide a more reliable basis for anticipating complications and for planning appropriate treatment.