Abstract
Background
Isolated fracture of the greater trochanter is an uncommon presentation of hip fracture. Traditional teaching has been to manage these injuries nonoperatively, but modern imaging techniques have made it possible to detect occult intertrochanteric extension of the fracture in up to 90% of cases.
This study aims to review the investigation and management of greater trochanter fractures in a single major trauma centre.
Methods
A retrospective review was completed of patients admitted with greater trochanter fractures. These were matched to cases with 2-part extracapsular fractures. Initial management and clinical outcome was established using electronic notes and radiographs. Mortality and length of stay was calculated for both groups.
Results
85 isolated greater trochanter fractures in 84 patients were identified from 2006–2017. 81/85 patients were treated non-operatively. 78 were mobilised full weight bearing. None required readmission or operation due to fracture displacement. 58 of these patients had cross-sectional imaging with MRI or CT and 15 of those scanned had intertrochanteric extension of the fracture. In the same time period, 998 2-part extra-capsular fractures were treated, using a sliding hip screw.
Length of stay was shorter in patients with greater trochanter fractures than 2-part extracapsular fractures (median 7 days vs 14 days, P<0.0001). 30-day mortality was 11.9%, with no significant difference to patients with 2-part extracapsular fractures.
Discussion
Cross sectional imaging rarely changed the treatment protocol for isolated greater trochanter fractures. The outcome following non-operative treatment is good even in the presence of occult fractures identified on CT or MRI. We advocate a treatment protocol that encourages early mobilisation and repeat plain radiographs if patients fail to progress. This will reduce unnecessary morbidity from fixation of stable occult fractures.
