Isolated greater trochanteric fracture

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Greater trochanteric fractures generally result from forceful muscle contraction of a fixed limb, which usually occurs in those who are young and physically active. It can also be caused by direct trauma.

Epidemiology

Generally, isolated trochanteric fractures are seen more so in young, active males, usually between the ages of 14-25. 85% of mild trochanteric avulsion fractures occur in patients less than 20 years of age. In the elderly, trochanteric fractures are usually due to direct trauma such as a fall.

Clinical presentation

Patients will present with pain especially in the anatomical position of the greater trochanter, especially on abduction and extension, which is exacerbated on palpation.

Pathology

Classification

Greater trochanteric fractures are a subset of trochanteric fractures. The trochanters are anatomical portions of the femur which serve as the attachment sites for several muscles. The greater trochanter is the bony prominence on the lateral aspect of the femur and is the insertion site for the hip abductors and external rotators.

Greater trochanteric fractures can be classified into:

  • isolated fractures
  • non-isolated fractures
Mechanism

Most commonly due to:

  • avulsion type fracture: forced muscle contraction of the hip abductors and external rotators, usually due to physical activity
  • direct trauma of the greater trochanter e.g. due to a fall onto the lateral hip

Radiograph features

Plain radiograph

Anterior - posterior (AP) and lateral or oblique radiographs are usually sufficient for diagnosis. They generally show an apophyseal avulsion fracture of the greater trochanter.

Treatment and prognosis

Most trochanteric fractures are self-limiting and can be treated without surgical intervention if the displacement is less than 1 cm. However, the patient must not bear weight on the affected leg for up to a month. Many patients may take up to 3 months to return to normal physical activity.

Complications of isolate trochanteric fractures are quite rare, usually manifesting as a slight loss of abduction force.