Archives of Orthopaedic and Trauma Surgery

, Volume 130, Issue 10, pp 1275–1280 | Cite as

Isolated fractures of the greater trochanter with occult intertrochanteric extension

  • Kee-Haeng Lee
  • Hyoung-Min Kim
  • Youn-Soo Kim
  • Changhoon Jeong
  • Chan-Woong Moon
  • Sang-Uk Lee
  • Il-Jung Park
Trauma Surgery

Abstract

Introduction

Isolated fractures of the greater trochanter (GT) are relatively rare. The diagnosis can be done on routine radiographs, but it is difficult to fully define the geographic extent of these injuries. This study examined the pattern and extent of an injury shown by magnetic resonance imaging (MRI) and radionuclide bone scan (RBS) in patients whose plain radiographs revealed fractures limited to the GT.

Materials and methods

Between July 2004 and October 2008, 25 patients who displayed an isolated GT fracture on plain radiograph examination were examined by both MRI and RBS due to a suspicion of an extension into the intertrochanteric (ITC) region. The patients were then divided into two groups. Group A patients had an isolated fracture of GT, and group B patients had an occult fracture of ITC.

Results

All 25 cases were caused by a low-energy injury and plain radiographs showed non-displaced or minimally displaced isolated GT fractures. For 22 of the 25 patients, the result agreed with MRI and RBS. However, three patients had focal increased uptake at the GT region only according to RBS and an extension of signal intensity into the ITC region according to MRI. Group A and B comprised 5 and 20 patients, respectively. Of the group B patients, 8 had fractures with MRI evidence of complete extension across the ITC region and 12 had incomplete extension. Eleven of the 12 incomplete types showed an extension more than half way to the medial cortex. Fifteen group B patients underwent an internal fixation using a two-hole dynamic hip screw.

Conclusion

Patients with an isolated fracture of GT can have a broader fracture extending into the ITC region than that diagnosed by standard radiographs. We recommend that all patients presenting with an isolated GT fracture on the plain radiographs should undergo MRI examination.

Keywords

Isolated fracture of the greater trochanter Magnetic resonance imaging Radionuclide bone scans Intertrochanteric fracture 

Notes

Acknowledgments

None of the authors received financial support for this study.

References

  1. 1.
    Armstrong GE (1907) Isolated fracture of the great trochanter. Ann Surg 46(2):292–297CrossRefPubMedGoogle Scholar
  2. 2.
    Blickenstaff LD, Morris JM (1966) Fatigue fracture of the femoral neck. J Bone Joint Surg Am 48(6):1031–1047PubMedGoogle Scholar
  3. 3.
    Craig JG, Moed BR, Eyler WR, van Holsbeeck M (2000) Fractures of the greater trochanter: intertrochanteric extension shown by MR imaging. Skeletal Radiol 29(10):572–576CrossRefPubMedGoogle Scholar
  4. 4.
    Deutsch AL, Mink JH, Waxman AD (1989) Occult fractures of the proximal femur: MR imaging. Radiology 170(1):113–116PubMedGoogle Scholar
  5. 5.
    Feldman F, Staron RB (2004) MRI of seemingly isolated greater trochanteric fractures. AJR Am J Roentgenol 183(2):323–329PubMedGoogle Scholar
  6. 6.
    Haramati N, Staron RB, Barax C, Feldman F (1994) Magnetic resonance imaging of occult fractures of the proximal femur. Skeletal Radiol 23(1):19–22CrossRefPubMedGoogle Scholar
  7. 7.
    Holder LE, Schwarz C, Wernicke PG, Michael RH (1990) Radionuclide bone imaging in the early detection of fractures of the proximal femur (hip): multifactorial analysis. Radiology 174(2):509–515PubMedGoogle Scholar
  8. 8.
    Kim SJ, Park BM, Yang KH, Kim DY (1988) Isolated fractures of the greater trochanter. Report of 6 cases. Yonsei Med J 29(4):379–383PubMedGoogle Scholar
  9. 9.
    Koval KJ, Zuckerman JD (1994) Functional recovery after fracture of the hip. J Bone Joint Surg Am 76(5):751–758PubMedGoogle Scholar
  10. 10.
    Matin P (1979) The appearance of bone scans following fractures, including immediate and long-term studies. J Nucl Med 20(12):1227–1231PubMedGoogle Scholar
  11. 11.
    Merlino AF, Nixon JE (1969) Isolated fractures of the greater trochanter. Report of twelve cases. Int Surg 52(2):117–124PubMedGoogle Scholar
  12. 12.
    Milch H (1939) Avulsion fracture of the great trochanter. Arch Surg 38:334–350Google Scholar
  13. 13.
    Omura T, Takahashi M, Koide Y, Ohishi T, Yamanashi A, Kushida K, Inoue T (2000) Evaluation of isolated fractures of the greater trochanter with magnetic resonance imaging. Arch Orthop Trauma Surg 120(3–4):195–197CrossRefPubMedGoogle Scholar
  14. 14.
    Ostrum RF, Chao EYS, Bassett CAL, Brighton CT, Einhorn TA, Lucas TS, Aro HT, Spector M (1994) Bone injury, regeneration and repair. In: Simon SR (ed) Orthopaedic basic science, 1st edn. American Academy of Orthopaedic Surgeons, Rosemont, pp 277–323Google Scholar
  15. 15.
    Quinn SF, McCarthy JL (1993) Prospective evaluation of patients with suspected hip fracture and indeterminate radiographs: use of T1-weighted MR images. Radiology 187(2):469–471PubMedGoogle Scholar
  16. 16.
    Rizzo PF, Gould ES, Lyden JP, Asnis SE (1993) Diagnosis of occult fractures about the hip magnetic resonance imaging compared with bone-scanning. J Bone Joint Surg Am 75(3):395–401PubMedGoogle Scholar
  17. 17.
    Schultz E, Miller TT, Boruchov SD, Schmell EB, Toledano B (1999) Incomplete intertrochanteric fractures: imaging features and clinical management. Radiology 211(1):237–240PubMedGoogle Scholar
  18. 18.
    Thienhaus CO (1906) Epiphyseal separation of the great trochanter with report of a case. Ann Surg 43(5):753–757CrossRefPubMedGoogle Scholar
  19. 19.
    Zuckerman JD (1996) Hip fracture. N Engl J Med 334(23):1519–1525CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Kee-Haeng Lee
    • 1
  • Hyoung-Min Kim
    • 1
  • Youn-Soo Kim
    • 1
  • Changhoon Jeong
    • 1
  • Chan-Woong Moon
    • 1
  • Sang-Uk Lee
    • 1
  • Il-Jung Park
    • 1
  1. 1.Department of Orthopedic SurgeryBucheon St. Mary’s Hospital, The Catholic University of KoreaBucheonKorea

Personalised recommendations