Isolated greater trochanter fractures

Isolated greater trochanter fractures

Authors

Keywords:

avulsion, greater trochanter, hip trauma, hip fracture, medius gluteus

Abstract

Introduction: Isolated fractures of the greater trochanter (GT) in adults are rare injuries and traditionally treated without surgery. The present systematic review was designed to examine the treatment protocol for isolated GT fractures and to discover if innovative surgical techniques, such as arthroscopy or suture anchors, can be used to improve outcomes in young active patients.

Methods: A systematic review was conducted including all full-text articles suited our inclusion criteria from January 2000 describing treatment protocols of isolated great trochanter fractures confirmed at MRI in adults.

Results: The searches identified a total of 247 patients from 20 studies with a mean age 56.1 years and mean follow-up 13,7 months. Only 4 case report treated 4 patients with not unique surgical strategy. The rest of the patients were treated conservatively.

Discussion: Most trochanteric fractures can heal without surgical intervention with good results However, the patient must not immediately bear full weight and the abductor’s function could decrease. Displaced GT fragments more than 2 cm or athletes, young, demanding patients may benefit from surgical fixation to regain abductor function and strength. Evidence-based surgical strategies could be provided by arthroplasty and periprosthetic literature.

Conclusion: The grade of fracture displacement and the physical demands of the athlete can be important factors in the decision process for or against surgery. By now, no evidence-based guideline exists for the ideal treatment method in demanding patients. It is necessary use a “patient-specific” treatment strategy. 

References

Kim, S.-J., Ahn, J., Kim, H. K. & Kim, J. H. Is magnetic resonance imaging necessary in isolated greater trochanter fracture? A systemic review and pooled analysis. BMC Musculoskelet. Disord. 16, 395 (2015).

Arshad, R., Riaz, O., Aqil, A., Bhuskute, N. & Ankarath, S. Predicting intertrochanteric extension of greater trochanter fractures of the hip on plain radiographs. Injury 48, 692–694 (2017).

Park, J. H. et al. How can MRI change the treatment strategy in apparently isolated greater trochanteric fracture? Injury 49, 824–828 (2018).

Ren, H. et al. Does isolated greater trochanter implication affect hip abducent strength and functions in intertrochanteric fracture? BMC Musculoskelet. Disord. 20, 79 (2019).

Saad, A., Iyengar, K. P., Vaishya, R. & Botchu, R. The incidence and management of Isolated Greater Trochanteric Fractures – A systematic review of 166 cases. J. Clin. Orthop. Trauma 21, 101537 (2021).

Prommik, P. et al. Isolated greater trochanter fracture may impose a comparable risk on older patients’ survival as a conventional hip fracture: a population-wide cohort study. BMC Musculoskelet. Disord. 23, 394 (2022).

Yang, J.-H., Pandher, D. S. & Oh, K.-J. Fracture of the Greater Trochanter during Closed Reduction of Obturator Type Hip Dislocation. Hip Pelvis 26, 275 (2014).

Lachiewicz, P. F. Abductor tendon tears of the hip: evaluation and management. J. Am. Acad. Orthop. Surg. 19, 385–391 (2011).

Sanderson, B., Washburn, F. & Allison, D. Triple Surgical Fixation Technique for an Isolated Greater Trochanter Fracture in an Amateur Weightlifter. JAAOS Glob. Res. Rev. 6, (2022).

HSc, B. L. B. Immediate Weight-bearing in Suspected Isolated Greater Trochanter Fractures as Delineated on MRI. 4.

Kambali, M. et al. Simultaneous bilateral isolated greater trochanter fracture. J. Orthop. Allied Sci. 1, 47 (2013).

Theerachai apivatthakakul, Jong-Keon Oh. AO surgery reference - Management of Fracture. https://surgeryreference.aofoundation.org/orthopedic-trauma/adult-trauma/proximal-femur/trochanteric-fracture-isolated-single-trochanteric/tension-band-wiring.

Busato, T. S. et al. Traumatic Avulsion of Gluteus Tendons Associated With Posterior Fracture-dislocation of the Femoral Head: A Case Report. JBJS Case Connect. 10, e19.00531-e19.00531 (2020).

Pritchett, J. W. Fracture of the greater trochanter after hip replacement. Clin. Orthop. 221–226 (2001) doi:10.1097/00003086-200109000-00025.

DeFroda, S., Silverman, A., Quinn, M. & Tabaddor, R. Mini-open double row gluteus medius repair provides good short-term functional outcomes. J. Hip Preserv. Surg. hnz038 (2019) doi:10.1093/jhps/hnz038.

Kenanidis, E., Kyriakopoulos, G., Kaila, R. & Christofilopoulos, P. Lesions of the abductors in the hip. EFORT Open Rev. 5, 464–476 (2020).

Hamadouche, M., Zniber, B., Dumaine, V., Kerboull, M. & Courpied, J. P. Reattachment of the ununited greater trochanter following total hip arthroplasty. The use of a trochanteric claw plate. J. Bone Joint Surg. Am. 85, 1330–1337 (2003).

Tang, J., Wu, T., Shao, H. & Zhou, Y. Greater trochanter fixed with a claw plate and cable system in complex primary and revision total hip arthroplasty: long-term follow-up. Int. Orthop. (2022) doi:10.1007/s00264-022-05538-3.

Kim, I.-S. et al. Greater Trochanteric Reattachment Using the Third-Generation Cable Plate System in Revision Total Hip Arthroplasty. J. Arthroplasty 32, 1965–1969 (2017).

Walsh, M. J., Walton, J. R. & Walsh, N. A. Surgical repair of the gluteal tendons: a report of 72 cases. J. Arthroplasty 26, 1514–1519 (2011).

Omura, T. et al. Evaluation of isolated fractures of the greater trochanter with magnetic resonance imaging. Arch. Orthop. Trauma Surg. 120, 195–197 (2000).

Craig, J. G., Moed, B. R., Eyler, W. R. & van Holsbeeck, M. Fractures of the greater trochanter: intertrochanteric extension shown by MR imaging. Skeletal Radiol. 29, 572–576 (2000).

Feldman, F. & Staron, R. B. MRI of Seemingly Isolated Greater Trochanteric Fractures. Am. J. Roentgenol. 183, 323–329 (2004).

Lee, K.-H. et al. Isolated fractures of the greater trochanter with occult intertrochanteric extension. Arch Orthop Trauma Surg 6 (2010).

Department of Radiology, Tuen Mun Hospital, Tuen Mun, Hong Kong et al. Occult Intertrochanteric Extension in Isolated Greater Trochanteric Fracture on Plain Radiographs. Hong Kong J. Radiol. 28–34 (2016) doi:10.12809/hkjr1615331.

Kim, S. J., Park, B. M., Yang, K. H. & Kim, D. Y. Isolated fractures of the greater trochanter. Report of 6 cases. Yonsei Med. J. 29, 379–383 (1988).

Chung, P. H. et al. Occult Intertrochanteric Fracture Mimicking the Fracture of Greater Trochanter. Hip Pelvis 28, 112 (2016).

Moon, N. H. et al. Diagnostic strategy for elderly patients with isolated greater trochanter fractures on plain radiographs. BMC Musculoskelet. Disord. 19, 256 (2018).

Noh, J., Lee, K. H., Jung, S. & Hwang, S. The Frequency of Occult Intertrochanteric Fractures among Individuals with Isolated Greater Trochanteric Fractures. Hip Pelvis 31, 23 (2019).

G, M., M, B., N, B. & G, M. Isolated Apophyseal Avulsion of the Greater Trochanter Treated by Minimally Invasive Osteosynthesis: A Case Report. Malays. Orthop. J. 14, 177–179 (2020).

Downloads

Published

23-06-2023

How to Cite

1.
Isolated greater trochanter fractures. Acta Biomed [Internet]. 2023 Jun. 23 [cited 2024 May 25];94(S2):e2023094. Available from: https://mattioli1885journals.com/index.php/actabiomedica/article/view/13815

Most read articles by the same author(s)

1 2 3 > >>