Hip Pelvis.  2016 Jun;28(2):112-119. 10.5371/hp.2016.28.2.112.

Occult Intertrochanteric Fracture Mimicking the Fracture of Greater Trochanter

• Chung PH
• Kang S
• Kim JP
• Kim YS
• Lee HM
• Back IH
• Eom KS

• KMID: 2328347
• DOI: http://doi.org/10.5371/hp.2016.28.2.112

Abstract

PURPOSE
Occult intertrochanteric fractures are misdiagnosed as isolated greater trochanteric fractures in some cases. We investigated the utility of three-dimensional computed tomography (3D-CT) and magnetic resonance imaging (MRI) in the diagnosis and outcome management of occult intertrochanteric fractures.
MATERIALS AND METHODS
This study involved 23 cases of greater trochanteric fractures as diagnosed using plain radiographs from January 2004 to July 2013. Until January 2008, 9 cases were examined with 3D-CT only, while 14 cases were screened with both 3D-CT and MRI scans. We analyzed diagnostic accuracy and treatment results following 3D-CT and MRI scanning.
RESULTS
Nine cases that underwent 3D-CT only were diagnosed with isolated greater trochanteric fractures without occult intertrochanteric fractures. Of these, a patient with displacement received surgical treatment. Of the 14 patients screened using both CT and MRI, 13 were diagnosed with occult intertrochanteric fractures. Of these, 11 were treated with surgical intervention and 2 with conservative management.
CONCLUSION
Three-dimensional CT has very low diagnostic accuracy in diagnosing occult intertrochanteric fractures. For this reason, MRI is recommended to confirm a suspected occult intertrochanteric fracture and to determine the most appropriate mode of treatment.

Keyword

Femur; Occult fracture; Intertrochanteric fracture; Magnetic resonance imaging; Computed tomography

MeSH Terms

Diagnosis
Femur*
Fractures, Closed
Hip Fractures
Humans
Magnetic Resonance Imaging

Figure

• 

  Fig. 1 A 91-year-old woman who presented with right hip pain after fall down. (A) Initial radiograph shows isolated greater trochanteric fracture. (B) Three-dimensional computed tomography shows no occult intertrochanteric fracture. (C) At 9 days after trauma, the radiography shows a displaced intertrochanteric fracture. (D) The postoperative radiograph shows fixation with compressive hip screw.

• 

  Fig. 2 A 68-years-old woman who presented with left hip pain after fall down. (A) Initial radiograph shows isolated greater trochanteric fracture. (B) Three-dimensional computed tomography shows no occult intertrochanteric fracture. (C) Coronal T1-weighted MRI revealed a fracture from the greater trochanter leading toward the lesser trochanter. (D) The postoperative radiograph shows fixation with compressive hip screw.

• 

  Fig. 3 Summary of diagnosis and treatment. CT: computed tomography, MRI: magnetic resonance imaging, ITC: intertrochanter, Fx.: fracture, GT: greater trochanter.

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