Hip Pelvis.  2019 Mar;31(1):23-32. 10.5371/hp.2019.31.1.23.

The Frequency of Occult Intertrochanteric Fractures among Individuals with Isolated Greater Trochanteric Fractures

• Noh J
• Lee KH
• Jung S
• Hwang S

• KMID: 2448038
• DOI: http://doi.org/10.5371/hp.2019.31.1.23

Abstract

PURPOSE
Isolated greater trochanteric (GT) fractures are often identified using plain radiography of patients with post-traumatic hip pain. In many cases, the fracture extends to form an occult intertrochanteric fracture. We conducted a study to determine the frequency of occult intertrochanteric fractures in patients diagnosed with isolated GT fractures using plain radiographs.
MATERIALS AND METHODS
Among 3,017 individuals who visited our emergency department with a trauma-induced pertrochanteric femur fracture between July 2004 and March 2018, 100 patients diagnosed with isolated GT fractures using plain radiographs were retrospectively analyzed. Patients were divided into two groups, those with: i) isolated GT fractures (group A) and ii) occult intertrochanteric fractures (group B). In addition, plain radiographs, magnetic resonance imaging results, and treatment methods were further analyzed in each group. If surgery treatment was needed, it was performed by one surgeon, and in all cases, a 2-hole dynamic hip screw was used.
RESULTS
Among the 100 cases of isolated GT fractures diagnosed using plain radiograph, additional examinations revealed that 10 (10.0%) were suffering from isolated GT fractures alone, while the remaining 90 (90.0%) were further diagnosed with occult intertrochanteric fracture. Gender, age, mechanism of injury, and bone mineral density did not correlate with fracture type.
CONCLUSION
In our analysis, 90% of injuries initially diagnosed as isolated GT fractures were found to extend into occult intertrochanteric fractures upon further examination with additional imaging modalities. Therefore, additional evaluation should be performed to test for the potential presence of occult intertrochanteric fractures and to establish appropriate treatment plans.

Keyword

Trochanteric fractures; Hip fractures; Closed fractures

MeSH Terms

Bone Density
Emergency Service, Hospital
Femur*
Fractures, Closed
Hip
Hip Fractures*
Humans
Magnetic Resonance Imaging
Radiography
Retrospective Studies

Figure

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  Fig. 1 Flow chart demonstrating how cases were selected and analyzed.

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  Fig. 2 An 87-year-old woman visited the hospital with right hip pain caused by a fall from height. (A) Plain radiography indicated an isolated greater trochanteric fracture. (B, C) A bone scan also revealed an isolated greater trochanteric fracture. (D) However, magnetic resonance imaging scans indicated that the fracture was more than half of the intertrochanteric area. (E) Surgical treatment was performed using two-hole dynamic hip screws.W.B: whole body bone scan, ANT: anterior, POST: posterior.

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  Fig. 3 A 36-year-old male patient visited the hospital with left hip pain following a traffic accident. Plain radiography (A) and magnetic resonance imaging (B) each indicated an isolated greater trochanteric fracture, and conservative treatment was performed.

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  Fig. 4 An 89-year-old woman visited the hospital with right hip pain caused by a fall from height. (A) Plain radiography indicated an isolated greater trochanteric fracture. (B) Magnetic resonance imagingscans further revealed an occult intertrochanteric fracture; however, the fracture was limited to less than half of the intertrochanteric area. (C) Conservative treatment was performed.

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  Fig. 5 A 75-year-old male visited the hospital with left hip pain caused by a fall from height. (A) Plain radiography indicated an isolated greater trochanteric fracture. (B) Magnetic resonance imaging scans further revealed an occult intertrochanteric fracture that was more than half of the intertrochanteric area. (C) Surgical treatment was performed using two-hole dynamic hip screws.

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  Fig. 6 A 41-year-old male visited the hospital with left hip pain caused by a fall from height. (A) Plain radiography indicated an isolated greater trochanteric fracture. (B, C) Magnetic resonance imaging scans further revealed an occult intertrochanteric fracture extended to more than half of the intertrochanteric area and the base of the neck. (D) Surgical treatment was performed using two-hole dynamic hip screws.

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