Greater trochanteric fractures with lntertrochanteric extension identified on MRI: What is the rate of displacement when treated nonoperatively? (original) (raw)
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Background: Isolated fractures of the greater trochanter are unusual injuries with a wide spectrum of presentation, investigations and management strategies. Aims: The objective of this study was to evaluate the incidence and treatment protocols used in the management of Isolated Greater Trochanteric Fractures (IGTF). Methods: A systematic literature review of the PubMed and Central Register of Controlled Trials (Cochrane) databases by using the search term 'greater trochanter fracture and hip fracture' was conducted for Randomised Controlled Trials (RCT's), including prospective and retrospective nonexperimental studies. Results: The search yielded 15 studies meeting our inclusion criteria encompassing 166 patients with Isolated Greater Trochanteric Fractures (IGTF). Most of the reports were observational studies due to paucity of coverage on this topic in literature. Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) were the common modalities used to diagnose these injuries. Most of the patients were managed with non-operative methods. Conclusion: This systematic review analyses the consensus of treatment of IGTF based on evidence-based practice. When the IGTF is identified, the majority of studies advocate conservative management to surgery for such cases. Furthermore, large cohort studies with clearly documented outcome follow up are required to establish objective treatment guidelines for IGTF.
Archives of Orthopaedic and Trauma Surgery, 2016
Introduction The clinical relevance of classification for trochanteric fractures is limited and little agreement exists on what type of implant should be used. It is unknown whether more advanced radio-diagnostics, such as CT, result in better agreement on the treatment. We assessed the effect of CT on agreement of classification and subsequent treatment for trochanteric fractures. Materials and methods Eleven observers (five radiologists, four trauma surgeons and two orthopedic residents) assessed 30 radiographs and CTs of trochanteric fractures. Each rating included an assessment according to the AO classification and of the preferred type of implant. The inter-observer agreement of the AO classification and on the choice of implant was calculated. Results The inter-observer agreement was j0.70 (SE 0.03) for radiographic assessment of the main groups of the AO classification and j0.68 (SE 0.03) for CT assessment. The agreement on choice of implant was j0.63 (SE 0.05) if the choice was made with radiographs and j0.69 (SE 0.05) with CTs. Six out of the 13 fractures were classified differently after assessment of the CT. Most corrections in choice of implant occurred for the assessment of A3 fractures. Conclusions This study confirmed that trochanteric fractures can be reliably classified on both radiographs and CT, according to the main groups of the AO classification. The implementation of CT for trochanteric fractures does not lead to higher agreement on fracture classification or choice of treatment. Therefore, the clinical relevance of CT for classification of trochanteric fractures seems low. For specific subgroups such as A3 fractures, CT may be of value for adequate fracture classification and subsequent treatment strategies.
Treatment strategy for elderly patients with the isolated greater trochanteric fracture
SAGE Open Medicine, 2020
Background: The objective of this study was to evaluate the risk of femur intertrochanteric fracture associated with femur trochanter major fractures in patients over 65 years of age with magnetic resonance examination for better diagnosis and treatment. Methods: Thirty-one patients who had incomplete femur intertrochanteric fracture diagnosed were included in the study. Patients were classified according to the length of the fracture line crossing the intertrochanteric border. Fracture patterns were described on magnetic resonance imaging coronal views. Group A, pattern 1, greater trochanteric fracture extends to intertrochanteric region with both cortices; Group B, pattern 2, fracture has characteristics of pattern 1 fracture including diametaphysis fracture line; Group C, pattern 3, greater trochanteric fracture only has extending superolateral cortex fracture line of intertrochanteric region; and Group D, pattern 4, fracture has characteristics of pattern 1 fracture and includin...
Case report rare greater trochanter fracture
International Journal of Orthopaedics Sciences
Introduction: The Greater Trochanter fracture is a rare injury. It is of two types, True fracture which occurs only in Adults or as Epiphyseal separation which are found in adolescent population. It is caused by direct hit or fall muscular disruption displacement of trochanteric fracture is secondary to short external rotators with forceful abduction with leg in external rotation. Case report: In this case report, 26 year male presented with pain over hip with weakness in abduction and limping. On X ray it was greater trochanter fracture which was fixed with cancellous screw, the outcome was good. The patient reverted to his obvious activities with normal range of movement. Conclusion: The surgical minimally invasive treatment have better outcome with early mobilization, good range of hip movement especially abduction post operative in adult.
The Professional Medical Journal, 2019
Introduction: Hip fractures are a leading cause of death and disability among elderly. Approximately half of these injuries are intertrochanteric fractures and the incidence is continuously increasing. These fractures are the most common injuries around the hip region and are more common in elderly people. Different types of implants were tried at different times for internal fixation of these fractures, of which dynamic hip screw has remained the most popular one. But with the advent of some newer implants, the efficacy of dynamic hip screw is being questioned. Objectives: To determine the results of dynamic hip screw as a method of internal fixation in closed stable as well as unstable intertrochanteric fractures of femur in adults. Design: Descriptive case series. Setting: The study was conducted in orthopedic department Allied Hospital Faisalabad. Period: 11months (from 26th, march, 2015 to 25th Feb, 2016). Subjects and Methods: Sixty cases of intertrochanteric fractures were in...
Journal of Evolution of Medical and Dental Sciences
BACKGROUND Trochanteric fractures are devastating injuries that most commonly affect the elderly and also the young; they have tremendous impact on both the health care system, and society in general. 1 The mainstay of the treatment of intertrochanteric fractures is fixation with DHS, intramedullary device, and proximal locking compression plate. The aim of the present study was to compare the result in terms of rate of union, time of ambulation and functional recovery of fracture intertrochanteric femur treated by either dynamic hip screw (DHS), proximal femoral interlocking nail (PFN) or proximal locking compression plate (PFLCP). METHODS This was a prospective study of 62 patients, 20 patients were treated by PFN (Group A), 32 cases were treated by DHS (Group B) and 10 cases treated by PFLCP (Group C). All Patients were followed up at 1 month, 3 months, 6 months and 1 year. Results were compared for functional outcome by using Harris Hip Score. RESULTS Comparison of Harris hip score at 12-month-follow-up period revealed that PFN group to be significantly more mobile (PFN-94.8 vs. DHS-90.8 vs. PFLCP-89.3). p-Value for PFN vs. DHS group is 0.12, p value for PFN vs. PFLCP is 0.073 (>0.05) and p value for DHS vs. PFLCP is 1.00. All p values show insignificant difference in functional outcome of patients. It shows that most of patients achieved approximately same level of functional outcome at the end of one year. CONCLUSIONS PFN is a biomechanically good device for fixation of comminuted intertrochanteric fracture femur. PFN allows faster mobilization, early rehabilitation, lower implant failure rate, and faster union as compared to DHS and PFLCP. In our study, PFLCP seems to be feasible alternative to PFN and DHS in certain complex, unstable, comminuted trochanteric fractures when weight bearing was restricted till radiological signs of fractures healing are seen. HOW TO CITE THIS ARTICLE: Singh G, Gautam S, Ahmed N, et al. Evaluation of various methods of trochanteric fracture fixation and their comparison-a prospective study.
Outcomes of surgical management of per-trochanteric fractures: About 363 cases
The Journal of Orthopaedics Trauma Surgery and Related Research, 2019
Background: Per trochanteric fractures are undoubtedly the lesions most frequently encountered in traumatology, particularly in the elderly, where they retain a high mortality rate The aim of our study was to evaluate the functional and radiological results of the surgical management of per trochanteric fractures. Materials and methods: This was a retrospective study of 363 cases of per trochanteric fractures taken care of and followed from January 2012 to December 2016. The average age was 68.89 years (23-100 years) with 59.2% men and 40.8% women. 97.5% had support (protected or not) before trauma compared with 2.5% non-autonomous. The evolution of the consolidation and functional score of Parker and Palmer was evaluated at 1; 3; 6 and 12 months. Results: 99.2% consolidation at 3.8 months (3-8 months). The cervico-diaphyseal angle variation was 4.2° (0°17.2°) for the overall population (p=0.0057); 4.3° (0°-17.2°) for Gamma Nail (GN) And 4.2° (0°-17°) for Dynamic Hip Screw (DHS). 94...