What is Greater Trochanter Fracture?
Intertrochanteric fractures are proximal femoral extracapsular fractures that take place between the lesser and greater trochanters. The intertrochanteric aspect of the femur is formed of thick trabecular bone and is situated between the lesser and greater trochanters. The greater trochanter is the point of origin for the vastus lateralis muscle and also acts as an insertion site for the gluteus medius, obturator internus, gluteus minimus, and piriformis muscles.
Greater trochanteric fractures are typically caused by the forceful contraction of a muscle in a fixed limb, which typically occurs in youthful, physically active individuals. Direct trauma is another factor that can contribute to it. Trochanteric fractures include greater trochanteric fractures as a subgroup. The attachment points for many muscles are located on the trochanters, which are anatomical sections of the femur.
Greater trochanteric fractures are classified as follows:
- Non-isolated fractures.
- Isolated fractures.
Isolated greater trochanteric fractures, also known as IGTFs, are a rare subtype of hip fracture. There are very few orthopedic studies on IGTFs that can be found in the medical literature, and only a small portion of textbooks discuss their demographics as well as the protocols for their treatment. Hip fractures are a well-known and serious issue for public health. Hip fractures require immediate orthopedic treatment, but they can have long-term rehabilitative, social, medical, and mental consequences that affect healthcare economics.
Non-isolated greater trochanteric fractures are those that include the greater trochanter, a noticeable bony protrusion on the top of the femur (thigh bone), in addition to other nearby bones. These fractures involve the greater trochanter and adjacent structures.
Imaging methods like X-rays, CT scans, and MRI are frequently used to assess non-isolated greater trochanteric fractures. Treatment depends on the fracture, accompanying injuries, and the patient’s condition. Pain management, cast or brace immobilization, and physical therapy can be used in non-surgical treatment.
Greater Trochanter Fracture Treatment
Following are some of the methods used to treat greater trochanter fractures:
- Surgery is the treatment of choice for a greater trochanter fracture if the bone pieces have been displaced more than 1 cm. In most cases, surgery entails realigning bone fragments using wires under tension, as well as painkillers, and other drugs to speed recuperation and surgical procedures.
- Treatment for fractures involving less than 1 cm of displacement includes the use of crutches, bed rest, to promote healing, and physical therapy to help the hips restore their normal function.
- Large portions of the afflicted bone are removed through surgery if the fracture is brought on by a tumor. Chemotherapy and radiation treatment can also be used.
Greater Trochanter Fracture Management
Greater trochanteric fractures in elderly individuals are typically the result of direct impact from accidents. Greater trochanter fractures that spread into the intertrochanteric region can be surgically treated like nondisplaced intertrochanteric fractures. MR is useful for determining whether or not a greater trochanteric fracture extends into the trochanteric region.
Operative management for these fractures is deemed urgent rather than emergent. This enables preoperative optimization of the numerous comorbidities that patients frequently present with, thereby reducing morbidity and mortality. Sliding hip screws or intramedullary hip screws are used to repair these fractures surgically, while arthroplasty is reserved for severe cases. Sliding hip screws can be used if a patient has a stable fracture pattern and an intact lateral wall. This technique offers results comparable to intramedullary nailing when performed for a proper fracture pattern.
Greater Trochanter Fracture Rehabilitation
The majority of trochanteric fractures are self-limiting, and if the displacement is less than 1 cm, they can be treated non-operatively. But the patient must wait up to a month before putting any weight on the injured limb. It can take many people up to three months to resume their regular physical activities. Isolated trochanteric fractures often only cause a mild reduction of abduction force and rarely cause any other complications.