Occult fracture propagation in patients with isolated greater trochanteric fractures: patterns and management

To demonstrate the degrees of occult intertrochanteric extension on MRI in patients with a greater trochanteric fracture on radiography or computer tomography (CT) and whether these patients undergo conservative or surgical management with hardware.

Retrospective review was performed of 146 patients (104 females, 42 males, ages 33-102) who had follow-up MRI after identification of a greater trochanteric fracture without intertrochanteric extension on radiography or CT. Extent of intertrochanteric extension was recorded. Subsequently, EMR review was performed to see if patients underwent surgery. Specific note was made of hardware type. Analysis was performed to determine if there is a correlation with fracture type and surgical management as well as fracture type and age and gender.

Nineteen patients had horizontal greater trochanter fractures without intertrochanteric extension; none underwent surgery. Seventeen patients had a vertical fracture along the lateral femoral cortex; one underwent surgery. Thirty-three patients had a fracture with intertrochanteric extension less than 50% in the mid coronal plane; 21 underwent surgery. Forty patients had intertrochanteric extension greater than 50% in the midcoronal plane not contacting the medial cortex; 28 underwent surgery. Thirty-seven patients had fractures contacting the medial cortex; 28 underwent surgery. There was significant difference with fractures extending 50% or greater of the midline of the intertrochanteric region undergoing surgical management compared with fractures less than 50% (p < 0.0001).

MRI identifies the presence and extent of occult intertrochanteric fractures in patients with greater trochanteric fractures. Description of intertrochanteric fractures on MRI helps determine the patient's treatment course and influence surgical decisions.