Trochanteric femur fracture

Background

• Greater trochanter
  • Caused by direct trauma (older patients) or avulsion injury (adolescents)
• Lesser trochanter
  • Avulsion due to forceful contraction of iliopsoas (adolescents) or pathologic bone

Clinical Features

• Greater Trochanter
  • Hip pain that increases with abduction; tenderness over greater trochanter
• Lesser Trochanter
  • Patients usually ambulatory
  • Pain in groin worse with flexion, or patient has difficulty lifting leg at hip from seated position (iliopsoas insufficiency)

Differential Diagnosis

Femur Fracture Types

Proximal

• Intracapsular
  • Femoral head fracture
  • Femoral neck fracture
• Extracapsular
  • Intertrochanteric femur fracture
  • Trochanteric femur fracture

Shaft

• Mid-shaft femur fracture (all subtrochanteric)

Evaluation

Hip fracture classification.

Location of femur fractures

• Consider AP pelvis in addition to AP/lateral views to compare contralateral side
• Consider MRI if strong clinical suspicion but negative x-ray

Management

General Fracture Management

• Acute pain management
• Open fractures require immediate IV antibiotics and urgent surgical washout
• Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
• Consider risk for compartment syndrome

Disposition

• Outpatient
  • Non-weight bearing with ortho follow up in 1-2 weeks (for both types)

See Also

• Femur fracture