Trochanteric femur fracture: Difference between revisions
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*Lesser trochanter | *Lesser trochanter | ||
**Avulsion due to forceful contraction of iliopsoas (adolescents) or pathologic bone | **Avulsion due to forceful contraction of iliopsoas (adolescents) or pathologic bone | ||
{{Femur fracture types}} | |||
==Clinical Features== | ==Clinical Features== | ||
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{ | {{Hip pain DDX}} | ||
==Evaluation== | ==Evaluation== | ||
Latest revision as of 19:40, 22 October 2020
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
Femur Fracture Types
Proximal
- Intracapsular
- Extracapsular
Shaft
- Mid-shaft femur fracture (all subtrochanteric)
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
Hip pain
Acute Trauma
- Femur fracture
- Proximal
- Intracapsular
- Extracapsular
- Shaft
- Mid-shaft femur fracture (all subtrochanteric)
- Proximal
- Hip dislocation
- Pelvic fractures
Chronic/Atraumatic
- Hip bursitis
- Psoas abscess
- Piriformis syndrome
- Meralgia paresthetica
- Septic arthritis
- Obturator nerve entrapment
- Avascular necrosis of hip
Evaluation
- 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
Specific Managment
Disposition
- Outpatient
- Non-weight bearing with ortho follow up in 1-2 weeks (for both types)