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 fractures

Proximal

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

Shaft

Mid-shaft femur fracture (all subtrochanteric)

Evaluation

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

Specific Managment

Disposition

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

See Also

Femur fracture

External Links

References

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