Difference between revisions of "Trochanteric femur fracture"

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==Background==
 
==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}}
  
 
==Clinical Features==
 
==Clinical Features==
 
*'''Greater Trochanter'''
 
*'''Greater Trochanter'''
**Via direct trauma (older patients) or avulsion injury (adolescents)
+
**[[Hip pain]] that increases with abduction; tenderness over greater trochanter
**Hip pain that increases with abduction; tenderness over greater trochanter
 
 
*'''Lesser Trochanter'''
 
*'''Lesser Trochanter'''
**Via avulsion due to forceful contraction of iliopsoas (adolescents) or pathologic bone
+
**Patients usually ambulatory
**Pts are usually ambulatory; c/o pain in groin worse w/ flexion  
+
**Pain in groin worse with flexion, or patient has difficulty lifting leg at hip from seated position (iliopsoas insufficiency)
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
{{Femur fracture types}}
+
{{Hip pain DDX}}
  
==Diagnosis==
+
==Evaluation==
 
{{Proximal femur fracture diagnosis}}
 
{{Proximal femur fracture diagnosis}}
  
 
==Management==
 
==Management==
*Treatment for both types:
+
{{General Fracture Management}}
**Non-weight bearing with ortho f/u in 1-2wk
+
 
 +
===Specific Managment===
  
 
==Disposition==
 
==Disposition==
 
*Outpatient
 
*Outpatient
 +
**Non-weight bearing with ortho follow up in 1-2 weeks (for both types)
  
 
==See Also==
 
==See Also==

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

Anterior view.
Posterior view.

Proximal

Shaft

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

Chronic/Atraumatic

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

Specific Managment

Disposition

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

See Also

External Links

References