Trochanteric femur fracture: Difference between revisions

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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 follow up 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

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

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

Specific Managment

Disposition

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

See Also

External Links

References