Difference between revisions of "Trochanteric femur fracture"
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==Background== | ==Background== | ||
*Greater trochanter | *Greater trochanter | ||
| − | ** | + | **Caused by direct trauma (older patients) or avulsion injury (adolescents) |
*Lesser trochanter | *Lesser trochanter | ||
| − | ** | + | **Avulsion due to forceful contraction of iliopsoas (adolescents) or pathologic bone |
| + | |||
| + | {{Femur fracture types}} | ||
==Clinical Features== | ==Clinical Features== | ||
*'''Greater Trochanter''' | *'''Greater Trochanter''' | ||
| − | ** | + | **[[Hip pain]] that increases with abduction; tenderness over greater trochanter |
| − | |||
*'''Lesser 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== | ==Differential Diagnosis== | ||
| − | {{ | + | {{Hip pain DDX}} |
| − | == | + | ==Evaluation== |
{{Proximal femur fracture diagnosis}} | {{Proximal femur fracture diagnosis}} | ||
==Management== | ==Management== | ||
| − | + | {{General Fracture Management}} | |
| − | + | ||
| + | ===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
Contents
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)