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 Fracture Types
Proximal
- Intracapsular
- Extracapsular
Shaft
- Mid-shaft femur fracture (all subtrochanteric)
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
- Treatment for both types:
- Non-weight bearing with ortho follow up in 1-2wk
Disposition
- Outpatient