Treatment strategy for elderly patients with the isolated greater trochanteric fracture

Yunus Oc, Ali Varol, Ethem Aytac Yazar, Semih Ak, Ahmet Onur Akpolat, Bekir Eray Kilinc, Yunus Oc, Ali Varol, Ethem Aytac Yazar, Semih Ak, Ahmet Onur Akpolat, Bekir Eray Kilinc

Abstract

Background: The objective of this study was to evaluate the risk of femur intertrochanteric fracture associated with femur trochanter major fractures in patients over 65 years of age with magnetic resonance examination for better diagnosis and treatment.

Methods: Thirty-one patients who had incomplete femur intertrochanteric fracture diagnosed were included in the study. Patients were classified according to the length of the fracture line crossing the intertrochanteric border. Fracture patterns were described on magnetic resonance imaging coronal views. Group A, pattern 1, greater trochanteric fracture extends to intertrochanteric region with both cortices; Group B, pattern 2, fracture has characteristics of pattern 1 fracture including diametaphysis fracture line; Group C, pattern 3, greater trochanteric fracture only has extending superolateral cortex fracture line of intertrochanteric region; and Group D, pattern 4, fracture has characteristics of pattern 1 fracture and including superior extension to the baso-cervical line. Surgical treatment with dynamic hip screw was applied to all patients with intertrochanteric extension after magnetic resonance examination.

Results: This study included 16 women (80.3 ± 6.7 years) and 15 men (76.9 ± 10.94 years). Group A had 11 patients, group B had 8 patients, group C had 6 patients, and group D had 6 patients. Ambulation was initially prescribed for these patients 1 day after the surgery. The average surgery durations of the A, B, C, and D patterns were 44.54 ± 7.56, 49.37 ± 12.65, 49.16 ± 3.76, and 44.16 ± 5.84 min, respectively. No statistically significant differences were observed among the four patterns (P = 0.404).

Conclusion: Surgical treatment of the greater trochanteric fracture which is considered an indicator of occult intertrochanteric fracture is a good choice for the treatment because of the procedure safety and early mobilization after the surgery.

Keywords: Orthopedics/rehabilitation/occupational therapy; geriatrics/gerontology; radiology.

Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

© The Author(s) 2020.

Figures

Figure 1.
Figure 1.
Group A, pattern 1, GT fracture extends to intertrochanteric region and its lateral and medial cortices.
Figure 2.
Figure 2.
Group B, pattern 2 fracture has characteristics of pattern 1 fracture plus extension of fracture to diametaphysis.
Figure 3.
Figure 3.
Group C, pattern 3 GT fracture only extends to superolateral cortex of intertrochanteric region.
Figure 4.
Figure 4.
Group D, pattern 4 fracture has characteristics of pattern A fracture plus superior extension of fracture to base of femoral neck.
Figure 5.
Figure 5.
Operated intertrochanteric fracture with dynamic hip screw.

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