Isolated greater trochanteric fractures most commonly result from forceful muscle contraction of a fixed limb, which usually occurs in those who are young and physically active.

Epidemiology

Isolated trochanteric fractures are more common in young, active males, usually between the ages of 14 and 25 ^ref. 85% of mild trochanteric avulsion fractures occur in patients <20 years ^ref. In the elderly, trochanteric fractures are usually due to direct trauma, such as a fall ^ref.

Clinical presentation

Patients will present with pain, especially the lateral hip and on abduction and extension, exacerbated on palpation ^ref.

Pathology

Greater trochanteric fractures are a subtype of trochanteric fractures and can be isolated or non-isolated ^ref.

Mechanism

Most commonly due to:

• avulsion type fracture: forced muscle contraction of the hip abductors and external rotators, usually due to physical activity

• direct trauma of the greater trochanter, e.g. due to a fall onto the lateral hip

Radiograph features

Plain radiograph

Anterior-posterior (AP) and lateral or oblique radiographs are usually sufficient for diagnosis. They generally show an apophyseal avulsion fracture of the greater trochanter.

Treatment and prognosis

Most trochanteric fractures are self-limiting and can be treated without surgical intervention if the displacement is less than 1 cm. However, the patient must not bear weight on the affected leg for up to a month. Many patients may take up to 3 months to return to normal physical activity.

Complications of isolate trochanteric fractures are quite rare, usually manifesting as a slight loss of abduction force.