Presentation
The patient fell down three stairs one week ago. Continued severe left hip pain eventually led him to seek medical attention in the emergency department.
Patient Data
Initially interpreted as "no acute findings".
In retrospect, there is a linear lucency of the greater trochanter which is likely related to the fracture.
Nondisplaced fracture of the superior aspect of the left greater tochanter.
Nondisplaced fracture of the superior aspect of the left greater trochanter.
There is a fracture line corresponding to the greater trochanter fracture; however, the fracture extends into the intertrochanteric region and lateral basicervical femoral neck.
There is a fracture line corresponding to the greater trochanter fracture; however, the fracture extends into the intertrochanteric region and lateral basicervical femoral neck (red arrow).
C-arm: Insertion of the guiding pin followed by insertion of guiding arm.
Post-operative X-ray: Successful left femoral neck fixation.
Case Discussion
Upon presentation to ED, the patient received x-rays, which were initially read as no acute findings. Subsequently, a CT was obtained and read as an isolated greater trochanteric fracture with probable extension into the femoral neck. The referring orthopedic service then ordered an MRI to evaluate extension into the femoral neck, which showed an intertrochanteric fracture and edema extending to the lateral basicervical femoral neck.
Learning points:
- Isolated greater trochanteric fractures are relatively rare
- Specific attention should be paid to the greater trochanter in patients presenting with hip pain
- Cross-sectional imaging with CT and MRI demonstrate inter-trochanteric extension of fracture
- Isolated greater trochanteric fractures are treated conservatively; however, greater trochanteric with intertrochanteric extension often require surgical repair
Additional contributors: