Background: In cases of suspected isolated greater trochanteric fracture, difficulty exists in establishing a definitive diagnosis when plain film is equivocal for fracture extension. There are reports of magnetic resonance imaging (MRI) being used to diagnose greater trochanter fractures, with varying treatment and follow-up, however validation of treatment based on MRI findings is lacking. To date, there is no consensus on the best way to manage isolated greater trochanteric fractures. Current treatment protocols are based on plain films. The purpose of this study is to offer a more effective means of treating patients with these fractures, and to stimulate further study of isolated greater trochanteric fractures based on MRI interpretation.
Methods: Patients from May 2001 to May 2003 with a clinical picture consistent with that of a hip fracture who had equivocal plain film evidence of an isolated greater trochanteric fracture received MRI scanning. Ten patients (five male and five female) ranging in age from 59-90 (mean age 79) showed a presumed isolated greater trochanteric fracture on MRI defined as a linear, vertical band of decreased signal (Tl-weighted) extending from the greater trochanter that did not cross the mid-line. These patients were allowed immediate weight bearing as tolerated and followed for an average of 15 months. Patients were contacted by telephone during this period and any problems were noted. Problems were defined as any limitations (pain, inability to ambulate) due to the presumed hip fracture.
Results: All ten patients diagnosed with an isolated greater trochanteric fracture on MRI reported no limitations during the follow-up period.
Conclusions: The linear, vertical bands of decreased signal (T1-weighted) extending from the greater trochanter and not crossing the midline on MRI can be considered isolated greater trochanteric avulsions, and can be managed with immediate weight-bearing.