Jai Hyung Park1, Hyun Chul Shon2, Jae Suk Chang3, Chul-Ho Kim3, Seong-Eun Byun4, Byeong Ryong Han1, Ji Wan Kim5. 1. Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea. 2. Department of Orthopedic Surgery, Chungbuk National University Hospital, Chungbuk National University, College of Medicine, Cheong-Ju, Republic of Korea. 3. Department of Orthopedic Surgery, Asan Medical Center, Ulsan University, College of Medicine, Seoul, Republic of Korea. 4. Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Bundang, Republic of Korea. 5. Department of Orthopedic Surgery, Asan Medical Center, Ulsan University, College of Medicine, Seoul, Republic of Korea. Electronic address: bakpaker@hanmail.net.
Abstract
INTRODUCTION: The purpose of this study was to evaluate the proportion of greater trochanter (GT) fractures with occult extension to the intertrochanteric region on magnetic resonance imaging (MRI) among apparently isolated GT fractures and to investigate the use of MRI for formulating a treatment strategy in patients with isolated GT fractures. PATIENTS AND METHODS: This retrospective cohort study reviewed 37 patients with isolated GT fractures on plain radiography. Surgical or conservative treatment was decided according to MRI findings. We divided patients into 3 groups according to the extension of the fracture line. In group 1, the fracture line was within the lateral one-third in the coronal plane. In group 2, the fracture line extended from the lateral one-third to the medial one-third. In group 3, the fracture line extended over the medial one-third and/or to the medial cortex of the femur. Conservative treatment was performed in groups 1 and 2, and surgical treatment was performed in group 3. The clinical results, radiography findings, and MRI findings were investigated. RESULTS: MRI revealed hidden intertrochanteric fractures (groups 2 [n = 10] and 3 [n = 4]) in 38% of apparently isolated GT fractures on radiography. No displacement was found in groups 1 (n = 23) and 2. Of the 4 patients in group 3, 3 were treated surgically and achieved good functional results and 1 refused to undergo surgery and finally developed complete intertrochanteric fracture. This patient presented 5 days later with increased hip pain, and radiography demonstrated displacement of the fracture, prompting surgical intervention. CONCLUSIONS: The evaluation of apparently isolated GT fractures using MRI can be useful to diagnose the extent of the occult fracture and determine the treatment strategy.
INTRODUCTION: The purpose of this study was to evaluate the proportion of greater trochanter (GT) fractures with occult extension to the intertrochanteric region on magnetic resonance imaging (MRI) among apparently isolated GT fractures and to investigate the use of MRI for formulating a treatment strategy in patients with isolated GT fractures. PATIENTS AND METHODS: This retrospective cohort study reviewed 37 patients with isolated GT fractures on plain radiography. Surgical or conservative treatment was decided according to MRI findings. We divided patients into 3 groups according to the extension of the fracture line. In group 1, the fracture line was within the lateral one-third in the coronal plane. In group 2, the fracture line extended from the lateral one-third to the medial one-third. In group 3, the fracture line extended over the medial one-third and/or to the medial cortex of the femur. Conservative treatment was performed in groups 1 and 2, and surgical treatment was performed in group 3. The clinical results, radiography findings, and MRI findings were investigated. RESULTS: MRI revealed hidden intertrochanteric fractures (groups 2 [n = 10] and 3 [n = 4]) in 38% of apparently isolated GT fractures on radiography. No displacement was found in groups 1 (n = 23) and 2. Of the 4 patients in group 3, 3 were treated surgically and achieved good functional results and 1 refused to undergo surgery and finally developed complete intertrochanteric fracture. This patient presented 5 days later with increased hip pain, and radiography demonstrated displacement of the fracture, prompting surgical intervention. CONCLUSIONS: The evaluation of apparently isolated GT fractures using MRI can be useful to diagnose the extent of the occult fracture and determine the treatment strategy.