Outcomes of treatment for isolated greater trochanteric fractures with occult intertrochanteric extension: a retrospective cohort of 118 patients.

Abstract

Introduction: Isolated greater trochanteric fractures are uncommon among the pertrochanteric femoral fractures. Magnetic resonance imaging (MRI) is recommended to confirm occult intertrochanteric extension fractures and prevent potential displacement. While treatment guidelines lack consensus, surgical intervention is suggested for intertrochanteric extension (IE) beyond the medial third portion. Our primary aim was to assess complications and functional outcomes of conservative treatment in patients with IE.

Methods: In this retrospective study, all patients aged 65 years and above with isolated greater trochanteric fractures diagnosed by X-ray were included. Subsequently, MRI divided the intertrochanteric area into lateral, medium, or medial portions based on extension proposed by Park. A minimum three-month follow-up was required. Treatment decisions, surgical or conservative, were based on surgeon criteria. Rehabilitation allowed weight-bearing as tolerated for both treatments. Analysis included demographic variables, complications, pre- and posttreatment functional status using the Parker mobility score, and overall mortality rate.

Results: From 2010 to 2022, 118 IGTF patients were analyzed, with a mean age of 79.8 years (SD: 11.3) and 69.5% female. Conservative treatment was performed in 93 patients (78.8%), with Park I: 8 (8.6%), Park II: 52 (55.9%), and Park III: 33 (35.5%). Surgical treatment was performed in 25 patients (21.2%), with Park I: 3 (12%), Park II: 7 (28%), and Park III: 15 (60%). The complication rate was 4.8% (n = 4) for conservative treatment (all due to secondary displacement, resolved surgically) and 4% (n = 1) for surgical treatment (deep infection). Radiological extension differed significantly by Park classification (p = 0.042). Functional outcomes (Parker scores) showed no significant changes at three months posttreatment (p = 0.177). Overall survival was 94% at three months and 90% at one year.

Conclusion: This study suggests that conservative treatment is a viable option for patients with isolated greater trochanter fractures and IE, including cases involving the medial third. Decisions regarding treatment should take into account not only the location and extent of IE as identified by MRI, but also individual clinical factors.