Isolated greater trochanter fractures of the native hip: Is magnetic resonance imaging needed?

Background: Isolated greater trochanter fractures represent a subset of hip fractures for which diagnostic work-up and treatment algorithms can vary. Magnetic resonance imaging has been described as the definitive method of evaluating fracture extension into the intertrochanteric region. While prophylactic fixation for those with fracture extension may prevent the propagation of the injury, treatment debates remain. This study aimed to assess adherence to protocols at our institution and evaluate outcomes in those whose care deviated from protocol. Methods: In a retrospective analysis, adult patients (≥18 years old) presenting with a greater trochanter fracture over a 7-year period (2015–2021) were identified. Patients were excluded if the injury was periprosthetic, had a ballistic mechanism, or had any concomitant fractures of the femoral head, neck, or shaft identified on plain radiographs. Patient demographics, comorbidities, treatment, and outcomes were tabulated via chart review. Results: In total, 57 isolated greater trochanter fracture patients were included. Of these, 52 patients (91%) had computed tomographic scans, yet only 41 patients (72%) had magnetic resonance imaging completed. In total, 10 of the 41 (24%) patients with magnetic resonance imaging showed <50% fracture line extension, and all of these patients were treated nonoperatively. In contrast, 24 of 41 magnetic resonance imaging patients (59%) showed >50% fracture line extension in both coronal and axial planes, of which 14 (58%) were treated operatively. However, the 10 nonoperative patients with significant fracture extension showed no increased hospital length-of-stay or fracture extension upon follow-up. Conclusions: Our study showed that institutional protocol for diagnostic workup and treatment evaluation for isolated greater trochanter fractures is not consistently followed. However, patients who deviated from treatment protocol showed no elevated risks of fracture propagation. Our study questions the need for magnetic resonance imaging in all isolated greater trochanter fractures, and suggests that protocols be revisited to ensure that workup is optimal for patients and costeffective for the healthcare system itself.