Background. Isolated fracture of the greater trochanter is an uncommon presentation of hip fracture. Traditional teaching has been to manage these injuries nonoperatively, but modern imaging techniques have made it possible to detect occult intertrochanteric extension of the fracture in up to 90% of cases. This study aims to review the investigation and management of greater trochanter fractures in a single major trauma centre. Methods. A retrospective review was completed of patients admitted with greater trochanter fractures. These were matched to cases with 2-part extracapsular fractures. Initial management and clinical outcome was established using electronic notes and radiographs. Mortality and length of stay was calculated for both groups. Results. 85 isolated greater trochanter fractures in 84 patients were identified from 2006–2017. 81/85 patients were treated non-operatively. 78 were mobilised full weight bearing. None required readmission or operation due to fracture displacement. 58 of these patients had cross-sectional imaging with MRI or CT and 15 of those scanned had intertrochanteric extension of the fracture. In the same time period, 998 2-part extra-capsular fractures were treated, using a sliding hip screw. Length of stay was shorter in patients with greater trochanter fractures than 2-part extracapsular fractures (median 7 days vs 14 days, P<0.0001). 30-day mortality was 11.9%, with no significant difference to patients with 2-part extracapsular fractures. Discussion. Cross sectional imaging rarely changed the treatment protocol for isolated greater trochanter fractures. The outcome following non-operative treatment is good even in the presence of occult fractures identified on CT or MRI. We advocate a treatment protocol that encourages early mobilisation and repeat plain radiographs if patients fail to progress. This will reduce unnecessary morbidity from fixation of stable occult fractures

Aims

We aimed to compare the implant survival, complications, readmissions, and mortality of Vancouver B2 periprosthetic femoral fractures (PFFs) treated with internal fixation with that of B1 PFFs treated with internal fixation and B2 fractures treated with revision arthroplasty.

Most hip fractures treated with modern internal fixation techniques will heal. However, failures occasionally occur and require revision procedures. Salvage strategies employed during revision are based on whether the fixation failure occurs in the femoral neck, or in the intertrochanteric region. Patient age and remaining bone stock also influence decision making. For fractures in young patients, efforts are generally focused on preserving the native femoral head via osteotomies and repeat internal fixation. For failures in older patients, some kind of hip replacement is usually selected. Disuse osteopenia, deformity, bone loss, and stress-risers from previous internal fixation devices all pose technical challenges to successful reconstruction. Attention to detail is important in order to minimise complications. In the majority of cases, good outcomes have been reported for the various salvage strategies.

Cite this article: Bone Joint J 2013;95-B, Supple A:7–10.