Title : Does cross-sectional imaging of isolated greater trochanter fractures influence management and clinical outcomes? A 19-year single-centre case-control study
Abstract:
Background: Isolated greater trochanter fractures (GTFs) are an uncommon presentation of hip fracture, representing approximately 2% of all hip fractures. Historically managed non-operatively, recent evidence using cross-sectional imaging has challenged this approach by showing a high rate of occult intertrochanteric (IT) extension. However, whether identifying such extension materially influences management and clinical outcomes in routine practice remains unclear.
Aims: To review whether cross-sectional imaging of isolated GTFs influences treatment decisions and clinical outcomes at a high-volume major trauma centre over a 19-year period.
Methods: This case-control study was carried out using the local hip fracture database at a major trauma centre. Patients who received cross-sectional imaging were matched against those who did not. Patient demographics, imaging modality, presence of IT extension, operative intervention, weight-bearing status, length of stay (LOS), repeat admissions, and mortality were recorded.
Results: One hundred and forty patients were identified (82 female, 58 male). Cross-sectional imaging was obtained in 111 patients (79.3%): 70 CT only, 39 MRI only, and 3 both. IT extension was identified in 31 of 111 scanned patients (27.9%). MRI detected IT extension in 59.0% of MRI-only cases (23/39) compared with 8.6% on CT alone (6/70). Only one patient (0.7%) underwent primary operative intervention, for a subtrochanteric extension identified on MRI. All remaining patients were managed non-operatively with full weight-bearing as tolerated. There was no significant difference in LOS or mortality between scanned and unscanned patients, nor between those with and without IT extension on imaging.
Conclusion: Whilst MRI significantly increases detection of occult IT extension compared to CT, identification did not alter operative management in our cohort. Clinical outcomes were not significantly different regardless of imaging or extension status. These results question the requirement for mandatory cross-sectional imaging of all GTFs and suggest that non-operative management with full weight-bearing is safe in the majority. A prospective multicentre study would be effective to define the role of MRI in this fracture pattern.
Keywords: greater trochanter fracture; intertrochanteric extension; cross-sectional imaging; MRI; occult hip fracture; non-operative management
