Trochanteric fractures on the femur are considered as uncommon injuries. The trochanters can end up fractured alone or as part of another type of hip fracture. The individual might end up with thigh or hip pain with or without known trauma causing the injury. The treatment for a trochanteric hip fracture is based on the severity and cause of the injury.
Close look on the anatomy
The greater and lesser trochanters are situated at the head of the femur close to the hip joint. The greater trochanter is a large-sized, bony prominence on the exterior of the femur which functions as an area of attachment for several muscles responsible for moving the leg at the hip joint.
As for the lesser trochanter, it is a bony prominence on the interior region of the femur. This serves as an area of attachment for the iliopsoas muscle which is responsible for bending the hip joint. The intertrochanteric line is a rough ridge in between the greater and lesser trochanters on the front part of the femur.
Causes of lesser trochanteric hip fractures
The lesser trochanteric hip fractures can develop as remote injuries or combined with other types of fractures. When it comes to isolated injuries, they are triggered by strong contraction of the iliopsoas muscle among teenagers or by benign or cancerous bone tumors among the older adults. Always bear in mind that tumors can lead to weakened bone, thus resulting to increased risk for fractures.
For isolated trochanteric hip fractures, they are rare. In case the fracture is a simple avulsion due to the forceful contraction of the iliopsoas, surgery is required to realign the bone fragments. An avulsion fracture occurs once a piece of bone is detached due to the forces transferred via the tendon from the muscle contraction. The bone fragment still has the tendon piece along with it.
In case a tumor is present, the tumor and bone might require treatment with a combination of surgery, radiation and chemotherapy.
Greater trochanteric hip fractures
For a greater trochanteric hip fracture, it mostly occurs as a phase of an intertrochanteric fracture configuration. Always bear in mind that an intertrochanteric fracture involves a fracture line via the intertrochanteric track of the femur. This can occur along with a greater trochanter fracture.
It is rare for an isolated greater trochanteric hip fracture to occur. It usually occurs among the elderly due to direct trauma to the exterior of the hip or indirectly via strong contractions of the gluteus medius and minimus muscles. Both help move the hip by attaching to the greater trochanter.
The greater trochanteric hip fractures are usually managed without surgery. The non-surgical measure initially involves bed rest. Once the symptoms subside, the individual can use crutches and perform stretching exercises to restore hip function.
Once the bone fragments are displaced more than 1 cm, surgery is carried out to realign the bone fragments and promote the healing process. The surgeon often utilizes wires under tension to realign the bony fragments.