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Trochanteric and Intertrochanteric Fracture
Julia R. Crim, MD; Adam C. Zoga, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Synonyms

                • Greater trochanteric fracture, lesser trochanteric fracture, trochanteric fracture, Evans fracture
              • Definitions

                • Intertrochanteric fracture
                  • Fracture extending along intertrochanteric line from greater to lesser trochanter
                • Reverse obliquity intertrochanteric fracture
                  • Fracture originates above lesser trochanter, extends inferolaterally to subtrochanteric region

              IMAGING

              • General Features

                • Radiographic Findings

                  • CT Findings

                    • MR Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          • Reporting Tips

                                            Selected References

                                            1. Isida R et al: Prospective study of the reproducibility of X-rays and CT scans for assessing trochanteric fracture comminution in the elderly: a series of 110 cases. Eur J Orthop Surg Traumatol. 25(7):1165-70, 2015
                                            2. Sheehan SE et al: Proximal femoral fractures: what the orthopedic surgeon wants to know. Radiographics. 140301, 2015
                                            3. Kesmezacar H et al: Predictors of mortality in elderly patients with an intertrochanteric or a femoral neck fracture. J Trauma. 68(1):153-8, 2010
                                            4. Ekström W et al: Quality of life after a stable trochanteric fracture--a prospective cohort study on 148 patients. J Orthop Trauma. 23(1):39-44, 2009
                                            5. McGrory BJ et al: The use of locking plates for greater trochanteric fixation. Orthopedics. 32(12):917-20, 2009
                                            6. Sankey RA et al: The use of MRI to detect occult fractures of the proximal femur: a study of 102 consecutive cases over a ten-year period. J Bone Joint Surg Br. 91(8):1064-8, 2009
                                            7. Nguyen JT et al: Stress-related injuries around the lesser trochanter in long-distance runners. AJR Am J Roentgenol. 190(6):1616-20, 2008
                                            8. Hagino T et al: Prognosis of proximal femoral fracture in patients aged 90 years and older. J Orthop Surg (Hong Kong). 14(2):122-6, 2006
                                            9. Holmberg AH et al: Risk factors for fragility fracture in middle age. A prospective population-based study of 33,000 men and women. Osteoporos Int. 2006;17(7):1065-77. Epub 2006 May 4. Erratum in: Osteoporos Int. 17(11):1704, 2006
                                            10. James SL et al: Atraumatic avulsion of the lesser trochanter as an indicator of tumour infiltration. Eur Radiol. 16(2):512-4, 2006
                                            11. Johnell O et al: An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 17(12):1726-33, 2006
                                            12. Orwig DL et al: Hip fracture and its consequences: differences between men and women. Orthop Clin North Am. 37(4):611-22, 2006
                                            13. Haidukewych GJ et al: Reverse obliquity fractures of the intertrochanteric region of the femur. J Bone Joint Surg Am. 83-A(5):643-50, 2001
                                            14. Trafton PG: Subtrochanteric-intertrochanteric femoral fractures. Orthop Clin North Am. 18(1):59-71, 1987
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Pathology

                                                    • Clinical Issues

                                                      • Diagnostic Checklist

                                                        TERMINOLOGY

                                                        • Synonyms

                                                          • Greater trochanteric fracture, lesser trochanteric fracture, trochanteric fracture, Evans fracture
                                                        • Definitions

                                                          • Intertrochanteric fracture
                                                            • Fracture extending along intertrochanteric line from greater to lesser trochanter
                                                          • Reverse obliquity intertrochanteric fracture
                                                            • Fracture originates above lesser trochanter, extends inferolaterally to subtrochanteric region

                                                        IMAGING

                                                        • General Features

                                                          • Radiographic Findings

                                                            • CT Findings

                                                              • MR Findings

                                                                • Imaging Recommendations

                                                                  DIFFERENTIAL DIAGNOSIS

                                                                    PATHOLOGY

                                                                    • General Features

                                                                      • Staging, Grading, & Classification

                                                                        CLINICAL ISSUES

                                                                        • Presentation

                                                                          • Demographics

                                                                            • Natural History & Prognosis

                                                                              • Treatment

                                                                                DIAGNOSTIC CHECKLIST

                                                                                • Consider

                                                                                  • Image Interpretation Pearls

                                                                                    • Reporting Tips

                                                                                      Selected References

                                                                                      1. Isida R et al: Prospective study of the reproducibility of X-rays and CT scans for assessing trochanteric fracture comminution in the elderly: a series of 110 cases. Eur J Orthop Surg Traumatol. 25(7):1165-70, 2015
                                                                                      2. Sheehan SE et al: Proximal femoral fractures: what the orthopedic surgeon wants to know. Radiographics. 140301, 2015
                                                                                      3. Kesmezacar H et al: Predictors of mortality in elderly patients with an intertrochanteric or a femoral neck fracture. J Trauma. 68(1):153-8, 2010
                                                                                      4. Ekström W et al: Quality of life after a stable trochanteric fracture--a prospective cohort study on 148 patients. J Orthop Trauma. 23(1):39-44, 2009
                                                                                      5. McGrory BJ et al: The use of locking plates for greater trochanteric fixation. Orthopedics. 32(12):917-20, 2009
                                                                                      6. Sankey RA et al: The use of MRI to detect occult fractures of the proximal femur: a study of 102 consecutive cases over a ten-year period. J Bone Joint Surg Br. 91(8):1064-8, 2009
                                                                                      7. Nguyen JT et al: Stress-related injuries around the lesser trochanter in long-distance runners. AJR Am J Roentgenol. 190(6):1616-20, 2008
                                                                                      8. Hagino T et al: Prognosis of proximal femoral fracture in patients aged 90 years and older. J Orthop Surg (Hong Kong). 14(2):122-6, 2006
                                                                                      9. Holmberg AH et al: Risk factors for fragility fracture in middle age. A prospective population-based study of 33,000 men and women. Osteoporos Int. 2006;17(7):1065-77. Epub 2006 May 4. Erratum in: Osteoporos Int. 17(11):1704, 2006
                                                                                      10. James SL et al: Atraumatic avulsion of the lesser trochanter as an indicator of tumour infiltration. Eur Radiol. 16(2):512-4, 2006
                                                                                      11. Johnell O et al: An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 17(12):1726-33, 2006
                                                                                      12. Orwig DL et al: Hip fracture and its consequences: differences between men and women. Orthop Clin North Am. 37(4):611-22, 2006
                                                                                      13. Haidukewych GJ et al: Reverse obliquity fractures of the intertrochanteric region of the femur. J Bone Joint Surg Am. 83-A(5):643-50, 2001
                                                                                      14. Trafton PG: Subtrochanteric-intertrochanteric femoral fractures. Orthop Clin North Am. 18(1):59-71, 1987