Greater trochanteric fractures with lntertrochanteric extension identified on MRI: What is the rate of displacement when treated nonoperatively?

Abstract

Introduction. Despite the ability of MRI to identify intertrochanteric (IT) fracture extension for greater trochanteric (GT) fractures, there is no consensus about which fractures require operative intervention. Previous studies have suggested GT fractures with >50% extension into the IT region might benefit from fixation. We sought to evaluate the rate at which GT fractures with IT extension displaced, requiring operative fixation. Patients and methods. This is a Retrospective Chart Review performed at a Level 1 Trauma Center. Patients included all nonoperatively treated GT fractures (OTA/AO 31A1.1) with IT extension identified on MRI between 2010 and 2017 at our institution. Patients lost to follow up prior to radiographic evidence of healing or fracture displacement were excluded. Patient charts and imaging were reviewed for demographic data, treatment plan, percent extension into the IT region (as determined from coronal MRI images), and clinical and radiographic evidence of fracture healing. Percent extension into the IT region was measured using coronal T1-weighted MRI images. The primary outcome measures were fracture displacement requiring operation and nonunion. Results. Seventeen patients met initial inclusion criteria, with two subsequently excluded due to no radiographic follow-up. Of the 15 patients, zero had displacement of their IT fracture. None required operative intervention. All 15 patients healed their fractures. Fourteen of 15 (93%) had IT extension of 50% or less across the IT region. One patient had initial IT extension of 60%, this patient also healed without displacement. Discussion. Incomplete intertrochanteric femur fractures are a relatively newer diagnosis that have become more prevalent with the increased usage and availability of MRI. Currently, there is no consensus on the ideal treatment of these injuries. To our knowledge, this is the largest series of its kind to help guide treatment of these GT fractures with IT extension. Conclusions. Fractures with less than 50% extension into the IT region have a low likelihood of future displacement and high union rates when treated nonoperatively. Level of evidence. IV