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BMC Musculoskeletal Disorders

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Open Access 01-12-2015 | Research article

Is magnetic resonance imaging necessary in isolated greater trochanter fracture? A systemic review and pooled analysis

Authors: Seung-Ju Kim, Joonghyun Ahn, Hyung Kook Kim, Jong Hun Kim

Published in: BMC Musculoskeletal Disorders | Issue 1/2015

Abstract

Background

Isolated fractures of the greater trochanter (GT) of the femur are uncommon and few studies have assessed the diagnosis and appropriate therapeutic schedule for these fractures. The current data regarding assessment of isolated fractures of the GT are limited to a few reviews based on the experience of a single institution. Therefore, we asked the following questions: (1) what proportion of cases has an associated extension of the fracture into the intertrochanteric region in isolated GT fracture and (2) what are the treatment options and outcomes of GT fractures with occult intertrochanteric fractures.

Methods

We conducted a systematic review of published studies that evaluated patients who displayed isolated GT fracture on routine radiographic examination and underwent a magnetic resonance imaging (MRI) scan because of the suspicion of extension into the intertrochanteric region. A structured literature review of multiple databases (PubMed, EMBASE, CINAHL, and Cochrane systematic reviews) referenced articles from 1950 to 2015.

Results

A total of 110 patients were identified from 7 published studies. MRI documented isolated GT fractures diagnosed on initial radiographs in only 11 of 110 patients (10 %). In 99 patients (90 %), MRI examinations revealed extension of the fracture into the intertrochanteric region. Surgical fixation was necessary for 61 patients, with a pooled percentage of 55 %. No complications were observed after surgery.

Conclusions

Our study has helped to elucidate further the assessment of isolated fracture of the GT. We believe that MRI is a reasonable option for patients presenting with isolated GT fracture on plain radiographs.

Merlino AF, Nixon JE. Isolated fractures of the greater trochanter. Report of twelve cases. Int Surg. 1969;52(2):117–24.PubMed

Lee KH, Kim HM, Kim YS, Jeong C, Moon CW, Lee SU, et al. Isolated fractures of the greater trochanter with occult intertrochanteric extension. Arch Orthop Trauma Surg. 2010;130(10):1275–80.PubMedCrossRef

Kim SJ, Park BM, Yang KH, Kim DY. Isolated fractures of the greater trochanter. Report of 6 cases. Yonsei Med J. 1988;29(4):379–83.PubMedCrossRef

Reiter M, O'Brien SD, Bui-Mansfield LT, Alderete J. Greater trochanteric fracture with occult intertrochanteric extension. Emerg Radiol. 2013;20(5):469–72.PubMedCrossRef

Omura T, Takahashi M, Koide Y, Ohishi T, Yamanashi A, Kushida K, et al. Evaluation of isolated fractures of the greater trochanter with magnetic resonance imaging. Arch Orthop Trauma Surg. 2000;120(3-4):195–7.PubMedCrossRef

Brun OC, Maansson L. Fractures of the greater trochanter following total hip replacement. Hip Int. 2013;23(2):143–6.PubMedCrossRef

Quinn SF, McCarthy JL. Prospective evaluation of patients with suspected hip fracture and indeterminate radiographs: use of T1-weighted MR images. Radiology. 1993;187(2):469–71.PubMedCrossRef

Schultz E, Miller TT, Boruchov SD, Schmell EB, Toledano B. Incomplete intertrochanteric fractures: imaging features and clinical management. Radiology. 1999;211(1):237–40.PubMedCrossRef

Feldman F, Staron RB. MRI of seemingly isolated greater trochanteric fractures. AJR Am J Roentgenol. 2004;183(2):323–9.PubMedCrossRef

10.

Craig JG, Moed BR, Eyler WR, van Holsbeeck M. Fractures of the greater trochanter: intertrochanteric extension shown by MR imaging. Skeletal Radiol. 2000;29(10):572–6.PubMedCrossRef

11.

Deutsch AL, Mink JH, Waxman AD. Occult fractures of the proximal femur: MR imaging. Radiology. 1989;170(1 Pt 1):113–6.PubMedCrossRef

12.

Haramati N, Staron RB, Barax C, Feldman F. Magnetic resonance imaging of occult fractures of the proximal femur. Skeletal Radiol. 1994;23(1):19–22.PubMedCrossRef

13.

Oka M, Monu JU. Prevalence and patterns of occult hip fractures and mimics revealed by MRI. AJR Am J Roentgenol. 2004;182(2):283–8.PubMedCrossRef

14.

Hommel A, Ulander K, Bjorkelund KB, Norrman PO, Wingstrand H, Thorngren KG. Influence of optimised treatment of people with hip fracture on time to operation, length of hospital stay, reoperations and mortality within 1 year. Injury. 2008;39(10):1164–74.PubMedCrossRef

15.

Alam A, Willett K, Ostlere S. The MRI diagnosis and management of incomplete intertrochanteric fractures of the femur. J Bone Joint Surg. 2005;87(9):1253–5.CrossRef

16.

Hossain M, Barwick C, Sinha AK, Andrew JG. Is magnetic resonance imaging (MRI) necessary to exclude occult hip fracture? Injury. 2007;38(10):1204–8.PubMedCrossRef

17.

Rizzo PF, Gould ES, Lyden JP, Asnis SE. Diagnosis of occult fractures about the hip. Magnetic resonance imaging compared with bone-scanning. J Bone Joint Surg Am. 1993;75(3):395–401.PubMed

18.

Bartonicek J, Sprindrich J, Skala-Rosenbaum J, Fric V. Diagnosing occult pertrochanteric fractures of proximal femur with MRI. Rozhl Chir. 2007;86(7):379–83.PubMed

19.

Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60.PubMedPubMedCentralCrossRef

20.

Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700.PubMedPubMedCentralCrossRef

21.

LaLonde B, Fenton P, Campbell A, Wilson P, Yen D. Immediate weight-bearing in suspected isolated greater trochanter fractures as delineated on MRI. Iowa Orthop J. 2010;30:201–4.PubMedPubMedCentral

22.

Kim J, Yoon HJ, Yoo JJ, Kim HJ. Multiplanar reformation computed tomogram is better than MR imaging in decision making for apparently isolated fractures of the greater trochanter. J Orthop Trauma. 2013;27(8):e181–185.PubMedCrossRef

23.

Suzuki K, Kawachi S, Nanke H. Insufficiency femoral intertrochanteric fractures associated with greater trochanteric avulsion fractures. Arch Orthop Trauma Surg. 2011;131(12):1697–702.PubMedCrossRef

24.

Grad WB, Desy NM. Bilateral occult hip fracture. CJEM. 2012;14(6):372–7.PubMed

25.

Koval KJ, Zuckerman JD. Functional recovery after fracture of the hip. J Bone Joint Surg Am. 1994;76(5):751–8.PubMed

26.

Matin P. The appearance of bone scans following fractures, including immediate and long-term studies. J Nucl Med. 1979;20(12):1227–31.PubMed

27.

Rubin SJ, Marquardt JD, Gottlieb RH, Meyers SP, Totterman SM, O'Mara RE. Magnetic resonance imaging: a cost-effective alternative to bone scintigraphy in the evaluation of patients with suspected hip fractures. Skeletal Radiol. 1998;27(4):199–204.PubMedCrossRef

28.

Lubovsky O, Liebergall M, Mattan Y, Weil Y, Mosheiff R. Early diagnosis of occult hip fractures MRI versus CT scan. Injury. 2005;36(6):788–92.PubMedCrossRef

Title: Is magnetic resonance imaging necessary in isolated greater trochanter fracture? A systemic review and pooled analysis
Authors: Seung-Ju Kim
Joonghyun Ahn
Hyung Kook Kim
Jong Hun Kim
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: BMC Musculoskeletal Disorders / Issue 1/2015
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-015-0857-y

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Is magnetic resonance imaging necessary in isolated greater trochanter fracture? A systemic review and pooled analysis

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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