Hip Fractures pp 129-190 | Cite as

Intertrochanteric Fractures

  • Kenneth J. Koval
  • Joseph D. Zuckerman

Abstract

Because they are located distal to the anatomic limits of the hip joint capsule, fractures in the region between the greater and lesser trochanters are characterized as extracapsular fractures (Figure 6.1). The cancellous bone in this intertrochanteric region is well vascularized. Therefore, one rarely encounters the problems of nonunion and osteonecrosis that can complicate intracapsular fractures.

Keywords

Femoral Head Femoral Shaft Trochanteric Fracture Intertrochanteric Fracture Gamma Nail 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Boyd HB, Griffin LL. Classifications and treatment of trochanteric fractures. Arch Surg 1949; 58:853–866.CrossRefPubMedGoogle Scholar
  2. 2.
    Evans E. The treatment of trochanteric fractures of the femur. J Bone Joint Surg Br 1949; 31:190–203.Google Scholar
  3. 3.
    Jensen JS, Michaelsen M. Trochanteric femoral fractures treated with McLaughlin osteosynthesis. Acta Orthop Scand 1975; 46:795–803.CrossRefPubMedGoogle Scholar
  4. 4.
    Kyle RF, Gustilo RB, Premer RF. Analysis of six hundred and twenty-two intertrochanteric hip fractures. J Bone Joint Surg Am 1979; 61:216–21.PubMedGoogle Scholar
  5. 5.
    Muller ME, Nazarian S, Koch P, Schatzker J. The Comprehensive Classifications of Fractures of Long Bones. Berlin: Springer-Verlag, 1990.CrossRefGoogle Scholar
  6. 6.
    Gehrchen PM, Nielsen JO, Olesen B. Poor reproducibility of Evan’s classification of the trochanteric fracture. Acta Orthop Scand 1993; 64:71–72.PubMedGoogle Scholar
  7. 7.
    Zuckerman JD. Comprehensive Care of Orthopaedic Injuries in the Elderly. Baltimore: Urban & Schwarzenberg, 1990.Google Scholar
  8. 8.
    Kyle RF, Cabanela ME, Russell TA, et al. Fractures of the proximal part of the femur. Instr Course Lect 1995; 44:227–253.PubMedGoogle Scholar
  9. 9.
    Zuckerman J. Current concepts: hip fracture. NEngl JMed 1996; 334:1519–1525.CrossRefGoogle Scholar
  10. 10.
    Heyse-Moore GH, MacEachern AG, Evans DCJ. Treatment of intertrochanteric fractures of the femur. J Bone Joint Surg Br 1983; 65:262–267.PubMedGoogle Scholar
  11. 11.
    Bannister G, Gibson A, Ackroyd C, Newman J. The fixation and prognosis of trochanteric fractures: a randomized prospective controlled trial. Clin Orthop 1990; 254:242–246.PubMedGoogle Scholar
  12. 12.
    Jacobs R, Armstrong H, Whitaker J, Pazell J. Treatment of intertrochanteric hip fractures with a compression hip screw and a nail plate. J Trauma 1976; 16:599–603.CrossRefPubMedGoogle Scholar
  13. 13.
    Medoff RJ, Maes K. A new device for the fixation of unstable pertrochanteric fractures of the hip. J Bone Joint Surg Am 1991; 73:1192–1199.PubMedGoogle Scholar
  14. 14.
    Watson J, Moed B, Cramer K, Karges D. Comparison of the compression screw with the Medoff sliding plate for intertrochanteric fractures. Clin Orthop 1998; 348:79–86.PubMedGoogle Scholar
  15. 15.
    Choueka J, Koval KJ, Kummer FJ, et al. Biomechanical comparison of the sliding hip screw and the dome plunger. Effects of material and fixation design. J Bone Joint Surg Br 1995; 77:277–283.PubMedGoogle Scholar
  16. 16.
    Chapman MW, Bowman WE, Csongradi JJ, et al. The use of Enders pins in extracapsular fractures of the hip. J Bone Joint Surg Am 1981; 63:14–28.PubMedGoogle Scholar
  17. 17.
    Cobelli N, Sadler A. Ender rod versus compression screw fixation of hip fractures. Clin Orthop 1985; 201:123–129.PubMedGoogle Scholar
  18. 18.
    Elabadien BSZ, Olerud S, Karlstrom G. Ender nailing of peritrochanteric fractures. Results at follow-up evaluation after one year. Clin Orthop 1984; 191:53–63.Google Scholar
  19. 19.
    Harper MC, Walsh T. Ender nailing for pertrochanteric fractures of the femur: an analysis of indications, factors related to mechanical failure, and postoperative results. J Bone Joint Surg Am 1985; 67:79–88.PubMedGoogle Scholar
  20. 20.
    Iwegbu CG, Patel RJ. Difficulties and complications of the Ender method of treatment of trochanteric fractures of the femur. Injury 1981; 13:116–124.CrossRefPubMedGoogle Scholar
  21. 21.
    Jensen JS, Sonne-Holm S, Tondevold E. Unstable trochanteric fractures: a comparative analysis of four methods of internal fixation. Acta Orthop Scand 1980:949–962.Google Scholar
  22. 22.
    Levy RN, Siegel M, Sedlin ED, Siffert R. Complications of Ender-pin fixation in basicervical, intertrochanteric and subtrochanteric fractures of the hip. J Bone Joint Surg Am 1983; 65:66–69.PubMedGoogle Scholar
  23. 23.
    Sernbo I, Johnell O, Gentz G, Nilsson J. Unstable intertrochanteric fractures of the hip: treatment with Ender pins compared with compression hip Screws. J Bone Joint Surg Am 1988; 70:1297–1303.PubMedGoogle Scholar
  24. 24.
    Rao JP, Banzon MT, Weiss AB, Rayhack J. Treatment of unstable intertrochanteric fractures with anatomic reduction and compression hip screw fixation. Clin Orthop 1983; 175:65–71.PubMedGoogle Scholar
  25. 25.
    Waddell J, Czitrom A, Simmons EH. Ender nailing in fractures of the proximal femur. J Trauma 1987:911–916.Google Scholar
  26. 26.
    Halder SC. The Gamma nail for peritrochanteric fractures. J Bone Joint Surg Br 1992; 74:340–344.PubMedGoogle Scholar
  27. 27.
    Leung KS, So WS, Shen WY, Hui PW. Gamma nails and dynamic hip screws for pertrochanteric fractures. A randomized prospective study in elderly patients. J Bone Joint Surg Br 1992; 74:345–351.PubMedGoogle Scholar
  28. 28.
    Boriani S, Bettelli G, Zmerly H, et al. Results of the multicentric Italian experience on the Gamma nail: a report on 648 cases. Orthopedics 1991; 14:1307–1314.PubMedGoogle Scholar
  29. 29.
    Bridle SH, Patel AD, Bircher M, Calvert P. Fixation of intertrochanteric fractures of the femur: a randomized prospective comparison of the gamma nail and the dynamic hip screw. J Bone Joint Surg Br 1991; 73:330–334.PubMedGoogle Scholar
  30. 30.
    Radford PJ, Needoff M, Webb JK. A prospective randomized comparison of the dynamic hip screw and the gamma locking nail. J Bone Joint Surg Br 1993; 75:789–793.PubMedGoogle Scholar
  31. 31.
    Butt M, Krikler S, Naffe S, Ali M. Comparison of dynamic hip screw and gamma nail: a prospective, randomized, controlled trial. Injury 1995; 26:615–618.CrossRefPubMedGoogle Scholar
  32. 32.
    Aune AK, Ekeland A, Odegaard B, et al. Gamma nail vs compression screw for trochanteric femoral fractures: 15 reoperations in a prospective, randomized study of 378 patients. Acta Orthop Scand 1994; 65:127–130.CrossRefPubMedGoogle Scholar
  33. 33.
    Baumgaertner M, Curtin S, Lindskog D. Intramedullary versus extramedullary fixation for the treatment of intertrochanteric hip fractures. Clin Orthop 1998; 348:87–94.PubMedGoogle Scholar
  34. 34.
    Hardy D, Descamps P, Krallis P, et al. Use of an intramedullary hip-screw compared with a compression hip-screw with a plate for intertrochanteric femoral fractures. A prospective, randomized study of one hundred patients. J Bone Joint Surg Am 1998; 80:618–630.PubMedGoogle Scholar
  35. 35.
    Rosenblum SF, Zuckerman JD, Kummer FJ, Tam BS. A biomechanical evaluation of the Gamma nail. J Bone Joint Surg Br 1992; 74:352–357.PubMedGoogle Scholar
  36. 36.
    Dimon JH, Hughston JC. Unstable intertrochanteric fractures of the hip. J Bone Joint Surg Am 1967; 49:440–450.PubMedGoogle Scholar
  37. 37.
    Dimon JH. The unstable intertrochanteric fracture. Clin Orthop 1973; 92:100–107.CrossRefPubMedGoogle Scholar
  38. 38.
    Sarmiento A. Intertrochanteric fractures of the femur: 150-degree-angle nail-plate fixation and early rehabilitation. A preliminary report of 100 cases. J Bone Joint Surg Am 1963; 45:706–722.Google Scholar
  39. 39.
    Sarmiento A, Williams EM. The unstable intertrochanteric fracture: treatment with a valgus osteotomy and I-beam nail-plate. J Bone Joint Surg Am 1970; 52:1309–1318.PubMedGoogle Scholar
  40. 40.
    Kaufer H, Matthews LS, Sonstegard D. Stable fixation of intertrochanteric fractures: a biomechanical evaluation. J Bone Joint Surg Am 1974; 56:899–907.PubMedGoogle Scholar
  41. 41.
    Chang WS, Zuckerman JD, Kummer FJ, Frankel VH. Biomechanical evaluation of anatomic reduction versus medial displacement osteotomy in unstable intertrochanteric fractures. Clin Orthop 1987; 225:141–146.PubMedGoogle Scholar
  42. 42.
    Hopkins CT, Nugent JT, Dimon JH. Medial displacement osteotomy for unstable intertrochanteric fractures. Twenty years later. Clin Orthop 1989; 245:169–172.PubMedGoogle Scholar
  43. 43.
    Gargan MF, Gundle R, Simpson AH. How effective are osteotomies for unstable intertrochanteric fractures? J Bone Joint Surg Br 1994; 76:789–792.PubMedGoogle Scholar
  44. 44.
    Desjardins AL, Roy A, Paiement G, et al. Unstable intertrochanteric fracture of the femur: a prospective randomized study comparing anatomical reduction and medical displacement osteotomy. J Bone Joint Surg Br 1993; 75:445–447.PubMedGoogle Scholar
  45. 45.
    Mulholland RC, Gunn DR. Sliding screw plate fixation of intertrochanteric femoral fractures. J Trauma 1972; 12:581–591.CrossRefPubMedGoogle Scholar
  46. 46.
    Wolfgang GL, Bryant MH, O’Neil JP. Treatment of intertrochanteric fracture of the femur using sliding screw plate fixation. Clin Orthop 1982; 163:148–158.PubMedGoogle Scholar
  47. 47.
    Kyle RF, Wright TM, Burstein AH. Biomechanical analysis of the sliding characteristics of compression hip screws. J Bone Joint Surg Am 1980; 62:1308–1314.PubMedGoogle Scholar
  48. 48.
    Meislin RJ, Zuckerman JD, Kummer FJ, Frankel VH. A biomechanical analysis of the sliding hip screw: the question of plate angle. J Orthop Trauma 1990; 4:130–136.CrossRefPubMedGoogle Scholar
  49. 49.
    Toolan BC, Koval KJ, Kummer FJ, et al. Effects of supine positioning and fracture post placement on the perineal countertraction force in awake volunteers. J Orthop Trauma 1995; 9:164–170.CrossRefPubMedGoogle Scholar
  50. 50.
    Baumgaertner MR, Curtin SL, Lindskog DM, Keggi J. The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg Am 1995; 77:1058–1064.PubMedGoogle Scholar
  51. 51.
    Baumgaertner M, Solberg B. Awareness of the tip-apex distance reduces failure of fixation of trochanteric fractures of the hip. J Bone Joint Surg Br 1997; 79:969–971.CrossRefPubMedGoogle Scholar
  52. 52.
    Reich S, Jaffe W, Kummer F. Biomechanical determination of the optimal number of fixation screws for the sliding hip screw. Bull Hosp Jt Dis 1993; 53:43–44.PubMedGoogle Scholar
  53. 53.
    Yian E, Banerji I, Mathews L. Optimal side plate fixation for unstable intertrochanteric hip fractures. J Orthop Trauma 1997; 11:254–259.CrossRefPubMedGoogle Scholar
  54. 54.
    Gundle R, Gargan MF, Simpson AHRW. How to minimize failures of fixation of unstable intertrochanteric fractures. Injury 1995; 26:611–614.CrossRefPubMedGoogle Scholar
  55. 55.
    Apel DM, Patwardhan A, Pinzur MS, Dobozi WR. Axial loading studies of unstable intertrochanteric fractures of the femur. Clin Orthop 1989; 246:156.PubMedGoogle Scholar
  56. 56.
    Olsson O, Ceder L, Lunsjo K, Hauggaard A. Biaxial dynamization in unstable intertrochanteric fractures. Good experience with a simplified Medoff sliding plate in 94 patients. Acta Orthop Scand 1997; 68:327–331.CrossRefPubMedGoogle Scholar
  57. 57.
    Ceder L, Lunsjo L, Olson O, et al. Different ways to treat subtrochanteric fractures with the Medoff sliding plate. Clin Orthop 1998; 348:101–106.PubMedGoogle Scholar
  58. 58.
    Lunsjo K, Ceder L, Stigsson L, Hauggaard A. One-way compression along the femoral shaft with the Medoff sliding plate: the first European experience of 104 intertrochanteric fractures with a 1 year follow-up. Acta Orthop Scand 1995; 66:343–346.CrossRefPubMedGoogle Scholar
  59. 59.
    Lunsjo K, Ceder L, Stiggson L, Hauggaard A. Two-way compression along the shaft and the neck of the femur with the Medoff sliding plate. J Bone Joint Surg Br 1996; 78:387–390.PubMedGoogle Scholar
  60. 60.
    Swiontkowski MF. Intracapsular hip fractures. In: Browner BD, Levine AM, Jupiter JB, Trafton PG, eds. Skeletal Trauma, Vol 2. Philadelphia: WB Saunders, 1992:1751–1832.Google Scholar
  61. 61.
    Madsen F, Linde F, Anderson E, et al. Fixation of displaced femoral fractures: a comparison between sliding screw plate and four cancellous bone screws. Acta Orthop Scand 1987; 58:212–216.CrossRefPubMedGoogle Scholar
  62. 62.
    Skinner PW, Powles D. Compression screw fixation for displaced subcapital fracture of the femur: success or failure. J Bone Joint Surg Br 1986; 68:78–82.PubMedGoogle Scholar
  63. 63.
    Swiontkowski MF, Harrington RM, Keller TS, Van Patten PK. Torsion and bending analysis of internal fixation techniques for femoral neck fractures: the role of implant design and bone density. J Orthop Res 1987; 5:433–444.CrossRefPubMedGoogle Scholar
  64. 64.
    Blair B, Koval KJ, Kummer F, Zuckerman JD. Basicervical fractures of the proximal femur. A biomechanical study of 3 internal fixation techniques. Clin Orthop 1994; 306:256–263.PubMedGoogle Scholar
  65. 65.
    Mullaji AB, Thomas TL. Low-energy subtrochanteric fractures in elderly patients: results of fixation with the sliding screw plate. J Trauma 1993; 34:56–61.CrossRefPubMedGoogle Scholar
  66. 66.
    Green S, Moore T, Proano F. Bipolar prosthetic replacement of unstable intertrochanteric hip fractions in the elderly. Clin Orthop 1986; 224:169–177.Google Scholar
  67. 67.
    Stern MB, Angerman A. Comminuted intertrochanteric fractures treated with a Leinback prosthesis. Clin Orthop 1987; 218:75–80.PubMedGoogle Scholar
  68. 68.
    Rosenfeld RT, Schwartz DR, Alter AH. Prosthetic replacement for trochanteric fractures of the femur. J Bone Joint Surg Am 1973; 55:420.Google Scholar
  69. 69.
    Stern MB, Goldstein TB. The use of the Leinback prosthesis in intertrochanteric fracture of the hip. Clin Orthop 1977; 128:325–331.PubMedGoogle Scholar
  70. 70.
    Stappaerts KH, Deldycke J, Broos PLO, et al. Treatment of unstable peritrochanteric fractures in elderly patients with a compression hip screw or with the Vandeputte (VDP) endoprosthesis: a prospective randomized study. J Orthop Trauma 1995; 9:292–297.CrossRefPubMedGoogle Scholar
  71. 71.
    Haentjens P, Casteleyn P, Opdecam P. Primary bipolar arthroplasty or total hip replacement for the treatment of unstable intertrochanteric and subtrochanteric fractures in elderly patients. Acta Orthop Belg 1994; 60:124–128.PubMedGoogle Scholar
  72. 72.
    Haentjens P, Casteleyn PP, De Boeck H, et al. Treatment of unstable intertrochanteric and subtrochanteric fractures in elderly patients: primary bipolar arthroplasty compared with internal fixation. J Bone Joint Surg Am 1989; 71:1214–1255.PubMedGoogle Scholar
  73. 73.
    Harrington KD. The use of methylmethacrylate as an adjunct in the internal fixation of unstable comminuted intertrochanteric fractures in osteoporotic patients. J Bone Joint Surg Am 1975; 57:744–750.PubMedGoogle Scholar
  74. 74.
    Muhr C, Tscherne H, Thomas R. Comminuted trochanteric femoral fractures in geriatric patients: the result of 231 cases treated with internal fixation and acrylic cement. Clin Orthop 1979; 138:41–44.PubMedGoogle Scholar
  75. 75.
    Bartucci EJ, Gonzalez MH, Cooperman DR, et al. The effect of adjunctive methylmethacrylate on failures of fixation and function in patients with intertrochanteric fractures and osteoporosis. J Bone Joint Surg Am 1985; 67:1094–1107.PubMedGoogle Scholar
  76. 76.
    Cheng CL, Chow SP, Pun WK, Leong JC. Long-term results and complications of cement augmentation in the treatment of unstable trochanteric fractures. Injury 1989; 20:134–138.CrossRefPubMedGoogle Scholar
  77. 77.
    Goodman SB, Bauer TW, Carter D, et al. Norian SRS cement augmentation in hip fracture treatment. Laboratory and initial clinical results. Clin Orthop 1998; 348:42–50.PubMedGoogle Scholar
  78. 78.
    Harrington K. Orthopaedic Management of Metastatic Bone Disease. St. Louis: CV Mosby, 1988.Google Scholar
  79. 79.
    Walling A, Bahner R. Pathological fractures. In: Koval K, Zuckerman J, eds. Fractures in the Elderly. Philadelphia: Lippincott-Raven, 1998:247–259.Google Scholar
  80. 80.
    Bone L, Bucholz R. The management of fractures in the patient with multiple trauma. J Bone Joint Surg Am 1986; 68:945–949.PubMedGoogle Scholar
  81. 81.
    Johnson KD, Cadambi A, Seibert GB. Incidence of adult respiratory distress syndrome in patients with multiple musculoskeletal injuries: effect of early operative stabilization of fractures. J Trauma 1985; 25:375–384.CrossRefPubMedGoogle Scholar
  82. 82.
    Swiontkowski MF. Ipsilateral femoral shaft and hip fractures. Orthop Clin North Am 1987; 18:73–84.PubMedGoogle Scholar
  83. 83.
    Baumgaertner MR, Chrostowski JH, Levy RN. Intertrochanteric hip fractures. In: Browner BD, Levine AM, Jupiter JB, Trafton PG, eds. Skeletal Trauma, Vol 2. Philadelphia: WB Saunders, 1992:1833–1881.Google Scholar
  84. 84.
    Nordin M, Frankel VH. Biomechanics of the hip. In: Nordin M, Frankel VH, eds. Basic Biomechanics of the Musculoskeletal System. Malvern, PA: Lea & Febiger, 1989:135–151.Google Scholar
  85. 85.
    Ecker ML, Joyce JJI, Kohl EJ. The treatment of trochanteric hip fractures using a compression screw. J Bone Joint Surg Am 1975; 57:23–27.PubMedGoogle Scholar
  86. 86.
    Koval K, Friend K, Aharonoff G, Zuckerman J. Weightbearing after hip fracture: a prospective series of 596 geriatric hip fracture patients. J Orthop Trauma 1996; 10:526–530.CrossRefPubMedGoogle Scholar
  87. 87.
    Aharonoff GB, Koval KJ, Skovron ML, Zuckerman JD. Hip fractures in the elderly: predictors of one year mortality. J Orthop Trauma 1997; 11:162–165.CrossRefPubMedGoogle Scholar
  88. 88.
    Altner PC. Reasons for failure in treatment of intertrochanteric fractures. Orthop Rev 1982; 11:117.Google Scholar
  89. 89.
    Boyd HB, Lipiniski SW. Nonunion of trochanteric and subtrochanteric fractures. Surg Gynecol Obstet 1957; 104:463–470.PubMedGoogle Scholar
  90. 90.
    Hunter GA. The results of operative treatment of trochanteric fractures of the femur. Injury 1975; 6:202–205.CrossRefPubMedGoogle Scholar
  91. 91.
    Mariani EM, Rand JA. Nonunion of intertrochanteric fractures of the femur following open reduction and internal fixation: results of second attempt to gain union. Clin Orthop 1987; 218:81–89.PubMedGoogle Scholar
  92. 92.
    Bodoky A, Neff U, Heberer M, Harder F. Antibiotic prophylaxis with two doses of cephalosporin in patients managed with internal fixation for a fracture of the hip. J Bone Joint Surg Am 1993; 75:61–65.PubMedGoogle Scholar
  93. 93.
    Burnett JW, Gustilo RB, Williams DN, Kind A. Prophylactic antibiotics in hip fractures. A double-blind, prospective study. J Bone Joint Surg Am 1980; 62:457–462.PubMedGoogle Scholar
  94. 94.
    Agarwal N, Reyes JD, Westerman DA, Cayten C. Factors influencing DRG 201 (hip fracture) reimbursement. J Trauma 1986; 26:426–431.CrossRefPubMedGoogle Scholar
  95. 95.
    Versluysen M. Pressure sores in elderly patients: the epidemiology related to hip operations. J Bone Joint Surg Br 1985; 67:10–13.PubMedGoogle Scholar
  96. 96.
    Claffey TJ. Avascular necrosis of the femoral head: an anatomical study. J Bone Joint Surg Br 1960; 42:802–809.PubMedGoogle Scholar
  97. 97.
    Cleveland M, Bosworth DM, Thompson FR, et al. A ten year analysis of intertrochanteric fractures of the femur. J Bone Joint Surg Am 1959; 41:1399–1408.PubMedGoogle Scholar
  98. 98.
    Mann RJ. Avascular necrosis of the femoral head following intertrochanteric fractures. Clin Orthop 1973; 92:108–115.CrossRefPubMedGoogle Scholar
  99. 99.
    Taylor GM, Newfield AJ, Nickel VL. Complications and failures in the operative treatment of intertrochanteric fractures of the femur. J Bone Joint Surg Am 1955; 37:306–316.PubMedGoogle Scholar
  100. 100.
    Brodell JD, Leve AR. Disengagement and intrapelvic protrusion of the screw from a sliding screw plate device, a case report. J Bone Joint Surg Am 1983; 65:697–701.PubMedGoogle Scholar
  101. 101.
    Joseph KN. Acetabular penetration of sliding screw. A case of trochanteric hip fracture. Acta Orthop Scand 1986; 57:245–246.CrossRefPubMedGoogle Scholar
  102. 102.
    Lichtblau S. A pitfall in the insertion of a sliding screw. Bull Hosp Jt Dis 1986:60–62.Google Scholar
  103. 103.
    Manoli A. Malassembly of the sliding screw-plate device. J Trauma 1986; 26:916–922.CrossRefPubMedGoogle Scholar
  104. 104.
    Soballe K. Laceration of the superficial femoral artery by an intertrochanteric fracture fragment. J Bone Joint Surg Am 1987; 69:781–783.PubMedGoogle Scholar
  105. 105.
    Merlino AF, Nixon JE. Isolated fractures of the greater trochanter. Int Surg 1969; 52:117–124.PubMedGoogle Scholar
  106. 106.
    Milch H. Avulsion fracture of the great trochanter. Arch Surg 1939; 38:334–350.CrossRefGoogle Scholar
  107. 107.
    Poston H. Traction fracture of the lesser trochanter of the femur. Br J Surg 1921–1922; 9:256–258.CrossRefGoogle Scholar
  108. 108.
    Kewenter Y. A case of isolated fracture of the lesser trochanter. Acta Orthop Scand 1931; 2:160–165.Google Scholar
  109. 109.
    Bertin KC, Horstman J, Coleman SS. Isolated fracture of the lesser trochanter in adults: an initial manifestation of metastatic malignant disease. J Bone Joint Surg Am 1984; 66:770–773.PubMedGoogle Scholar
  110. 110.
    Gradwohl JR, Mailliard JA. Cough induced avulsion of the lesser trochanter. Nebr Med J 1987; 72:280–281.PubMedGoogle Scholar
  111. 111.
    Phillips C, Pope T, Jones J, et al. Nontraumatic avulsion of the lesser trochanter: a pathognomonic sign of metastatic disease. Skeletal Radiol 1988; 17:106–110.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2000

Authors and Affiliations

  • Kenneth J. Koval
    • 1
    • 2
  • Joseph D. Zuckerman
    • 1
    • 2
  1. 1.Department of Orthopaedic SurgeryNYU — Hospital for Joint DiseasesUSA
  2. 2.Orthopaedic SurgeryNYU School of MedicineUSA

Personalised recommendations