Greater Trochanter Fracture
Fractures of the greater trochanter in the pediatric patient are rare injuries in isolation. Most nonpathological fractures result from high-energy trauma and can often involve associated fractures of the proximal femur. Treatment is guided by degree of displacement and extent of associated injury to the proximal femur. Minimally displaced fractures of the greater trochanter can be treated nonsurgically with spica casting in young children (<5 years old) and with protected weight-bearing in older children. Anatomic reduction and stable fixation are indicated for nearly all displaced hip fractures in children. Fixation options range from screw fixation of the greater trochanter alone, to a construct including a compression screw and side plate or fixed angle device (blade plate; proximal femoral locking plate) in proximal femur fractures. In displaced fractures, achievement of fracture stability is prioritized over the preservation of the proximal femoral physis and/or the trochanteric apophysis. Complications after this injury are frequent in children due to the vulnerability of the proximal femur to vascular or physeal injury. Avascular necrosis, angular deformity of the proximal femur, premature physeal closure, and nonunion are complications that account for poor outcomes. These injuries require careful follow-up until both fracture healing and skeletal maturity.
References and Suggested Reading
- Swiontkowski M (2003) Fractures and dislocations about the hips and pelvis. Elselvier, Skeletal Trauma in ChildrenGoogle Scholar