Pritchett J W
Department of Orthopaedic Surgery, University of Washington, Seattle, USA.
Clin Orthop Relat Res. 2001 Sep(390):221-6. doi: 10.1097/00003086-200109000-00025.
Fracture of the femur is one of the common complications of hip replacement surgery. Five percent of femur fractures involve just the greater trochanter. This series consisted of 21 women and nine men with fractures of just the greater trochanter after total or partial hip replacement. The fracture was displaced 2.5 cm or less in 90% of patients. Only three (10%) patients had an increase in the amount of displacement more than 2 months after the fracture was recognized. The direction of displacement was always medially and superiorly toward the femoral head, rather than directly superiorly as in an ununited trochanteric osteotomy. For 18 (60%) patients, the fracture was asymptomatic. For 12 patients, the fracture was painful or there was a significant limp. In six of the 12 patients, the pain and limp improved over several months. There were no dislocations or subluxations in this series. Three patients continued to have pain or limp but thought it was not severe and declined surgical repair and experienced progressive improvement. In three patients, the pain, a limp, or both persisted at 1 year and the displacement was 2 cm or more. These three patients underwent operative repair of the trochanter. Two patients experienced improvement after repair of the trochanter. The conclusion was that fractures of the greater trochanter generally are stable and usually do not require additional treatment.
股骨骨折是髋关节置换手术的常见并发症之一。5%的股骨骨折仅累及大转子。本系列研究包括21名女性和9名男性，他们在全髋关节或半髋关节置换术后仅发生了大转子骨折。90%的患者骨折移位2.5厘米或更少。只有3名（10%）患者在骨折被发现后2个月以上移位量增加。移位方向总是向内侧和上方朝向股骨头，而不像转子间截骨不愈合那样直接向上。18名（60%）患者的骨折无症状。12名患者的骨折有疼痛或明显跛行。12名患者中有6名，疼痛和跛行在几个月内有所改善。本系列中没有脱位或半脱位情况。3名患者持续存在疼痛或跛行，但认为不严重，拒绝手术修复，病情逐渐改善。3名患者在1年时疼痛、跛行或两者都持续存在，移位2厘米或更多。这3名患者接受了转子手术修复。2名患者在转子修复后病情改善。结论是，大转子骨折通常是稳定的，通常不需要额外治疗。
