Liu Hai-Chang, Liu Gang
Department of Orthopedics, Yangquan Second People's Hospital, Shanxi 045011, China.
Zhonghua Yi Xue Za Zhi. 2012 May 22;92(19):1349-51.
To explore the treatment of greater trochanter fracture after total hip replacement (THR).
This series consisted of 3 males and 8 females with fractures of greater trochanter after total or partial hip replacement from 2004 to 2009. The mean age at the time of fracture diagnosis was 69 years old (range: 52 - 79). Two fractures were seen on radiograph at Day 2 postoperation and 3 found during a regular follow-up within the first 7 months after primary THR. They had no symptoms. Six patients fell and five of them occurred over 2 years after THR. The average migration between trochanter and proximal femur were 12 mm (range: 3 - 38). Ten cases underwent protected weight bearing for 6 - 12 weeks and avoidance of active abduction until union was complete or there was no pain. Only one case suffered hip dislocation with a 38-mm migration and underwent operative repair of greater trochanter with suture. Hip pain, instability, range of motion and Trendlenburg gait were examined during a regular follow-up. Evaluations of fracture migration and bone healing were performed from the radiograph of AP and lateral views of hip.
There was no patient loss. The mean follow-up period was 40 months (range: 12 - 68). All had nearly normal function and no symptoms at the latest follow-up. For 10 non-operatively treated cases, the fractures remained non-displaced and the Trendlenburg sign was negative at the final visit. Bone healing occurred in 5 patients. Fibrous union occurred in another 6 patients.
The post-THR fractures of greater trochanter are usually stable and may be treated non-operatively.
