Noh Jongho, Lee Kee Haeng, Jung Sehoon, Hwang Sunwook
Department of Orthopedic Surgery, The Catholic University of Korea, Bucheon St. Mary's Hospital, Bucheon, Korea.
Hip Pelvis. 2019 Mar;31(1):23-32. doi: 10.5371/hp.2019.31.1.23. Epub 2019 Mar 5.
Isolated greater trochanteric (GT) fractures are often identified using plain radiography of patients with post-traumatic hip pain. In many cases, the fracture extends to form an occult intertrochanteric fracture. We conducted a study to determine the frequency of occult intertrochanteric fractures in patients diagnosed with isolated GT fractures using plain radiographs.
Among 3,017 individuals who visited our emergency department with a trauma-induced pertrochanteric femur fracture between July 2004 and March 2018, 100 patients diagnosed with isolated GT fractures using plain radiographs were retrospectively analyzed. Patients were divided into two groups, those with: i) isolated GT fractures (group A) and ii) occult intertrochanteric fractures (group B). In addition, plain radiographs, magnetic resonance imaging results, and treatment methods were further analyzed in each group. If surgery treatment was needed, it was performed by one surgeon, and in all cases, a 2-hole dynamic hip screw was used.
Among the 100 cases of isolated GT fractures diagnosed using plain radiograph, additional examinations revealed that 10 (10.0%) were suffering from isolated GT fractures alone, while the remaining 90 (90.0%) were further diagnosed with occult intertrochanteric fracture. Gender, age, mechanism of injury, and bone mineral density did not correlate with fracture type.
In our analysis, 90% of injuries initially diagnosed as isolated GT fractures were found to extend into occult intertrochanteric fractures upon further examination with additional imaging modalities. Therefore, additional evaluation should be performed to test for the potential presence of occult intertrochanteric fractures and to establish appropriate treatment plans.
创伤后髋部疼痛患者常通过X线平片来诊断单纯性大转子骨折。在很多情况下，骨折会延伸形成隐匿性转子间骨折。我们开展了一项研究，以确定通过X线平片诊断为单纯性大转子骨折的患者中隐匿性转子间骨折的发生率。
回顾性分析了2004年7月至2018年3月间因创伤性股骨转子周围骨折前来我院急诊科就诊的3017例患者，其中100例经X线平片诊断为单纯性大转子骨折。患者分为两组：i）单纯性大转子骨折组（A组）和ii）隐匿性转子间骨折组（B组）。此外，对每组患者的X线平片、磁共振成像结果及治疗方法进行了进一步分析。如需手术治疗，则由一名外科医生进行，所有病例均使用双孔动力髋螺钉。
在100例经X线平片诊断为单纯性大转子骨折的病例中，进一步检查发现10例（10.0%）仅为单纯性大转子骨折，其余90例（90.0%）进一步诊断为隐匿性转子间骨折。性别、年龄、损伤机制和骨密度与骨折类型无关。
在我们的分析中，最初诊断为单纯性大转子骨折的损伤中，90%经进一步影像学检查发现延伸为隐匿性转子间骨折。因此，应进行额外评估以检测隐匿性转子间骨折的潜在存在，并制定合适的治疗方案。
