Rohinth S, Tarun Prashanth K R, Thirunthaiyan M R, Dorai Kumar R, Sundararaja B
Department of Orthopedic Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.
J Orthop Case Rep. 2025 Jun;15(6):131-135. doi: 10.13107/jocr.2025.v15.i06.5690.
Femoral fractures in the transtrochanteric region and avulsion of the greater trochanter in skeletally immature individuals occur due to high-energy trauma. Due to the unique anatomy and blood supply of the proximal femur in growing children, these fractures are notorious for high rates of complications despite appropriate management. Classification of these fractures is done according to the Delbet system and AO classification, which not only guides management but also provide prognostic clues. Multiple fixation methods have been described, and there is no consensus on what constitutes the best treatment. Non-union, coxa vara, and pre-mature physeal arrest are the most frequent complications. The association of a transverse transtrochanteric proximal femur fracture with avulsion of the greater trochanter in a young patient, to the best of our knowledge, has not been previously described in the literature.
We present the case of a 16-year-old boy who sustained an injury to the right hip following a high-velocity road traffic accident. Initial clinical examination revealed severe swelling and tenderness in the hip joint, and imaging confirmed a transtrochanteric transverse fracture with a greater trochanter avulsion fracture. Higher imaging, such as computed tomography, was performed to understand the fracture anatomy. Surgical management involved open reduction and internal fixation of the proximal femur. Post-operative rehabilitation focused on joint mobility and strength, and the patient achieved full weight-bearing and near-complete range of motion by 3 months.
A transtrochanteric transverse fracture with greater trochanter avulsion requires appropriate surgical intervention, which helps in early mobilization and prevents long-term complications.
骨骼未成熟个体的转子间区域股骨骨折及大转子撕脱是由高能创伤引起的。由于生长中儿童近端股骨独特的解剖结构和血供，尽管进行了适当的处理，这些骨折的并发症发生率仍很高，因而声名狼藉。这些骨折根据德尔贝（Delbet）系统和AO分类法进行分类，这不仅能指导治疗，还能提供预后线索。已经描述了多种固定方法，对于什么是最佳治疗方法尚无共识。骨不连、髋内翻和过早骨骺阻滞是最常见的并发症。据我们所知，一名年轻患者的股骨近端转子间横行骨折合并大转子撕脱，此前文献中尚未有过描述。
我们报告一例16岁男孩，在高速道路交通事故中右髋部受伤。初步临床检查发现髋关节严重肿胀和压痛，影像学检查证实为转子间横行骨折合并大转子撕脱骨折。进行了更高分辨率的成像检查，如计算机断层扫描，以了解骨折的解剖结构。手术治疗包括股骨近端切开复位内固定。术后康复侧重于关节活动度和力量训练，患者在3个月时实现了完全负重和接近完全的活动范围。
转子间横行骨折合并大转子撕脱需要适当的手术干预，这有助于早期活动并预防长期并发症。
