628 - Isolated Greater Trochanter Fractures of the Native Hip: Is Magnetic Resonance Imaging Needed?

Friday, February 23, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

AV

Amoolya Vayalapalli, BS

Medical Student
Medical College of Georgia
Duluth, Georgia, United States

Co-Author(s)

AV

Ankita Vayalapalli, BS

Medical Student
Medical College of Georgia
Augusta, Georgia, United States
TM

Thomas Moore, MD

Department of Orthopedics, Assistant Professor
Emory University School of Medicine
Atlanta, Georgia, United States

Objectives: Hip fractures are associated with high rates of morbidity, mortality, and financial distress. Isolated greater trochanter (GT) fractures, a subset of hip fractures, occur due to direct trauma. Unfortunately, radiographs poorly display complications of these fractures, esp. extensions into the intertrochanteric region. Propagation of this fracture is evaluated with CT and MRI scans. Yet management of GT fractures are debated. This study evaluates adherence of an urban, Level I trauma center upon its treatment protocols for isolated GT fractures and their corresponding outcomes.

Design: After IRB approval, all patients (18+) with isolated GT fractures from 10/2015 to 12/2021 were identified with the aid of our institution’s billing database. Imaging modalities and biological variables were determined from a chart review. Differences in average modified Frailty Index (mFI) scores between treatment options were analyzed utilizing Student’s t-tests. Generalized linear regression was performed to determine differences in the average length of stay based on imaging modalities and management techniques.

Results: 57 patients met inclusion criteria for isolated GT fractures. Initial CT scans were performed on 52 patients, but only 41 patients had MRI scans. Of those who obtained an MRI, 10 patients showed < 50% fracture line extension and were treated nonoperatively. Meanwhile, 24 of the 41 patients showed >50% extension, but only 14 patients were treated operatively. MR imaging increased hospital stay by an average of 5.4 days. Nonoperative management increased hospital stay by 3.1 days.

Conclusions: Our protocol suggests that patients with a fracture extending >50% into the IT region on MRI should undergo surgical stabilization. However, only 14 of 24 patients with >50% extension underwent surgery. Despite this deviation, conservatively managed patients presented with no complications. This retrospective review questions the need for MR imaging and surgery in GT fractures and suggests re-evaluation of protocols for those with fracture extension.