Lessons from fixation failure in isolated greater trochanter fracture: A case report

• Author Details:   
• J.S.R.G Saran ^*
• Varun Devdass
• Wasal Sartaj Khan,
• Praneeth Divi
• Durai Anand Thanigachalam

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Isolated fractures of the greater trochanter (GT) are rare and seen usually in the elderly population due to direct impact injuries and also in young athletes due to avulsion caused by the strong pull of the abductor muscles. They are generally identified on radiographs and confirmed with computed tomography or magnetic resonance imaging, the latter being the better modality in detecting intra-osseous fracture extensions. The management is determined depending on the extent of involvement of the intertrochanteric area. Historically, they were treated conservatively, but with recent advances, surgical management is preferred for early rehabilitation. We present a case of an elderly male diagnosed with isolated minimally displaced GT fracture with no intertrochanteric extension. He underwent a fully threaded cortico-cancellous screw fixation to stabilize the fragment but on follow up, the radiograph showed superior displacement of the GT fragment even though he was asymptomatic with return to daily activities. Therefore, our report stresses on proper pre-operative planning, decision on the surgical procedure while following the principles of reduction to prevent failure of implant.

Keywords: Fixation failure, Isolated greater trochanter fractures, Cortico-cancellous screws.