Diagnosing occult pertrochanteric fractures of proximal femur with MRi
Bartonícek, J.; Sprindrich, J.; Skála-Rosenbaum, J.; Fric, V.
Rozhledy V Chirurgii Mesicnik Ceskoslovenske Chirurgicke Spolecnosti 86(7): 379-383
2007
ISSN/ISBN: 0035-9351 PMID: 17879717 Document Number: 609954
A group of 9 patients with a suspected fracture of the hip underwent radiography and subsequently magnetic resonance imaging (MRI) diagnosis. Radiographic findings were in 2 cases negative and in 7 cases the radiographs revealed a fissure or fracture of the greater trochanter. MRI proved a complete pertrochanteric fracture in 1 case, an incomplete pertrochanteric fracture in 8 cases and in all the 9 cases a fracture of the greater trochanter. Occult pertrochanteric fractures were readily demonstrated with frontal scans. Sagittal and transversal scans showed only more precisely the course of the fracture line and involvement of the intertrochanteric crest, if any. Among the 9 patients, 6 were managed conservatively and 3 patients were treated with a 2-hole DHS (dynamic hip screw). Indication for surgery was based primarily on the scope of the patients' subjective complaints and on their general condition. All the 9 patients healed without complications. The authors indicate MR imaging diagnosis in clinically suspected fractures of the proximal femur where the radiographic finding is negative. Fractures with a radiographic finding of a fissure or fracture of the greater trochanter should be examined by MRI that in most cases reveals an occult pertrochanteric fracture.