What is the recommended treatment for a 50-year-old male with a fracture of the greater trochanter of the hip secondary to trauma?

Treatment of Greater Trochanter Fracture of Hip in a 50-Year-Old Male Secondary to Trauma

For isolated greater trochanter fractures in a 50-year-old male with trauma, conservative non-surgical management is the recommended first-line treatment unless displacement exceeds 2 cm or the patient has high physical demands requiring full abductor function. 1

Initial Assessment and Classification

• Evaluate fracture pattern and stability using radiographic imaging (X-rays and CT)
• Assess displacement of the fracture (critical threshold is 2 cm)
• Determine if isolated greater trochanter fracture or part of more complex injury
• Rule out associated injuries (acetabular fractures, hip dislocations)

Treatment Algorithm

Conservative Management (First-Line for Most Cases)

• Indications: Displacement less than 2 cm, low to moderate activity demands
• Protocol:
  • Limited weight-bearing with crutches or walker for 4-6 weeks
  • Pain management with appropriate analgesics
  • Activity modification to avoid abductor stress
  • Progressive mobilization as symptoms allow
  • Regular radiographic follow-up at 6 weeks, 3 months, 6 months, and 1 year 2

Surgical Management

• Indications:

  • Displacement greater than 2 cm
  • Young, active patients with high physical demands
  • Persistent pain or significant functional limitation with conservative treatment
  • Athletes requiring full abductor function

• Surgical Options:

  • Open reduction and internal fixation (ORIF) with cable fixation or tension band wiring 3, 4
  • In cases with associated osteolytic lesions, allogeneic bone grafting may be added 5

Rehabilitation Protocol

• Early post-injury/post-surgical rehabilitation:

  • Protected weight-bearing for 4-6 weeks
  • Abduction orthosis may be used in surgical cases 5
  • Early gentle range of motion exercises avoiding abductor stress
  • Progressive strengthening of hip musculature as healing progresses

• Later rehabilitation (6-12 weeks):

  • Progressive weight-bearing as tolerated
  • Balance training and multidimensional fall prevention 6
  • Return to full activities typically at 3-4 months based on radiographic healing and functional recovery

Expected Outcomes and Prognosis

• Most isolated greater trochanter fractures heal well with conservative management 7
• Approximately 60% of patients remain asymptomatic throughout treatment 7
• For symptomatic patients, pain and limp typically improve over several months 7
• Only 10% of patients experience increased displacement during healing 7

Monitoring and Follow-up

• Clinical assessment for pain, limp, and abductor function
• Radiographic evaluation at regular intervals (6 weeks, 3 months, 6 months, 1 year) 2
• Consider surgical intervention if persistent symptoms and functional limitation after 3-6 months of conservative management

Potential Complications

• Persistent pain or limp (approximately 10% of cases) 7
• Decreased abductor function
• Nonunion (rare with appropriate treatment)
• Post-surgical complications if ORIF performed (infection, hardware failure)

Special Considerations

• For younger patients with high physical demands, surgical treatment may be considered earlier to restore optimal abductor function 1
• In older patients, assessment for underlying bone quality and consideration of osteoporosis treatment may be warranted 6
• Direction of displacement is typically medially and superiorly toward the femoral head 7