Follow-up Schedule for Greater Trochanter Fractures
For isolated greater trochanter fractures, follow-up should occur at 2-4 weeks after initial diagnosis, then at 6-8 weeks, and again at 12 weeks to assess for fracture healing and functional recovery.
Initial Assessment and Classification
The appropriate follow-up schedule for greater trochanter fractures depends on several factors:
- Fracture characteristics: Isolated vs. extension into intertrochanteric region
- Displacement: Non-displaced (<2 cm) vs. displaced (>2 cm)
- Patient factors: Age, activity level, comorbidities
- Treatment approach: Conservative vs. surgical
Diagnostic Imaging
- Initial evaluation should include plain radiographs of the hip 1
- When radiographs are equivocal or negative but clinical suspicion remains high, MRI without contrast is recommended as the next imaging study 1
- MRI can accurately identify isolated greater trochanter fractures and determine if there is extension into the intertrochanteric region 1
Follow-up Protocol for Conservative Management
Most isolated greater trochanter fractures can be treated non-operatively with good outcomes 2:
First Follow-up (2-4 weeks)
- Clinical evaluation for pain, mobility, and Trendelenburg gait
- Radiographs to assess fracture position
- Evaluate compliance with weight-bearing restrictions
- Assess need for assistive devices
Second Follow-up (6-8 weeks)
- Repeat radiographs to evaluate early healing
- Assess pain levels and functional recovery
- Begin progressive weight bearing if radiographic and clinical improvement noted
- Initiate physical therapy focusing on hip abductor strengthening
Third Follow-up (12 weeks)
- Radiographic evaluation for fracture healing (bone healing typically occurs within 3-5 months) 3
- Functional assessment including gait analysis and Trendelenburg sign
- Discontinue assistive devices if appropriate
Additional Follow-up (6 months)
- Final radiographic assessment to confirm complete healing or fibrous union
- Full functional evaluation
Weight-bearing Recommendations
- For non-displaced isolated greater trochanter fractures confirmed by MRI, immediate weight-bearing as tolerated may be appropriate 4
- For displaced fractures or those with intertrochanteric extension, protected weight-bearing for 6-12 weeks is recommended 3
- Avoidance of active abduction until union is complete or pain-free 3
Surgical Management Follow-up
For patients requiring surgical intervention (displaced >2 cm, young active patients, or athletes) 2:
Post-operative Follow-up
- 2 weeks: Wound check, suture removal, radiographs
- 6 weeks: Radiographs to assess early healing and hardware position
- 12 weeks: Radiographic evaluation of healing, functional assessment
- 6 months: Evaluation of complete healing and functional recovery
Special Considerations
Elderly Patients
- More frequent follow-up may be needed (every 2-4 weeks initially)
- Particular attention to preventing deconditioning and maintaining mobility
- Consider bone health assessment and treatment for osteoporosis
Young, Active Patients
- May benefit from more aggressive rehabilitation protocols
- Consider earlier follow-up (1-2 weeks) to initiate controlled rehabilitation
- More frequent imaging may be warranted to ensure proper healing before return to activities
Complications to Monitor
- Persistent pain beyond 3 months
- Development of Trendelenburg gait
- Non-union or fibrous union (occurs in approximately 60% of cases) 3
- Hardware complications in surgically treated cases
Conclusion
While most greater trochanter fractures heal well with conservative management, appropriate follow-up is essential to ensure optimal outcomes. The standard follow-up schedule of 2-4 weeks, 6-8 weeks, and 12 weeks provides adequate monitoring of healing progression and functional recovery for most patients.