From the Guidelines
The treatment of an acute nondisplaced greater trochanteric fracture in the emergency department should involve pain management with nonopioid analgesic therapies, protected weight-bearing with assistive devices, and orthopedic follow-up. Patients should be prescribed appropriate analgesics such as acetaminophen 650-1000mg every 6 hours and/or NSAIDs like ibuprofen 400-600mg every 6-8 hours if not contraindicated, as recommended by the Annals of Emergency Medicine 1. For more severe pain, a short course of opioids may be considered, such as oxycodone 5-10mg every 4-6 hours for 3-5 days, but this should be done with caution and only when necessary, as stated in the clinical policy for critical issues related to opioids in adult patients presenting to the emergency department 1. Weight-bearing as tolerated with crutches or a walker is recommended to reduce stress on the fracture site while maintaining mobility. Some key points to consider in the management of these fractures include:
- Patients should be instructed on proper crutch use and advised to avoid activities that cause pain.
- Ice can be applied to the hip area for 20 minutes every 2-3 hours for the first 48-72 hours to reduce swelling and pain.
- Orthopedic follow-up should be arranged within 1-2 weeks to reassess the fracture and adjust the treatment plan. The use of multimodal analgesia, including peripheral block, is also recommended for pain mitigation, as seen in the management of hip fractures in older adults 1. This approach is effective because nondisplaced greater trochanteric fractures generally have good healing potential with conservative management, as the fracture fragments remain in anatomical alignment and the surrounding musculature provides stability to the fracture site.
From the Research
Treatment of Acute Nondisplaced Greater Trochanteric Fracture in ED
- The treatment of acute nondisplaced greater trochanteric fracture in the emergency department (ED) may involve conservative management with crutches and orthopedic follow-up, along with pain control 2, 3.
- A study published in 2023 found that conservative treatment of greater trochanteric fractures with occult intertrochanteric fractures resulted in similar outcomes to surgical treatment, with no significant differences in functional ambulation category scores or length of hospital stay 2.
- Another study published in 2020 found that greater trochanteric fractures with intertrochanteric extension identified on MRI had a low likelihood of displacement and high union rates when treated nonoperatively, with none of the 15 patients in the study requiring operative intervention 3.
- However, some studies suggest that surgical treatment may be necessary for certain types of fractures, such as those with significant intertrochanteric extension or in elderly patients with multiple comorbidities 4, 5.
- The use of crutches and orthopedic follow-up, along with pain control, may be a suitable treatment plan for acute nondisplaced greater trochanteric fractures in the ED, but the decision to operate or not should be made on a case-by-case basis, taking into account the individual patient's characteristics and fracture pattern 2, 3.
Considerations for Treatment
- The treatment plan should be individualized based on the patient's age, medical history, and fracture characteristics 4, 5.
- MRI may be useful in identifying intertrochanteric extension and guiding treatment decisions 3, 5.
- Surgical treatment may be necessary for fractures with significant intertrochanteric extension or in elderly patients with multiple comorbidities 4, 5.
- Conservative treatment with crutches and orthopedic follow-up, along with pain control, may be a suitable option for acute nondisplaced greater trochanteric fractures in the ED 2, 3.