Multiplanar Reformation Computed Tomogram Is Better Than MR Imaging in Decision Making for Apparently Isolated Fractures of the Greater Trochanter

Kim, Ju‐Young; Yoon, Hyeong Jo; Yoo, Jeong Joon; Kim, Hee Joong

doi:10.1097/bot.0b013e31827d0ad8

Cited by 6 publications

(3 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While MR imaging has an advantage in detecting an occult fracture and viewing intramedullary extension, MPR CT is more sensitive in detecting cortical bone integrity, which may be more critical for fracture stability. Our results suggest that conservative treatment can be used if cortical breakage is not detected on MPR CT regardless of the extent of the intramedullary intertrochanteric extension on MR images, which is also supported by the results of a small number of cases by Kim et al 17) …”

Section: Discussionsupporting

confidence: 88%

Further Imaging for Suspected Isolated Greater Trochanteric Fractures: Multiplanar Reformation Computed Tomography or Magnetic Resonance Imaging

et al. 2022

Self Cite

View full text Add to dashboard Cite

Background Most isolated greater trochanter (IGT) fractures are treated conservatively. However, some require surgical fixation although indications for surgery have not yet been established. Many surgeons perform surgical fixation when the intertrochanteric extension crosses the midline on magnetic resonance (MR) images. Nevertheless, for mechanical strength, cortical bone integrity is more important than that of intramedullary cancellous trabeculae. We retrospectively evaluated the clinical usefulness of multiplanar reformation computed tomography (MPR CT) in determining treatment strategies for IGT fractures. Methods We evaluated 99 cases of suspected IGT fractures between October 2004 and December 2019. They were 66 women and 33 men with a mean age of 77 years. The mean follow-up period was 34 months. Most patients were evaluated with plain radiographs, followed by additional imaging study via MPR CT in 65 cases, magnetic resonance imaging (MRI) in 5 cases, and both in 17 cases. Typically, fractures were fixed surgically when a cortical breakage was detected in the intertrochanteric area on MPR CT, while fractures without evidence of cortical breakage on MPR CT were treated conservatively. Results In 13 out of 82 cases evaluated by MPR CT, incomplete cortical breakage in the intertrochanteric area was detected, of which 10 were treated surgically. The remaining 3 cases were treated conservatively due to patient’s refusal, poor medical condition, and failure to detect breakage. Of 69 cases without cortical breakage, 61 cases were successfully treated conservatively. Among the 17 cases evaluated by both MPR CT and MRI, cortical breakage was detected in 3, of which the intertrochanteric extension crossed the midline on the MR image only in 1 case. Of the remaining 14 cases without breakage, the intertrochanteric extension crossed the midline in 5. Among these 5 cases, 3 were treated conservatively. Conclusions The results suggest that MPR CT is a useful imaging modality for further evaluation of IGT fractures. It was especially valuable in evaluating cortical bone integrity, which may be more critical for fracture stability.

show abstract

Section: Discussionsupporting

confidence: 88%

Further Imaging for Suspected Isolated Greater Trochanteric Fractures: Multiplanar Reformation Computed Tomography or Magnetic Resonance Imaging

et al. 2022

Self Cite

View full text Add to dashboard Cite

show abstract

“…Surgical fixation was necessary for 61 patients, with a pooled percentage of 55 % (Table 2 ). The dynamic hip screw (DHS) was the most commonly used device for internal fixation of fractures of the intertrochanteric region [ 2 , 10 , 22 ]. Five proximal femoral nails (3 Stryker Gamma 3 and 2 Zimmer ITST) and 3 sliding hip hooks were also used [ 23 ].…”

Section: Resultsmentioning

confidence: 99%

“…GT nonunion was noted on imaging studies in 1 patient from the conservative-care group, and the patient experienced residual pain. This patient was treated with open reduction and internal fixation 15 months after the initial trauma [ 22 ]. Inconsistencies in reporting made it difficult to analyze the rehabilitation protocols.…”

Section: Resultsmentioning

confidence: 99%

Is magnetic resonance imaging necessary in isolated greater trochanter fracture? A systemic review and pooled analysis

Kim

Ahn

Kim

2015

BMC Musculoskelet Disord

View full text Add to dashboard Cite

BackgroundIsolated fractures of the greater trochanter (GT) of the femur are uncommon and few studies have assessed the diagnosis and appropriate therapeutic schedule for these fractures. The current data regarding assessment of isolated fractures of the GT are limited to a few reviews based on the experience of a single institution. Therefore, we asked the following questions: (1) what proportion of cases has an associated extension of the fracture into the intertrochanteric region in isolated GT fracture and (2) what are the treatment options and outcomes of GT fractures with occult intertrochanteric fractures.MethodsWe conducted a systematic review of published studies that evaluated patients who displayed isolated GT fracture on routine radiographic examination and underwent a magnetic resonance imaging (MRI) scan because of the suspicion of extension into the intertrochanteric region. A structured literature review of multiple databases (PubMed, EMBASE, CINAHL, and Cochrane systematic reviews) referenced articles from 1950 to 2015.ResultsA total of 110 patients were identified from 7 published studies. MRI documented isolated GT fractures diagnosed on initial radiographs in only 11 of 110 patients (10 %). In 99 patients (90 %), MRI examinations revealed extension of the fracture into the intertrochanteric region. Surgical fixation was necessary for 61 patients, with a pooled percentage of 55 %. No complications were observed after surgery.ConclusionsOur study has helped to elucidate further the assessment of isolated fracture of the GT. We believe that MRI is a reasonable option for patients presenting with isolated GT fracture on plain radiographs.

show abstract

How can MRI change the treatment strategy in apparently isolated greater trochanteric fracture?

Park

Shon

Chang

et al. 2018

Injury

View full text Add to dashboard Cite

Multiplanar Reformation Computed Tomogram Is Better Than MR Imaging in Decision Making for Apparently Isolated Fractures of the Greater Trochanter

Abstract: The evaluation of IFGT with MPR CT was shown to be valuable for determining the optimal treatment method.

Cited by 6 publications

References 15 publications

Further Imaging for Suspected Isolated Greater Trochanteric Fractures: Multiplanar Reformation Computed Tomography or Magnetic Resonance Imaging

Further Imaging for Suspected Isolated Greater Trochanteric Fractures: Multiplanar Reformation Computed Tomography or Magnetic Resonance Imaging

Is magnetic resonance imaging necessary in isolated greater trochanter fracture? A systemic review and pooled analysis

How can MRI change the treatment strategy in apparently isolated greater trochanteric fracture?

Contact Info

Product

Resources

About