Triple Surgical Fixation Technique for an Isolated Greater Trochanter Fracture in an Amateur Weightlifter

Abstract

Isolated greater trochanter fractures have been infrequently described in the literature and are typically managed conservatively. Functional strength after injury to the abductor complex can be markedly affected resulting in a Trendelenburg gait and overall abductor weakness. We present a case of a 35-year-old athlete who underwent surgical fixation because of notable fracture displacement and function debility. This case vignette demonstrates the importance of using all available interdisciplinary orthopaedic surgery literature to provide a patientspecific surgical construct. Our patient benefitted from arthroscopic, arthroplasty, and trauma evidence-based medicine to successfully treat his displaced greater trochanteric hip fracture. Successful surgical fixation was enhanced by combining three different methods of fixation: osteosynthesis with partially threaded screws and washers (DePuy Synthes), suture anchor (Arthrex) direct fracture approximation and tendon reinforcement, and a knotless double-row suture bridge (Arthrex) tension band construct. The patient was able to return weightlifting at 4 months postoperatively with no evidence of weakness or trendelenburg gait. I solated greater trochanter (GT) fractures are rare injuries, and recent literature has mainly focused on the incidence and treatment of intertrochanteric fracture extension in the elderly and periprosthetic fractures. [1][2][3][4][5] Magnetic resonance imaging (MRI) is recommended to fully evaluate the extent of the injury and identify notable intertrochanteric extension. 1,4,[6][7][8][9] Surgical indications for isolated greater trochanteric fractures without notable intertrochanteric extension are not clearly defined because of the lack of evidence on the topic. [4][5][6][7] Young, active patients with large, displaced GT fragments may benefit from surgical fixation as opposed to nonsurgical treatment due to the risk of diminished abductor function. 10 In this clinical vignette, we describe the clinical course and novel triple fixation surgical technique of a young, active patient who sustained an isolated displaced GT fracture after a motor vehicle collision.