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MRI of Seemingly Isolated Greater Trochanteric Fractures

¹ Both authors: Department of Radiology, New York Presbyterian Hospital, 622 W 168th St., New York, NY 10032.

View larger version (112K): [in a new window]   Fig. 1A. —70-year-old woman who presented in emergency department with right hip pain after trauma. Anteroposterior radiograph shows only isolated greater trochanteric fracture (arrows).

View larger version (68K): [in a new window]   Fig. 1B. —70-year-old woman who presented in emergency department with right hip pain after trauma. Radionuclide-enhanced bone scintiscan obtained on same day as A shows radionuclide predominantly concentrated in greater trochanter.

View larger version (180K): [in a new window]   Fig. 1C. —70-year-old woman who presented in emergency department with right hip pain after trauma. Coronal T1-weighted MR image (TR/TE, 700/30; slice thickness, 5 mm; interslice, 0) shows right greater trochanteric fracture (arrow) extending to intertrochanteric region without involving medial cortex.

View larger version (87K): [in a new window]   Fig. 1D. —70-year-old woman who presented in emergency department with right hip pain after trauma. Axial T1-weighted MR image (700/30; slice thickness, 3 mm; interslice, 0) confirms that fracture (arrow) fails to extend to medial femoral cortex.

View larger version (129K): [in a new window]   Fig. 1E. —70-year-old woman who presented in emergency department with right hip pain after trauma. Anteroposterior tomogram (slice thickness, 2 mm) obtained immediately after injury only shows greater trochanter fracture (arrow) on multiple sections.

View larger version (147K): [in a new window]   Fig. 2A. —87-year-old man who presented with left hip pain immediately after trauma. Anteroposterior radiograph shows only isolated greater trochanteric fracture (arrow), with fragments displaced upward, medially, and posteriorly.

View larger version (115K): [in a new window]   Fig. 2B. —87-year-old man who presented with left hip pain immediately after trauma. Axial CT scan (slice thickness, 3 mm) corroborates findings on routine radiograph (A), with fracture (arrows) confined to greater trochanter.

View larger version (112K): [in a new window]   Fig. 2C. —87-year-old man who presented with left hip pain immediately after trauma. Axial T1-weighted spin-echo MR image (TR/TE, 600/14; slice thickness, 3 mm; interslice section, 0) shows fractured left greater trochanter (arrows) with focally decreased signal.

View larger version (94K): [in a new window]   Fig. 2D. —87-year-old man who presented with left hip pain immediately after trauma. Coronal T1-weighted spin-echo MR image (600/14; slice thickness, 3 mm; interslice section, 0) shows greater tuberosity fracture (thick arrow) extending to medullary diaphysis (thin arrow).

View larger version (161K): [in a new window]   Fig. 3A. —60-year-old man who presented with left hip pain after trauma. Anteroposterior radiograph shows only isolated greater trochanteric fracture (arrow), with fragments displaced upward, medially, and posteriorly.

View larger version (72K): [in a new window]   Fig. 3B. —60-year-old man who presented with left hip pain after trauma. Axial CT scan (slice thickness, 3 mm) obtained with bone algorithm reveals left greater trochanter fracture (arrow) on this and other reconstructed planes.

View larger version (105K): [in a new window]   Fig. 3C. —60-year-old man who presented with left hip pain after trauma. Axial T1-weighted spin-echo MR image (TR/TE, 600/14; slice thickness, 3 mm; interslice section, 0) shows diminished signal (arrows) confined to left greater trochanter with edema in femoral neck that coincides with CT evidence of isolated injury.

View larger version (88K): [in a new window]   Fig. 3D. —60-year-old man who presented with left hip pain after trauma. Coronal T2-weighted fast spin-echo fat-suppressed MR image (5,300/90) shows greater trochanter (upper arrow) and intertrochanteric and mid diaphyseal fracture extensions (lower arrows) with associated intramedullary edema.

View larger version (153K): [in a new window]   Fig. 4A. —87-year-old woman who presented with right hip pain after trauma. Anteroposterior radiograph shows only isolated greater trochanteric fracture (arrow), with fragment displaced upward, medially, and posteriorly.

View larger version (152K): [in a new window]   Fig. 4B. —87-year-old woman who presented with right hip pain after trauma. Selected axial (B) and coronal (C) reconstructions and sagittal sections (not shown) of axial CT scan (slice thickness, 2 mm) obtained with bone algorithm reveal only nonpropagated greater trochanteric fracture (arrows).

View larger version (114K): [in a new window]   Fig. 4C. —87-year-old woman who presented with right hip pain after trauma. Selected axial (B) and coronal (C) reconstructions and sagittal sections (not shown) of axial CT scan (slice thickness, 2 mm) obtained with bone algorithm reveal only nonpropagated greater trochanteric fracture (arrows).

View larger version (128K): [in a new window]   Fig. 4D. —87-year-old woman who presented with right hip pain after trauma. Coronal T1-weighted MR image of right hip (TR/TE, 600/14; slice thickness, 3 mm; interspace, 0) shows fracture emanating from base of greater trochanter (white arrow) to intertrochanteric regions with additional diaphyseal extension on other sections. Note patchy edema in right ilium (black arrow).

View larger version (12K): [in a new window]   Fig. 5A. —Illustrations of propagations of greater trochanter fractures seen on MR images of 35 patients. In pattern 1, greater trochanter fracture extends to intertrochanteric region and its lateral and medial cortices (21 patients).

View larger version (15K): [in a new window]   Fig. 5B. —Illustrations of propagations of greater trochanter fractures seen on MR images of 35 patients. Pattern 2 fracture has characteristics of pattern 1 fracture plus extension of fracture to diametaphysis (11 patients).

View larger version (13K): [in a new window]   Fig. 5C. —Illustrations of propagations of greater trochanter fractures seen on MR images of 35 patients. In pattern 3, greater trochanter fracture only extends to superolateral cortex of intertrochanteric region (two patients).

View larger version (13K): [in a new window]   Fig. 5D. —Illustrations of propagations of greater trochanter fractures seen on MR images of 35 patients. Pattern 4 fracture has characteristics of pattern 1 fracture plus superior extension of fracture to base of femoral neck (one patient).

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