Multiplanar reformation computed tomogram is better than MR imaging in decision making for apparently isolated fractures of the greater trochanter.

Abstract

We evaluated isolated fractures of the greater trochanter (IFGT) on plain radiographs with multiplanar reformation computed tomography (MPR CT). Retrospective review of patients. University teaching hospital. This study included 27 consecutive patients with apparently IFGT. The clinical results, X-ray, computed tomography, magnetic resonance imaging, bone scintigraphy findings were investigated. Four of 27 cases demonstrated anterior cortical breakage or extensive damage of the trabecular bone in the intertrochanteric area on MPR CT images. Surgical fixation was necessary for these 4 cases. The other 23 cases, in which no structural damage was detected, were treated conservatively, and the results were satisfactory without progression to a complete intertrochanteric fracture. All 9 cases evaluated with magnetic resonance imaging demonstrated extension into the intertrochanteric area. In 5 cases, the extension crossed the midline on the mid-coronal image. Two of the cases were treated surgically because of anterior cortical breakage and extensive trabecular impaction on MPR CT, respectively. However, the other 3 cases and 4 cases with mild intertrochanteric extension were treated conservatively without problem. The evaluation of IFGT with MPR CT was shown to be valuable for determining the optimal treatment method.