title: Predicting intertrochanteric extension of greater trochanter fractures of the hip on plain radiographs.
abstract: BACKGROUND
  It is important to distinct between isolated greater trochanter (GT) fractures and complete intertrochanteric (IT) extension to prevent unwanted morbidities. Aim of this study was to determine if there was any particular fracture pattern, of GT fractures on a plain radiograph of the hip which could predict IT extension.
  
  
  METHODS
  Retrospective review of radiographs of 49 patients with a GT fracture who presented in the last 10 years (January 2005-December 2015). All images were reviewed by a consultant musculoskeletal radiologist and an orthopaedic surgeon. The AP plain radiographs were assessed to look for fracture angle and length of the fracture. The fracture length was taken as a percentage and was measured as the length of the fracture crossing the intertrochanteric line/the total length of the intertrochanteric line. The fracture angle was measured as the angle between a line drawn from the most superior point of the fracture on the lateral cortex of the GT, to a perpendicular line along the medial cortex of the femoral shaft. The subsequent MRI and CT scans were assessed to see if there was true intertrochanteric extension.
  
  
  RESULTS
  32 patient were female and 17 male. 27 CT scans of which 8 showed complete IT extension. 22 had MRI scan of which 6 showed complete extension. The mean fracture length of patients with complete extension was 56% with a range of 50%-63%. The mean fracture length of patients with incomplete extension was 33% with a range of 12%-55%. The mean fracture angle for patients with complete extension was 39° with a range of 35-42°. The mean fracture angle for patients with incomplete extension was 58° with a range of 44-124°.
  
  
  CONCLUSIONS
  For greater trochanter fractures that do not cross >50% of the IT line and do not have a fracture angle between 35 and 42° do not require further imaging as they will not have complete intertrochanteric extension.
authors.affiliation: Department of Orthopaedics, Calderdale and Huddersfield Foundation Trust, West Yorkshire, HD3 3EA, United Kingdom.
authors.forename: Rizwan
authors.initials: R
authors.lastname: Arshad
authors.affiliation: Department of Orthopaedics, Calderdale and Huddersfield Foundation Trust, West Yorkshire, HD3 3EA, United Kingdom. Electronic address: osmanriaz@doctors.org.uk.
authors.forename: Osman
authors.initials: O
authors.lastname: Riaz
authors.affiliation: Department of Orthopaedics, Calderdale and Huddersfield Foundation Trust, West Yorkshire, HD3 3EA, United Kingdom.
authors.forename: Adeel
authors.initials: A
authors.lastname: Aqil
authors.affiliation: Department of Orthopaedics, Calderdale and Huddersfield Foundation Trust, West Yorkshire, HD3 3EA, United Kingdom.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Bhuskute
authors.affiliation: Department of Orthopaedics, Calderdale and Huddersfield Foundation Trust, West Yorkshire, HD3 3EA, United Kingdom.
authors.forename: Sudhi
authors.initials: S
authors.lastname: Ankarath
mesh_terms: D000058:Accidental Falls; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D005269:Femur / Q000000981:diagnostic imaging / Q000293:injuries*; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D017102:Fracture Healing; D006620:Hip Fractures / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
keywords: Greater trochanter fracture; Hip fracture; Intertrochanteric extension