Trochanteric Fracture

Fracture Incidence/
Mechanism Clinical Findings ED Management Disposition and Follow-Up Complications
Greater trochanteric Uncommon; older patients or adolescents Direct trauma (older patients); avulsion due to contraction of gluteus medius (young patients)
Ambulatory; pain with palpation or abduction Analgesics; protected weight-bearing Orthopedic follow-up 1-2 wk; possible ORIF if displacement >1 cm Nonunion rare
Lesser trochanteric Uncommon; adolescents (85%) > adults Avulsion due to forceful contraction of iliopsoas (adolescents); avulsion of pathologic bone (older adults) Usually ambulatory; pain with flexion or rotation Analgesics;
weight-bearing as tolerated; evaluate for possible pathologic fracture
Orthopedic or PCP follow-up in 1-2 wk;

Admit or urgent follow-up for pathologic fracture
Nonunion rare