Fracture of the greater trochanter with occult intertrochanteric fracture in an adult treated by percutaneous screw fixation: Case report of an often missed injury

INTRODUCTION AND IMPORTANCE: Fractures of the greater trochanter with occult intertrochanteric extension are rare and difficult to diagnose. This type of fracture is not identified on standard radiographs and is considered to be an isolated fracture of the greater trochanter that is not subject to surgery. MRI is used to make the diagnosis or, failing that, CT. These fractures are most often surgically fixed to avoid further displacement, prevent complications of bed rest and allow early rehabilitation. CASE PRESENTATION: We present the case of a patient who was diagnosed with a fracture of the greater trochanter with an occult intertrochanteric fracture based on CT, treated by percutaneous screw fixation with full recovery of hip mobility and consolidation after 3 months. CLINICAL DISCUSSION: Isolated fractures of the greater trochanter are most often associated with an occult intertrochanteric fracture found on MRI. This diagnosis changes the prognosis and management since an isolated greater trochanter fracture is usually treated conservatively whereas an intertrochanteric extension most likely requires surgical fixation. Various approaches have been used to fix this type of fracture. In our case, we opted for percutaneous screw fixation with good results. CONCLUSION: Isolated fractures of the greater trochanter with an occult intertrochanteric fracture are a rare entity that most often go unnoticed. MRI or, alternatively, CT should be systematically requested in the presence of an isolated fracture of the greater trochanter on standard radiographs. Surgical management can avoid complications and early management while restoring gluteal muscle function.