Multiplanar Reformation Computed Tomogram Is Better Than MR Imaging in Decision Making for Apparently Isolated Fractures of the Greater Trochanter

Objectives: We evaluated isolated fractures of the greater trochanter (IFGT) on plain radiographs with multiplanar reformation computed tomography (MPR CT).Design: Retrospective review of patients.Setting: University teaching hospital.Patients: This study included 27 consecutive patients with apparently IFGT.Main Outcome Measurements: The clinical results, X-ray, computed tomography, magnetic resonance imaging, bone scintigraphy findings were investigated.Results: 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.Conclusions: The evaluation of IFGT with MPR CT was shown to be valuable for determining the optimal treatment method.