Is Magnetic Resonance Imaging Useful for Isolated Greater Trochanter Fractures?

Purpose: To determine the interrater reliability of utilizing magnetic resonance imaging (MRI) to assess greater trochanter (GT) fractures for occult intertrochanteric (IT) extension fracture and the need for fixation and to compare outcomes of operative versus nonoperative management. Methods: A retrospective review of patients with GT fractures and MRIs was performed. Four surgeons reviewed MRIs to determine if IT extension was complete and needed fixation. Patients with complete IT extension treated with operative versus nonoperative management were compared in terms of length of stay, discharge disposition, and IT fracture displacement. Results: Eighty-six patients were included. The median age was 64 years (IQR 53 to 73) and 66.3% (n=57) were males. Agreement for complete IT extension on MRI and the need for fixation were both considered weak (Kappa 0.55). At least 3 of 4 reviewers agreed that 22 (25.6%) fractures had complete IT extension. Patients with complete IT extension managed operatively (n=14), versus nonoperatively (n=8), were more likely to need hospital admission (100.0% vs 37.5%, p=0.002) and had trends of being more likely to be unable to ambulate on presentation (71.0% vs. 25.0%, p=0.07) and to have longer hospital stays (4.0 vs. 1.0 days, p=0.07). No patient with complete IT extension managed nonoperatively had IT fracture displacement. Conclusions: There was weak agreement for determining complete IT extension of GT fractures and the need for fixation based on MRI. Nonoperative management did not affect hospital stay, discharge disposition, or IT fracture displacement. Level of Evidence: Level 3, diagnostic