Greater trochanter fracture and fixation in a teenage athlete: A case report

Introduction: Greater trochanter fractures are rare subtypes of hip fractures¹, with limited reports in the literature, resulting in disparities in demographics and management protocols.² Isolated greater trochanter fractures can occur due to avulsion injuries in younger patients caused by strong hip abduction, as well as pathological processes or traumatic injuries in the elderly. Fractures displaced by more than one centimeter typically require open reduction internal fixation (ORIF), while others can often be managed nonoperatively.³ These displaced fractures more pressing concerns due to the risk of avascular necrosis (AVN) of the femoral head, which may occur if the medial circumflex femoral artery is disrupted as it traverses the greater trochanter.⁴ Pediatric patients are particularly at risk for traumatic AVN in the setting of displaced fractures. Unlike skeletally mature patients, whose vascular supply to the femoral head may include contributions from the metaphysis, pediatric patients rely heavily on the medial femoral circumflex artery for femoral head blood supply. This reliance increases their risk of AVN with greater displacement and delayed reduction. Although displaced fractures necessitate surgical intervention, ORIF carries inherent risks, including potential iatrogenic injury to the medial circumflex femoral artery, which could also result in femoral head AVN.