Greater Trochanter Fracture

The greater trochanter of the thigh bone or the femur is a large, quadrilateral, and irregularly-shaped structure and a component of the skeletal system. It is placed somewhat posterior and laterally. Due to the difference in the anatomies of male and female pelvic region, females feature a bigger distance between the two greater trochanters. It features 4 borders and 2 surfaces and is a traction epiphysis.

Greater trochanter: Borders and surfaces

• Borders: The lower border is characterized by a visible, rough, and somewhat curved ridge which acts as the origin point of the upper section of the vastus lateralis. It corresponds to the trochanter’s line of junction at the base along with the body’s lateral surface.
  • The upper border is irregular, thick, free, and marked by an impression at the center. The impression acts as an insertion point for the piriformis.
  • The back border is very visible and features a free, circular edge, which attaches to the back section of the trochanteric fossa.
  • The front border is slightly irregular and visible. Its lateral section allows insertion of the glutaeus minimus.
• Surfaces: The lateral surface of the greater trochanter has a quadrilateral form and is rough, broad, and convex. It is characterized by an impression which runs diagonally from the postero-superior angle to the antero-inferior and acts as an insertion point of the gluteus medius tendon.
  • A triangular surface is present above the diagonal impression; it may be occasionally rough for part of the gluteus medius tendon, and occasionally smooth for the placement of a bursa between the bone and the tendon. Another triangular but smooth surface is present below the impression; the gluteus maximus tendon plays over it and a bursa is interposed.
  • The medial surface of the greater trochanter does not extend as much as the lateral surface. A deep impression, i.e., the digital fossa or the trochanteric fossa, occurs at the base of the medial surface; it acts as an insertion point for the obturator externus tendon. Another impression is present in front of and above the medial surface; it acts as an insertion point for the obturator internus tendon and the inferior and superior gemellus muscles.

Greater trochanter health problems

The greater trochanter may suffer from varied health problems, the two most common being greater trochanter fracture and trochanteric bursitis.

Greater trochanter fracture

A greater trochanter fracture may be accompanied by the below listed signs and symptoms:

• Swelling, pain and visible bruising in the hip area. In rare cases, the hip region may look deformed.
• Increased weakness which may pose problems in even lifting the leg or bending the hip.
• Addition of weight on the hip can cause moderate to severe pain in the groin. Standing and walking may aggravate the fracture and intensify the pain. Sometimes, the pain may be so severe as to prevent any kind of movement.

Fracture of the greater trochanter are commonly caused due to the below listed factors:

• Fracture of the greater trochanter is quite rare. It may occur due to direct injuries, especially in older adults, or it may occur indirectly due to string contraction of the gluteus minimus and gluteus medius muscles. It may be noted that these muscles aid in hip movement by joining to the greater trochanter.
• Fracture of the greater trochanter may also occur in conjunction with an intertrochanteric fracture. The later refers to a fracture line which occur through the femur’s intertrochanteric line.

Treatment of greater trochanter fracture includes the following:

• If the bone fragments associated with greater trochanter fracture are displaced over 1 cm, then it is treated via surgery. Surgery usually involves realignment of bone fragments via use of wires under tension, and pain killers and other medications to aid recovery.
• If the fragments displacement is less than 1 cm, then treatment involves bed rest, use of crutches to help heal, and physical therapy to help regain the function of the hips.
• In case the fracture is caused due to a tumor, then large sections of the affected bone are surgically removed. Chemotherapy and radiation therapy may also be used.

Trochanteric bursitis

Trochanteric bursitis refers to inflammation of the greater trochanter bursa. Patients may suffer from the below listed possible signs and symptoms:

• Pain when sleeping on the side that’s affected, moving the thighs, climbing stairs, cycling, walking, and running.
• Increased tenderness in the hip region.
• Pain in the knees, buttocks, and/or the hip region.
• In severe cases, the patient may experience walking difficulties or may be unable to walk at all.

Trochanteric bursitis is commonly caused due to:

• Activities that exert prolonged pressure on the hip can result in inflammation of the bursa.
• Recurrent and frequent friction of the tendons and the muscles over the bursa; it can occur due to activities like excessive cycling and running.
• Problems with a patient’s posture or gait can exert excess pressure on the hip.
• Gout and other underlying conditions which cause buildup of insoluble crystals or stones in the bursa, thereby inflaming it and causing pain.
• Bumping the hip onto a hard surface or falling on it can injure the bursa.
• Any kind of hip surgery can cause inflammation and injury of the greater trochanter bursa.
• Increased pressure on the hips due to obesity of being overweight.
• Any kind of infection of the bursa can result in its inflammation.
• When the iliotibial band is too tight, then it can exert added pressure on the bursa thereby inflaming it.
• Increased irritation and rubbing of the bursa against bone spurs of the hip can result in inflammation.
• Rheumatoid arthritis and other similar conditions are often characterized by inflammation of the greater trochanter bursa.
• Incorrectly performing certain exercises can exert pressure on the hip thereby causing bursa inflammation.

Trochanteric bursitis is treated in the following ways:

• Intake of oral analgesic and anti-inflammatory medications.
• Removing the fluid in the greater trochanter bursa sacs.
• Daily application of cold compresses or ice packs on the affected site.
• Accompanying infections are treated with antibiotics
• Corticosteroid injections directly into the affected bursa.
• Physical therapy, including stretching exercises such as iliotibial band stretch: side leaning; Iliotibial band stretch: standing; leg raise; wall squat; and hip extension, for pain alleviation and expediting recovery.
• Surgically removing the affected bursa.