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Fractures of the Lesser and Greater Trochanter



- Lesser Trochanteric Fracture:
    - isolated fracture of the lesser trochanter is quite rare but may develop as a result of the avulsion force if the iliopsoas muscle;
    - it occurs commonly as a component of intertrochanteric fracture;
    - frx of the lesser trochanter along with a subtroch or intertroch fracture is by definition unstable;
- Greater Trochanteric Fracture:
    - isolated fracture of the greater trochanter may be caused by direct injury or may occur indirectly as a result of the activity of gluteus 
         medius and gluteus minimus muscles;
    - it occurs most commonly as a component of intertrochanteric fractures;
    - if displacement is less than 1 cm and there is no tendency to further displacement (determined by repeated x-ray examinations), 
         treatment may be by bedrest w/ affected extremity in balanced suspension until the acute pain subsides;
    - as rapidly as symptoms permit, activity can increase gradually to protected wt bearing with crutches;
    - full wt bearing is permitted as soon as healing is apparent, usually in 6 to 8 weeks;
    - if displacement is greater than 1 cm and increases on adduction of thigh, extensive tearing of surrounding soft tissues may be assumed