Management of Suspected Greater Trochanter Contusion with Significant Edema

Diagnostic Approach

The American Academy of Orthopaedic Surgeons recommends obtaining CT hip without IV contrast immediately if not already done, as plain radiographs miss 24.1% of hip fractures and CT changes management in 20% of cases 1
CT has 94% sensitivity and 100% specificity for detecting radiographically occult hip fractures that are invisible on plain films 1
The American Academy of Orthopaedic Surgeons suggests that a 1-week delay with worsening edema raises concern for an occult fracture, particularly given that isolated greater trochanter fractures can extend to the femoral neck 1
Do not rely on preserved range of motion and weight-bearing ability to exclude fracture—patients with basicervical and minimally displaced fractures can maintain function initially 2

Allow weight-bearing as tolerated with assistive device (crutches or walker) for the first 2-3 weeks to reduce pain while preventing deconditioning 2, 3
Do not prescribe complete bed rest, as immobility increases complications 4, 5
Begin gentle range-of-motion exercises (hip flexion, abduction, adduction) after initial pain subsides, typically 3-5 days 1
Progress to resistance exercises and impact activities only after pain-free range of motion is achieved, typically 3-4 weeks 3
Return to activity only after full pain-free function is restored, typically 6-8 weeks for severe contusions 3

Repeat evaluation at 1-2 weeks to confirm clinical improvement 3
If pain or edema worsens or fails to improve by 2 weeks, obtain MRI to evaluate for occult fracture, muscle tear, or hematoma requiring intervention 2, 1
New inability to bear weight requires urgent re-evaluation 2

Do not assume normal radiographs exclude fracture in a patient with significant trauma and delayed presentation with worsening symptoms—proceed to CT or MRI 1
Do not recommend complete immobilization—early mobilization as tolerated prevents complications and promotes healing 4, 5