Both fractures usually follow a fall directly on to the greater trochanter, or a sharp twisting injury.
The patient is unable to weight bear, and on examination, the leg is often shortened and externally rotated. It cannot be actively raised.
Radiology may reveal a barely visible crack along the intertrochanteric line, or more frequently, severe comminution and separation of of one or both trochanters. Occasionally, the fracture may be continuous with a spiral fracture involving the proximal femoral shaft.
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