Isolated Avulsion Fractures of Lesser Trochanter in Adolescents - A Case Series and Brief Literature Review

Abstract

Introduction: Adolescent apophyseal avulsion injuries related to sports is common around the pelvis and proximal femur. Amid them, avulsions of the lesser trochanter are uncommon as compared to other sites. The growth plates in children are weaker than the unossified bone and tendons to which they attach. As a result, with sudden violent muscular contraction, avulsion fracture of the apophysis occurs. The periosteum remains attached to the avulsed fragment preventing gross displacement. Treatment is usually symptomatic with good outcomes.

Case series: We present a series of three cases of isolated avulsions of lesser trochanter. Patients presented with pain in groin and limp following sprinting and fall. Radiographs revealed the diagnosis, and we proceeded with conservative management in all patients since the displacement was not significant. Patients recovered fully with no long-term complaints. Indications for surgery are not well defined, and we believe conservative treatment has good functional outcomes.

Conclusion: In patients with painful limp after sporting activities, there should be a high index of suspicion for avulsion fractures. Radiographs should be done, and other pathologies were excluded. Symptomatic treatment is recommended with a gradual return to sports after at least 3 months.

Keywords: Adolescent; apophysis; lesser trochanter; limp; sprinting.

Figure 1

Anteroposterior radiograph of the pelvis with both hips demonstrating an avulsion fracture of lesser trochanter on the left side.

Figure 2

Anteroposterior radiograph left hip with the proximal femur of same patient at 2 weeks after injury demonstrating no further displacement of fracture.