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Review
. 2020 Nov-Dec;34(6):3519-3526.
doi: 10.21873/invivo.12193.

Isolated Avulsion Fracture of the Lesser Trochanter in Adults

Hwan Seong Cho #  1 , Young-Kyun Lee #  1 , Byung-Ho Yoon  2 , Jung-Wee Park  3 , Yong-Chan Ha  4 , Kyung-Hoi Koo  1   5
Affiliations
Review

Isolated Avulsion Fracture of the Lesser Trochanter in Adults

Hwan Seong Cho et al. In Vivo. 2020 Nov-Dec.

Abstract

Background/aim: Isolated fractures of the lesser trochanter (LT) of adults are rare and most of them are pathologic fractures due to an underlying malignancy. The aim of our study was to provide comprehensive information on the epidemiology, etiology, diagnostic approach, and treatment algorithm of adult LT fractures.

Patients and methods: We present the cases of six patients who were treated for isolated LT fractures between November 2010 and May 2019. A literature review was performed to identify adult LT fracture cases in previous studies.

Results: In two patients, the LT fracture was the first manifestation of the underlying tumors. Through a literature review, we identified 32 adults with isolated LT fractures. Among these, 27 were pathologic fractures. In 11 pathologic fractures, LT avulsion was the first manifestation of malignancy.

Conclusion: Metastasis and the first manifestation of an underlying malignancy should be suspected in adult patients with isolated LT fracture. A stepwise approach can prevent misdiagnosis and offer rational treatment modality.

Keywords: Fracture; neoplasm metastasis; pathologic fracture.

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Conflict of interest statement

This study was supported by a grant from the Seoul National University Bundang Hospital Research Fund, Seongnam, Korea (No.02-2012-015)

Figures

Figure 1
Figure 1. A 68-year old man had a right hip pain without trauma. (A) Anterior-posterior radiograph of the hip showed right isolated lesser trochanter avulsion fracture. (B) He was treated with use of The MUTARS (Modular Universal Tumor and Revision System, Implantcast, Buxtehude, Germany)
Figure 2
Figure 2. A 56-year old man had pain in the right hip without trauma. (A) T2 weighted coronal and (B) T2 transverse MRI showed right isolated lesser trochanter avulsion fracture and enhanced surrounding soft tissue
Figure 3
Figure 3. Preferred Reporting Items for Systematic review and Meta-analysis flow diagram details the process of relevant study selection
Figure 4
Figure 4. Treatment algorithm for isolated LT avulsion fracture
See this image and copyright information in PMC

References

    1. Singh P, Kumar A, Shekhawat V, Singh P. Nonpathological lesser trochanter fracture in adult: Case report and brief review of literature. J Clin Diagn Res. 2015;9(11):RD04–RD05. doi: 10.7860/JCDR/2015/15760.6834. - DOI - PMC - PubMed
    1. Kumar P, Agarwal S, Rajnish RK, Kumar V, Jindal K. Isolated spontaneous atraumatic avulsion of lesser trochanter of femur-a pathognomonic sign of malignancy in adults? A case report and review of literature. J Orthop Case Rep. 2017;7(6):16–19. doi: 10.13107/jocr.2250-0685.930. - DOI - PMC - PubMed
    1. Rouvillain JL, Jawahdou R, Labrada Blanco O, Benchikh-El-Fegoun A, Enkaoua E, Uzel M. Isolated lesser trochanter fracture in adults: An early indicator of tumor infiltration. Orthop Traumatol Surg Res. 2011;97(2):217–220. doi: 10.1016/j.otsr.2010.11.005. - DOI - PubMed
    1. Homma Y, Baba T, Ishii S, Matsumoto M, Kaneko K. Avulsion fracture of the lesser trochanter in a skeletally immature freestyle footballer. J Pediatr Orthop B. 2015;24(4):304–307. doi: 10.1097/BPB.0000000000000154. - DOI - PubMed
    1. Afra R, Boardman DL, Kabo JM, Eckardt JJ. Avulsion fracture of the lesser trochanter as a result of a primary malignant tumor of bone. A report of four cases. J Bone Joint Surg - Series A. 1999;81(9):1299–1304. doi: 10.2106/00004623-199909000-00011. - DOI - PubMed