Conservative Treatment of Avulsion Injuries of the Lesser Trochanter in Adolescent Athletes

Abstract

Background: Avulsion injuries of the lesser trochanter apophysis are relatively uncommon injuries and there have been no peer-reviewed case series dedicated to the evaluation and treatment of this injury. The purpose of this study is to characterize avulsion injuries of the lesser trochanter apophysis, review treatment protocols, and time to return to sport.Methods: We reviewed 30 confirmed avulsion fractures of the lesser trochanter. Clinical data were reviewed to evaluate treatment protocols, duration, and time to return to sport. Radiographs were reviewed to confirm lesser trochanter avulsion and fracture displacement.Results: There were 26 males and 4 females, with the average age at the time of injury being 14.2 years. Treatment modalities consisted of protective weight-bearing, discontinuation of the patient's sport in all cases, and formal physical therapy in 18 cases. The average treatment duration was 30.7 days. The mean follow-up time was 102 days. The radiographic assessment demonstrated an average fracture displacement of 5.1 mm. The average return to sport was 11 weeks.Conclusion: This is the first large case series studying avulsion injuries of the lesser trochanter. We have shown that these athletes can be managed non-surgically and can successfully return back to sport within three months.

Isolated Avulsion Fracture of the Lesser Trochanter in an Adolescent: A Case Report and Review of the Literature

“…Isolated fractures of the lesser trochanter represent less than 1% of hip injuries in adolescents and less than 3% of pelvic avulsion fractures. Hence, reports in the literature are scarce [ 2 , 5 ]. A definite traumatic event is almost always described by such patients, although minor trauma resulting in lesser trochanter avulsion fractures should raise the suspicion of underlying bone diseases, especially in adults.…”

“…The variations in pelvic anatomy regarding both the skeleton maturation and the biomechanical complexity until adulthood determine to a significant extent that the pelvis is the most usually affected site. Secondary ossification centers of the pelvis are the most vulnerable sites, including the ischial tuberosity, the anterior inferior ischial spine, and the anterior superior iliac spine [ 2 ].…”

“…Avulsion fractures of the lesser trochanter, greater trochanter, and iliac crest are less common. Isolated avulsion fractures of the lesser trochanter account for less than 1% of hip injuries in adolescents [ 2 ]. As the result of forceful muscle contraction of the iliopsoas, the open growth plate is at greater risk of disruption because the musculotendinous unit and the attached Sharpey’s fibers are less susceptible to injury compared to the cartilaginous growth plate.…”

“…Regarding the relatively rare frequency of isolated lesser trochanter fractures, only a few case reports and case studies have assessed the treatment options and rehabilitation of such patients in the literature. Traditionally, non-operative treatment has been the mainstay of management, providing sufficient functional outcomes [ 2 ]. However, there is still controversy concerning the beneficial potential of surgical treatment in several cases, either as a primary or secondary option [ 2 , 4 ].…”

“…Traditionally, non-operative treatment has been the mainstay of management, providing sufficient functional outcomes [ 2 ]. However, there is still controversy concerning the beneficial potential of surgical treatment in several cases, either as a primary or secondary option [ 2 , 4 ]. We hereby present the case of a conservatively treated adolescent football player who sustained an avulsion fracture of the lesser trochanter during soccer.…”