Lesser trochanter avulsion

Case
A 13-year-old male football player presented with acute pain in his right groin. He developed this as he forcefully extended his right hip while kicking a ball. At the time of his initial presentation he reported pain that was 9/10 in severity. He was unable to weight bear. There was tenderness on palpation in the proximal adductor region without any obvious swelling. When lying in a supine position he was unable to perform a straight leg raise.

Findings
An AP x-ray image conducted at the time of injury shows evidence of a lesser trochanter avulsion fracture. A subsequent MRI scan further demonstrated the avulsion (coronal T1 image) and shows a large peritrochanteric effusion (coronal STIR image.

Discussion
This young player was managed with one month of rest (no weight bearing) followed by a progressive weight bearing period. Two months after the injury he started a coordinated rehabilitation programme, performing 21 sessions in the gym and 13 sessions on the field. He was able to return to the team and play four months after the injury.

Avulsion fractures of the lesser trochanter are rare. They are generally caused by a sudden and forceful contraction of the iliopsoas muscle. There is little literature to guide their treatment. A recent case series (of only five patients) showed that the mean age of patient that presented with this injury was 13.8 years (range: 13-15 years). Excellent results were seen in this group with non-operative treatment. All patients returned to competitive sports and none had residual symptoms at an average five-year follow-up. When there is a significant displacement (or in in some cases when the patient is functionally demanding) surgery may be considered. This can be done arthroscopically.

Important notice
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C est une pathologie qui est L apanage des jeunes à cause de leur très jeune âge. C est une fracture par arrachement qui peux être plus ou moins sérieuse. Le type 1et 2 est moins grave mais par contre le type 3et 4 doit être pris au sérieux quelque fois suivi d une intervention chirurgicale s il s agit d un déplacement.
Le traitement demande un repos et la reprise pas avant 3 ou 4 mois.