Lesser trochanter avulsion

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A 13-year-old male football player presented following an acute onset of pain in his right groin. This occurred as he forcefully extended his right hip while kicking a ball. At the time he was seen he reported pain that was 9/10 in severity, he was unable to walk and had pain/guarding with all hip movements. He was unable to perform an active straight leg raise.

This AP x-ray of the right hip shows that there is an avulsion fracture of the lesser trochanter. There is minimal (<2mm) displacement. The upper femoral and greater trochanter physes remain open and are radiologically normal. Subsequent MRI sequences have further demonstrated this injury and excluded other causes for pain. The coronal MRI (STIR sequence) image shown here confirms the avulsion and shows a large peritrochanteric effusion. The coronal MRI (T1 sequence) image shows the other physes and epiphyses on the right side (upper femoral and greater trochanter).

This player was initially prescribed a one-month period of rest (no weight bearing) followed by a progressive weight-bearing period. Two months after the injury he started more formal rehabilitation, performing a total of 21 sessions in the gym and 13 sessions on the field. He was able to return to the team and play 4 months after the injury, reaching the rehabilitation goal we shared with him at the beginning.
Avulsion fractures of the lesser trochanter are rare injuries (<1% of all hip injuries) caused by sudden and forceful contraction of the iliopsoas muscle. Most players present immediately after their injury with acute hip and groin pain and difficulty weight-bearing. While this player had an MRI scan this is generally not needed. In the majority of cases the injury can readily be seen, and defined, on x-ray images. Non-surgical treatment is generally considered to be the gold standard treatment. Surgical management has been recommended in the literature when there is displacement of >2 cm, symptomatic non-union, exostosis or when the patient has been unable to return to sports.

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08 January 2021 15:22

Thanks for sharing

Seyed MohammadJavad AshrafMansouri
11 January 2021 5:57
Sometimes a psoas  muscle abscess manifests itself with these symptoms. Of course, history is very important. right?