Acute Groin Pain in an Adolescent Sprinter: A Case Report

Abstract

Avulsion fractures of the lesser trochanter apophysis are rare injuries due to strenuous musculo-skeletal activity in sporting adolescents. The tendons and ligaments of the immature skeleton are able to withstand greater tensile forces than the vulnerable developing apophysis, thus resulting in these avulsion injuries associated with vigorous eccentric musculo-skeletal contractions. We report the case of a 13-year-old boy who presented with acute onset of limp and groin pain following sprinting. Radiographs revealed an acute avulsion of the lesser trochanter of the proximal femur. Full recovery followed a period of protected weight-bearing and symptomatic treatment.

A rare case of lesser trochanter fracture

“…[1][2][3] This is the first account of this type of injury, by a unique mechanism, reported in a child <7 years. Metaphyseal fractures are fractures that may be indicative of abuse, particularly in children under the age of two years.…”

Preliminary Presentation of Metastatic Non-Small Cell Carcinoma of the Lung as Atraumatic Avulsion Fracture of the Lesser Trochanter

“…Avulsion fractures of the lesser trochanter are an unusual presentation. In younger adults, the cause is almost always from high-intensity sport [1][2][3]. In older people, such a presentation necessitates investigation for malignancy, the proximal portion of the femur being a common site for metastases [5][6][7][8].…”

“…Spontaneous isolated avulsion fracture of the lesser trochanter is not a common injury in adults [1]. It is usually seen in children and the adolescent age group, especially those who are involved in contact sports and whose growth plate is not fused [2,3]. Avulsion fracture of the lesser trochanter in young adolescents occurs due to a quick and unexpected strong contraction of the iliopsoas tendon [4].…”

Avulsion fracture of the lesser trochanter apophysis

“…Apophyseal avulsion of the lesser trochanter can be classified as a Salter-Harris type I fracture. Even though the fragment is displaced proximally by the pull of the iliopsoas muscle, mostly the displacement is not significant as the periosteum is usually in continuity with the fragment [4]. Conservative management with an anti-inflammatory medications and non-weight bearing for a period of 6 weeks, has been the most popular mode of treatment for the avulsion fractures of the lesser trochanter.…”

“…It has been suggested that surgical intervention should be considered with fragment displacement of greater than 2 cm or if early return to sports is indicated, but the fragment should be of sufficient size to hold hardware. According to the literature the complications of Conservative management are non-union and exostosis which will warrant a surgical intervention [3,4]. According to McKinney and Nelson based on the displacement, avulsion fractures of apophyses can be classified into four types.…”