Arthroscopically assisted fixation of the lesser trochanter fracture: a case series

Abstract

Avulsion fractures of the lesser trochanter in adolescents are uncommon. This injury is a result of a sudden forceful contraction of the iliopsoas tendon. It usually occurs during vigorous sport activity. Historically, these injuries were treated non-operatively, with guarded results, including weak hip flexor strength and non-union, hindering return to competitive sport. We report a series of three arthroscopically assisted fracture fixations performed by the senior author, using cannulated screw fixation in two cases and an anchor in one case. Mobilization was commenced immediately following surgery, allowing weight bearing as tolerated using crutches for 4 weeks, thereafter unaided walking was allowed. Patients were assessed at 2 weeks, 6 weeks, 3 months and 1-year post-operatively. Radiographs were utilized to confirm full union. All three patients were able to mobilize unaided by 4 weeks post-operatively and two of the three patients returned to competitive sport at 3 months. Near—anatomical union was achieved in all cases. No complications were noted during surgery and the peri-operative period in our series. The utilization of arthroscopic reduction and fixation of avulsion of the lesser trochanter results in good fixation and allows a faster recovery with a return to sports activity, and therefore, we suggest it as a viable treatment option for such injuries.

Lesser Trochanter Avulsion Fracture: A Case Report

“…McKinney and collaborators have made a review of publications in English on the subject and, in none of them, surgical treatment was indicated [10]. We found in our research two authors indicating surgical treatment in cases whose evolution of conservative treatment has not been satisfactory [11][12][13].…”

Avulsion fracture of the lesser trochanter apophysis

“…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. Immobilization in a spica-cast has not been proved to be of an additional benefit in the conservative approach [3,5]. 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.…”

“…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.…”

Biomechanical Comparison of Anterograde and Retrograde Lesser Trochanter Avulsion Repair

“…3 Unfortunately, the literature on this injury and patient population is limited to only a few published case reports. 8,9,13,15,17,25 Regardless of the setting or mechanism of injury, lesser trochanter avulsion can produce significant morbidity. Severe pain, swelling, local tenderness to palpation, limited hip flexion, and disturbed gait and weightbearing are all symptoms of this injury and can inhibit daily function and return to competitive sports.…”

“…Severe pain, swelling, local tenderness to palpation, limited hip flexion, and disturbed gait and weightbearing are all symptoms of this injury and can inhibit daily function and return to competitive sports. [8][9][10]12,13,15,17,20,25 Treatment is almost always nonoperative; to our knowledge, only 1 study has reported on the long-term results of nonoperatively treated patients, and that study included 5 patients. 20 While nonoperative treatment is preferred as the initial treatment option in most cases, McKinney et al 12 recommended surgical intervention for symptomatic nonunions and avulsions with a displacement greater than 2 cm.…”