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The Journal of Bone and Joint Surgery 81:1299-304 (1999)
© 1999 The Journal of Bone and Joint Surgery, Inc.

Avulsion Fracture of the Lesser Trochanter as a Result of a Primary Malignant Tumor of Bone. A Report of Four Cases*

ROBERT AFRA, B.A.{dagger}, DAVID L. BOARDMAN, M.D.{ddagger}, J. MICHAEL KABO, PH.D.{ddagger} and JEFFREY J. ECKARDT, M.D.{ddagger}, LOS ANGELES, CALIFORNIA

Investigation performed at the Department of Orthopaedic Surgery, University of California at Los Angeles School of Medicine, Los Angeles


   Introduction
 
A review of the current literature identified two primary causes of avulsion of the lesser trochanter: strenuous flexion of the hip in adolescent athletes with open epiphyses2,5-9,11,15,16 and pathological fracture associated with a metastatic lesion of bone3,14. In both cases, stress concentration at the site of the iliopsoas muscle leads to a tensile failure of either the apophysis or the lesser trochanter. Typically, the force necessary to avulse an otherwise normal apophysis is much greater than that required to produce a pathological fracture, and the latter mechanism is rarely associated with a history of trauma20. We report the cases of four patients who had an avulsion fracture of the lesser trochanter secondary to a primary malignant tumor of bone. To our knowledge, this is the first report in which a pathological fracture of the lesser trochanter was the presenting symptom leading to the diagnosis of such a tumor. . . . [Full Text of this Article]


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