Thomas Ruffing1, Tilmann Rückauer2, Frederic Bludau3, Alexander Hofmann1, Markus Muhm1, Arnold J Suda4. 1. Westpfalz-Klinikum Kaiserslautern, Department of Trauma and Orthopaedics, Medical Faculty Mannheim, University of Heidelberg and University of Mainz, Hellmut-Hartert-Str. 1, 67655 Kaiserslautern, Germany. 2. University Medical Center Mannheim, Medical Faculty Mannheim of Heidelberg University, Department of Pediatric Surgery, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany. 3. University Medical Center Mannheim, Medical Faculty Mannheim of Heidelberg University, Department of Orthopaedics and Trauma Surgery, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany. 4. University Medical Center Mannheim, Medical Faculty Mannheim of Heidelberg University, Department of Orthopaedics and Trauma Surgery, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany. Electronic address: arnold@drsuda.com.
Abstract
INTRODUCTION: Avulsion fractures of the lesser trochanter in adolescents are rare. They are a result of a sudden and forceful contraction of the iliopsoas muscle. Functional results in the medium term after non-operative treatment are unknown. Therefore we aimed to report these in the present study. MATERIALS AND METHODS: A retrospective two-center study was performed in a case series treated between 2011 and 2017. All adolescents with an acute avulsion fracture of the lesser trochanter were included. Age, gender, mechanism of injury, fracture side, amount of displacement, and therapy were analyzed. In the follow-up, the Harris Hip Score (HHS), the sports level, the power of flexion in the hip, and signs of an ischio-femoral impingement (IFI) were investigated. RESULTS: An avulsion fracture of the lesser trochanter was diagnosed in 4 boys and 1 girl. The mean age of the patients was 13.8 years (range: 13-15 years). We observed 2 type II and 3 type III fractures. The patients received similar non-operative treatment. Follow-up was performed at a mean of 4.9 years (range: 3.5-6.2 years) after injury. All patients returned to competitive sports. The Harris Hip Score (HHS) was 100 out of 100 points. History and provocation test concerning an IFI were negative in all patients. CONCLUSION: Our study shows excellent results with non-operative treatment in acute avulsion fractures of the lesser trochanter in a case series of five adolescents. All patients returned to competitive sports. In our opinion, acute avulsion fractures of the lesser trochanter should be treated non-operatively.
INTRODUCTION:Avulsion fractures of the lesser trochanter in adolescents are rare. They are a result of a sudden and forceful contraction of the iliopsoas muscle. Functional results in the medium term after non-operative treatment are unknown. Therefore we aimed to report these in the present study. MATERIALS AND METHODS: A retrospective two-center study was performed in a case series treated between 2011 and 2017. All adolescents with an acute avulsion fracture of the lesser trochanter were included. Age, gender, mechanism of injury, fracture side, amount of displacement, and therapy were analyzed. In the follow-up, the Harris Hip Score (HHS), the sports level, the power of flexion in the hip, and signs of an ischio-femoral impingement (IFI) were investigated. RESULTS: An avulsion fracture of the lesser trochanter was diagnosed in 4 boys and 1 girl. The mean age of the patients was 13.8 years (range: 13-15 years). We observed 2 type II and 3 type III fractures. The patients received similar non-operative treatment. Follow-up was performed at a mean of 4.9 years (range: 3.5-6.2 years) after injury. All patients returned to competitive sports. The Harris Hip Score (HHS) was 100 out of 100 points. History and provocation test concerning an IFI were negative in all patients. CONCLUSION: Our study shows excellent results with non-operative treatment in acute avulsion fractures of the lesser trochanter in a case series of five adolescents. All patients returned to competitive sports. In our opinion, acute avulsion fractures of the lesser trochanter should be treated non-operatively.
Authors: Alexander Otto; Joshua B Baldino; Alyssa M DiCosmo; Katherine Coyner; Jeremiah D Johnson; Elifho Obopilwe; Mark P Cote; Lukas N Muench; Knut Beitzel; Bastian Scheiderer; Andreas B Imhoff; Augustus D Mazzocca; Julian Mehl Journal: Orthop J Sports Med Date: 2020-01-21