Isolated fracture of the lesser trochanter in adults: an initial manifestation of metastatic malignant disease.

An avulsion fracture of the lesser trochanter in the absence of known or appropriate antecedent trauma was the initial manifestation of unrecognized metastatic malignant disease in the subtrochanteric area of four patients. In three patients the fracture healed but a pathological subtrochanteric fracture then occurred, and in one patient prophylactic nailing of the hip was performed to prevent this fracture. A thorough search for occult metastatic malignant disease should be made whenever this fracture occurs in an adult. Prophylactic internal fixation to prevent or delay a subsequent pathological subtrochanteric fracture seems worth while.