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.

Highlights

  • Injuries to the hip and groin related to athletic activities account for 1 in 10 patient visits to sports clinics [1,2,3]

  • 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

  • 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

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Summary

Introduction

Injuries to the hip and groin related to athletic activities account for 1 in 10 patient visits to sports clinics [1,2,3]. The apophysis is an osteochondral plate at the tendinous insertion. It is a secondary centre of ossification contributing to a change in shape or size of the bone, but not its length [6]. In adolescents the muscles are more resistant to injury than the bones [5, 8]. This imbalance renders the apophysis to be the weakest part of the skeleton, and makes it vulnerable to avulsion injuries [4, 5, 8]

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