Kumar Prasoon, Agarwal Saurabh, Rajnish Rajesh Kumar, Kumar Vishal, Jindal Karan
Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandi-garh, India.
J Orthop Case Rep. 2017 Nov-Dec;7(6):16-19. doi: 10.13107/jocr.2250-0685.930.
Avulsion fractures of lesser trochanter (LT) of femur are generally seen following trauma with intertrochanteric or sub trochanteric fractures. Non-traumatic fractures of LT could oc-cur due to sudden violent contraction of the iliopsoas muscle that inserts on the LT; during vigorous exercise, or sudden pull involving flexion of hip. These are seen commonly in adolescents where the physis has not fused yet. Such a scenario in an adult patient most often or not leads to a diagnosis of an underlying malignancy or metastatic lesion.
A 60-year-old female patient, presented to the outpatient department of our institute with pain on walking, with no history of trauma. X-ray showed an incidental finding of avulsion of LT of femur. Magnetic resonance imaging showed a large intramedullary tumour in the metaphysis though she had no symptoms or signs of malignancy. On further evaluation, she was diagnosed with primary lung carcinoma with widespread metastasis. Biopsy from the proximal femur also revealed a metastatic lesion. She was given palliative treatment in the form of a proximal femoral nail after which she was started on chemoradiation.
A high index of suspicion of malignancy should be maintained in atraumatic fracture of LT in adults until proved otherwise. Lesser trochanter fracture.
股骨小转子撕脱骨折通常在伴有转子间或转子下骨折的创伤后出现。股骨小转子的非创伤性骨折可能由于附着于小转子的髂腰肌突然剧烈收缩所致；在剧烈运动期间，或涉及髋关节屈曲的突然牵拉时发生。这些情况常见于骨骺尚未融合的青少年。而在成年患者中出现这种情况，往往会导致潜在恶性肿瘤或转移病灶的诊断。
一名60岁女性患者因行走时疼痛前来我院门诊就诊，无外伤史。X线检查偶然发现股骨小转子撕脱。磁共振成像显示干骺端有一个大的髓内肿瘤，尽管她没有恶性肿瘤的症状或体征。进一步评估后，她被诊断为原发性肺癌伴广泛转移。股骨近端活检也显示有转移病灶。她接受了股骨近端髓内钉的姑息治疗，之后开始进行放化疗。
在成人股骨小转子无创伤性骨折中，除非另有证明，否则应高度怀疑恶性肿瘤。小转子骨折。
