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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.†; DAVID L. BOARDMAN, M.D.‡; J. MICHAEL KABO, PH.D.‡; JEFFREY J. ECKARDT, M.D.‡, LOS ANGELES, CALIFORNIA
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Investigation performed at the Department of Orthopaedic Surgery, University of California at Los Angeles School of Medicine, Los Angeles
J Bone Joint Surg Am, 1999 Sep 01;81(9):1299-304
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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. In the absence of a traumatic event, an isolated fracture of the lesser trochanter should suggest an underlying pathological process, particularly a primary or metastatic tumor. To avoid inappropriate operative procedures, a pathological diagnosis must be made by means of a biopsy before internal fixation is attempted.
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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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