MANUAL MINORS
A trochanteric avulsion fracture occurs when a sudden or forceful contraction of the muscles attached to the trochanter (such as the gluteus medius and minimus on the greater trochanter, or the hamstring muscles on the lesser trochanter) pulls off a fragment of bone.
This type of fracture is more common in adolescents and young athletes due to the immaturity of the bone apophyses, but it can also occur in young adults and the elderly following trauma or falls.
Diagnosis
The diagnosis is suspected in patients presenting with sharp, localised pain in the hip or thigh region following intense physical activity (such as jumping or running) or trauma. The pain worsens with contraction of the muscles attached to the affected trochanter, and there may be weakness in the limb.
It is confirmed by X-rays of the pelvis and hip, where the avulsed bone fragment can be seen. In uncertain cases, magnetic resonance imaging (MRI) or computed tomography (CT) may be required for better assessment of soft tissues and the extent of the fracture.
Differential Diagnosis
Condition | Key Characteristics |
|---|---|
Muscle tear | Muscle pain with no evidence of fracture on X-rays |
Hip fracture | Severe hip pain, typically in older individuals |
Trochanteric bursitis | Pain on the lateral side of the hip, without a history of acute trauma |
Pelvic contusion | Localised pain without radiographic evidence of fracture |
Emergency Management
Pain control: Administer analgesics, such as NSAIDs (ibuprofen or paracetamol), to relieve pain.
Rest: Rest with avoidance of intense physical activity is recommended to allow bone healing. Weight-bearing on the affected limb should be avoided.
Ice and elevation: Apply ice to the affected area to reduce inflammation in the first 48 hours.
Diagnostic imaging: Request X-rays of the pelvis and hip to confirm the diagnosis and evaluate the degree of displacement of the bone fragment.
Mobilisation with crutches: If there is no significant displacement, the patient may be mobilised with crutches, avoiding weight-bearing on the affected limb.
Definitive Treatment
Definitive treatment depends on the degree of displacement and the level of functional impairment:
Non-displaced or minimally displaced fractures (<2 cm): These fractures are managed conservatively with relative rest, pain relief, and physiotherapy. Recovery typically takes 4 to 6 weeks. Rehabilitation includes a progressive exercise programme to restore strength and mobility.
Significantly displaced fractures (>2 cm): In these cases, open reduction and internal fixation (ORIF) may be necessary to restore proper muscle attachment and joint function. Screws or plates are used to secure the avulsed bone fragment.
Rehabilitation
In both cases, rehabilitation is essential to restore hip mobility and muscle strength. A physiotherapist will guide the patient in gradually returning to physical and sporting activities, generally after 6 to 8 weeks.
With appropriate treatment, trochanteric avulsion fractures typically have a good prognosis, and patients can return to their normal activities without significant limitations.
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