Avulsion Fracture of the Lesser Trochanter and the Use of Conservative Treatment

Avulsion fractures of the lesser trochanter of the femur are extremely rare injuries in the pediatric population, most commonly resulting from physical activity. The typical mechanism involves a sudden contraction of the iliopsoas muscle, which inserts on the lesser trochanter. We present a rare case of such an injury in a pediatric patient, emphasizing the importance of appropriate imaging and the effectiveness of conservative management in achieving full recovery. An 11-year-old boy presented to the emergency department with perineal trauma sustained after losing balance while riding a bicycle and striking his perineum against the handlebars. He suffered a large laceration involving the pubic symphysis region, the base of the penis, and the right groin. Surgical wound exploration under general anesthesia revealed a 5-mm bone fragment near the damaged fascia of the quadriceps muscle. Postoperatively, the patient reported severe pain during attempts at right hip flexion, prompting further imaging. Pelvic radiographs and femoral CT scans revealed medial and superior displacement of the ossification center of the lesser trochanter of the right femur by 12 mm. Following multidisciplinary consultation with orthopedic surgeons, a conservative treatment approach was selected. The patient remained stable throughout treatment, showed progressive improvement, and achieved full functional recovery without the need for surgical intervention. Avulsion fracture of the lesser trochanter is a rare but clinically significant injury in pediatric trauma care. This case highlights the importance of accurate imaging for diagnosis and demonstrates that conservative management can lead to complete recovery without surgical intervention.