Illustrative Case Reports Copyright 984 by The Journal of Bone and Joint Surgery. Incorporated 770 THE JOURNAL OF BONE AND JOINT SURGERY Isolated Fracture of the Lesser Trochanter in Adults: An Initial Manifestation of Metastatic Malignant Disease

ABSTRACT: An avulsion fracture of the lesser tro-chanter in the absence of known or appropriate ante-cedent trauma was the initial manifestation of unrecognized metastatic malignant disease in the sub-trochanteric area of four patients. In three patients the fracture healed but a pathological subtrochanteric frac-ture then occurred, and in one patient prophylactic nail-ing of the hip was performed to prevent this fracture. A thorough search for occult metastatic malignant dis-ease should be made whenever this fracture occurs in an adult. Prophylactic internal fixation to prevent or delay a subsequent pathological subtrochanteric fracture seems worth while. Isolated fracture of the lesser trochanter is uncommon. Dimon collected thirty cases of isolated fracture of the lesse