The lesser trochanter is the conical medial eminence at the base of the femoral neck, the exclusive insertion of the iliopsoas tendon. Its ossification centre in adolescents is the site of iliopsoas avulsion fractures from explosive hip flexion in young athletes. In adults, isolated lesser trochanter avulsion fracture in patients over 50 is a pathological fracture pattern highly suggestive of metastatic disease weakening the bone.
Spontaneous lesser trochanter avulsion fracture in an adult over 40 without antecedent significant trauma should be treated as a pathological fracture from metastatic disease until proven otherwise. The most common primary cancers to metastasise to this location include prostate, breast, kidney, lung, and thyroid cancers. MRI or bone scan should be obtained to assess the remainder of the skeleton for additional metastases before any surgical intervention.
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