Lesser Trochanter Attachments, Palpation, Avulsion, Fracture

A bony projection that is conical in shape and located posteromedially on the femoral shaft is known as the lesser trochanter. It functions as the iliopsoas muscle's primary insertion point and is crucial for stress distribution and reconstruction stability in intertrochanteric fractures. Fracture or dislocation of the lesser trochanter occurs infrequently and is typically the result of indirect trauma, such as iliopsoas muscle contraction. When treating intertrochanteric femoral fractures, it is not uncommon for the fragment of the lesser trochanter to displace. This can have a big effect on the healing of the fracture, the patient's ability to function, and their quality of life.

Lesser Trochanter Attachments

Many muscles are attached to the lesser trochanter of the femur, including:

The iliopsoas muscle, a strong hip flexor, attaches to the lesser trochanter of the femur from its lumbar spine and pelvic origins. Pectineus muscle is little muscle, which is found in the area of the groin, aids in flexing and adducting the hip joint. It is attached to the lesser trochanter's anterior surface. The Gracilis muscle is a long, slender muscle that runs along the inner thigh and aids in adducting the hip joint. It is attached to the upper portion of the medial surface of the tibia bone below the knee, and its tendon is also attached to the upper portion of the medial surface of the lesser trochanter. Adductor muscles include the adductor brevis, adductor longus, and adductor magnus muscles. The adductor magnus muscle attaches to the medial and posterior sides of the femur, including the lesser trochanter.

Lesser Trochanter Palpation

The following steps should be taken in order to palpate the lesser trochanter of the femur:

1. The patient should be placed supine (on their back) with their legs outstretched and at rest.
2. Determine the location of the greater trochanter of the femur, a bony protrusion on the lateral (outside) aspect of the thigh.
3. Put your palm on the inside of the patient's thigh and slide it towards the body's midline until you feel a bony protrusion. This is the less trochanter.
4. Move your hand up and down and gently push your fingertips onto the lesser trochanter to check for any soreness or swelling.
5. In order to determine whether the patient is experiencing any pain or discomfort, ask patients to bend and rotate their hip joint while keeping the pressure on the lesser trochanter.

Lesser Trochanter Avulsion

Children rarely get avulsion fractures of the lesser trochanter, which are caused by sudden, strong muscle contractions. Adolescent athletes who participate in sports like gymnastics, jumping, and running frequently sustain these injuries. Adolescent athletes who suffer from minor trochanter avulsion injuries can usually return to normal activity and sports after conservative treatment. An isolated avulsion of the lesser trochanter in the absence of applicable trauma is a rare manifestation of hip fractures in adults. Beyond the age of 18, the majority of avulsions of the lesser trochanter are degenerative fractures caused by malignant tumors.

Lesser Trochanter Fracture

When the iliopsoas muscle contracts vigorously while the leg is extended, the attachment to the muscle tears, leading to fractures of the lesser trochanter. Lesser trochanter-isolated fractures are rare, and they typically affect young athletes. A forceful muscle contraction of the iliopsoas on an apophysis with insufficient bone support causes avulsion fractures of the lesser trochanter, which commonly happen during sport. The incidence of isolated fractures of the lesser trochanter (LT) has been shown to have a bimodal age distribution, peaking in adolescence and older people.