Isolated Fracture of the Lesser Trochanter- An Indicator of Malignancy at Proximal Femoral Head A Case Report

Isolated fracture of lesser trochanter is a rare type of fracture. It is noted occasionally by case reports and most of them are known as manifestation of malignancy at proximal femoral head. We report a case of isolated fracture of Right lesser trochanter secondary to a nasopharyngal cancer metastasis. A 58 years old male patient came to the emergency room because of an acute (R) hip pain and low back pain after having fallen down on the buttock. 1 year ago, he had a nasopharyngeal cancer and received a full radiotherapy. Physical examination reveiled a decrease of ROM of (R) hip joint and a firm and painful (R) Scarpa’s triangle. Plain pelvic X-ray showed an isolated avulsion of (R) lesser trochanter. CT scan found an osteolysis at proximal femoral head. MRI showed a widely spreading metastasis at lumbar spine, pelvic ring and both of proximal femoral heads, with infiltration of soft tissue and numerous hypertrophic aortic ganglions. The biopsy of (R) proximal femoral head showed a non-differentiated carcinoma. Due to the financial condition, our patient refused further treatment and has been discharged. Isolated fracture of lesser trochanter in adults, traumatic or not, should be seen as a sign of malignancy until proven otherwise.