2017 Resarch Forum

EM: C-2

Applicant: Amanda Montgomery MD

Avulsion of the lesser trochanter following a shot put sport session Mohamed Habib Grissa MD 1, 2 ; Nasri Bzeouich MD 1, 2 ; Makrim Zrig MD 2 ; Hamdi Boubaker MD 1, 2 ; Mohamed Amine Msolli MD 1, 2 ; Abderrazak Abid MD 2 ; Semir Nouira MD 1, 2 & Amanda Montgomery MD 3

1 University of Monastir, Dept. of Emergency Medicine 2 Fattouma Bourguiba University Hospital 3 Kern Medical, Dept. of Emergency Medicine

INTRODUCTION

Avulsion of the lesser trochanter is an uncommon injury. The mechanism by which it occurred in this particular case was unusual, prompting a close look. PURPOSE A 14 year old male sustained an avulsion fracture to the lesser trochanter of his left leg during a shot put session. The injury occurred without blunt force to the affected area but rather through forceful abduction and external rotation of the left hip. DISCUSSION This case warrants discussion for several reasons. First, the injury that occurred is rare. This case may prompt providers who have not seen this particular injury to have appropriate clinical suspicion in similarly presenting cases. Second, the mechanism of injury during an upper body exertion may not prompt an emergency physician to obtain imaging of the painful area. In the absence of blunt force trauma, suspicion of this type of injury may be low and the avulsion could easily be missed. Third, it is important to educate providers on proper management of this type of case. Treatment for this injury is primarily conservative and nonsurgical. Bed rest and non-weight bearing status are an important part of the recovery process. CONCLUSION The emergency physician must keep this type of injury on the differential diagnosis of a patient with similar presenting symptoms. In cases with high clinical suspicion, it is reasonable to order imaging studies to avoid a missed injury and potential permanent disability.