Traumatic avulsion fracture of the lesser trochanter in a dog

Summary

A 15-month-old 25 kg female spayed American Staffordshire Terrier was examined to determine the cause of a six month period of lameness of the left pelvic limb. Signs of severe pain were evident on hyperextension and simultaneous internal rotation or abduction of the left hip joint; crepitus or instabiltiy was not detected. The diagnosis of avulsion fracture of the lesser trochanter was based on radiographs, computed tomography (CT) and magnetic resonance imaging (MRI), supported by initial findings such as lameness and hip joint pain in extension. The dog was treated with strict confinement for eight weeks followed by a gradual increase in activity; non-steroidal anti-inflammatory drugs were given for one month. Three months later, the dog was clinically sound and unrestricted activity was resumed. Soundness was confirmed on follow-up 18 months after injury. CT and especially MRI were powerful diagnostic tools to identify chronic iliopsoas strains with an avulsion fracture of the lesser trochanter. Complete recovery ensued following conservative treatment only, despite the proximal diplacement of an avulsed segment of the lesser trochanter. Thus, traumatic injury to the iliopsoas muscle and to the lesser trochanter should be included as differential diagnosis in cases of hind leg lameness.

Keywords

Dog - avulsion fracture - lesser trochanter - magnetic resonance imaging (MRI) - computed tomography (CT)

• References

• 1 Assheuer J, Sager M. MRI and CT Atlas of the dog. Berlin: Blackwell; 1997: 183-313.
• 2 Breuer GJ, Blevins WE. Traumatic injury of the iliopsoas muscle in three dogs. J Am Vet Med Assoc 1997; 210 (11) 1631-4.
• 3 Breuer GJ, Blevins WE. Traumatic injury of the iliopsoas muscle in 25 dogs. Vet Surg 1996; 25 (3) 262 scientific presentation abstracts.
• 4 Breuer GJ, Blevins WE. Traumatic injury of the iliopsoas muscle. Vet Surg 1994; 23 (5) 421-2 scientific presentation abstracts.
• 5 Burk RL, Ackerman N. Small Animal Radiology and Ultrasound. Philadelphia: WB Saunders; 1996: 427-529.
• 6 Dimon JH. Isolated fractures of the lesser trochanter of the femur. Clin Orthop 1972; 82: 144.
• 7 Giacomini S, Di Gennaro. GL, Donzelli O. Fracture of the lesser trochanter. Chir Organi Mov 2002; 87 (4) 255-8.
• 8 Jones PG. Analgesia in soft-tissue injury: current practice in Auckland is not supported by the available evidence. N Z Med J 1999; 112 (1097) 376-9.
• 9 Karlsson J, Sward L, Kalebo P. et al. Chronic groin injuries in athletes. Recommendations for treatment and rehabilitation. Sports Med 1994; 17 (2) 141-8.
• 10 Koepke M, Grevel V, Jurina K. et al. Myositis ossificans bei einer Dobermann-Hündin. Ein Fallbericht. Tieraerztl Prax 2003; 31 (K) 225-333.
• 11 Kohaus H, Peters P, Strunk E. Rupture of the iliopsoas muscle. Unfallheilkunde, 1980; 83: 127-9.
• 12 Levine D, Taylor RA, Millis DL. Common orthopedic conditions and their physical rehabilitation. In: Millis DL, Levine D, Taylor RA. Canine Rehabilitation & Physical Therapy. St. Louis, USA: WB Saunders; 2004: 355-87.
• 13 Mayrhofer E, Olensky G. Bursitis calcarea im Hüftgelenksbereich beim Hunde. Wien. Tieraerztl Mschr 1978; 65: 193-9.
• 14 Peetrons P. Ultrasound of muscles. Eur Radiol 2002; 12: 35-43.
• 15 Sharp NJ. Nervous System. In Textbook of small animal surgery. Slatter D. (ed.) Philadelphia: WB Saunders; 2003: 1092-277.
• 16 Schwobel MG. Apophyseal fractures in adolescents. Chirurg 1985; 56: 699-704.
• 17 Theologis TN, Epps H, Latz K. et al. Isolated fractures of the lesser trochanter in children. Injury, 1997; 28: 363-4.
• 18 Vasseur PB. Musculoskeletal System. In: Textbook of small animal surgery. Slatter D. (ed.) Philadelphia: WB Saunders; 2003: 1774-2285.
• 19 Weiler JM. Medical modifiers of sports injury; the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in sports soft-tissue injury. Clin Sports Med 1992; 11 (3) 625-44.
• 20 Werner G. Der lumbosakrale Übergang des Hundes in der Computertomographie. Wien. 2000 Vet Med Univ Diss.