Secondary Migration of the Lesser Trochanter after Surgical Treatment of a Trochanteric Fracture: A Case Report

Secondary displacement of the lesser trochanter into the groin after osteosynthesis of trochanteric fractures is not common and only scarcely described in the literature. Most reported cases are associated with neurovascular damage caused by the displaced fragment and lead to revision surgery with resection of the migrated fragment. However, revision surgery due only to persistent pain and impairment of mobility without neurovascular compromise is even less common. We present the case of a 79-year-old female patient with a pertrochanteric fracture of the left proximal Femur (AO 31.A1.3) with a lesser trochanter fragment after a fall from her own height. She underwent closed reduction and intramedullary nailing with satisfactory intraoperative reduction and implant positioning. Initial postoperative radiographs showed a moderate proximal displacement of the lesser trochanter. The patient was mobilized with full weight bearing and enrolled in an early rehabilitation program. Five weeks postoperatively, she returned with acute immobilizing pain in the left hip. Imaging confirmed a complete proximal displacement of the lesser trochanter into the groin. Due to persistent, immobilising pain, she underwent surgical revision with resection of the lesser trochanter via a direct anterior approach. Postoperative recovery was uneventful, and the patient regained painless full weight-bearing mobility. The clinical benefit in our case was striking, highlighting the need to consider early revision surgery regardless of neurovascular involvement.