The lesser trochanter as a cause of hip impingement: pathophysiology and treatment options

Impingement of the lesser trochanter on the ischium or the posterior acetabular rim is not a frequent pathology, but has recently received increased recognition. We have seen 14 cases over a period of 14 years, but concentrate on eight hips showing complex deformities revealing similar characteristics. All eight hips had a residual Perthes or a Perthes-like disease with an elliptically deformed femoral head, but a congurent joint a short or absent femoral neck, a high riding greater trochanter, and a reduced vertical distance between the head and the lesser trochanter. Impingement took place between the lesser trochanter and the ischium or the posteroinferior acetabular border, but was hardly recognisable due to the predominant intraarticular impingement of the nonspherical femoral head and the extraarticular impingement of the greater trochanter. In three cases the impingement showed reproducible subluxation of the hip. While in our hips, excision was the preferred treatment for impingement due to an oversized lesser trochanter, distal advancement was used in the hips with the Perthes morphology; the surgical time was not longer. The overall clinical results in this group however were dominated by a substantial increase in the range of motion (ROM), dependent mainly on the achieved contour of the femoral head and the relative lengthening of the neck. Strength of active hip flexion was normal. Recurrent subluxation disappeared and no complications were recorded.

Lesser Ury

Lothar Brieger

Lesser Ury's Landschaften

G. Kutna

Neues von Lesser Ury

Adolph Donath

Lesser Ury [Illustration] : (Porträt)

Scan von Monochrom-Mikroform

Lesser Ury-Ausstellung im Salon von Keller & Reiner

M. Rapsilber

Isaac Lesser [Illustration] : (Porträt)

Scan von Monochrom-Mikroform

Lesser Ury

M. Rapsilber

Zu den Gemälden von Lesser Ury

Karl Bayer

Lesser Ury

Karl Schwarz

Lesser Ury zum 60. Geburtstag : (7. November 1921)

Karl Schwarz

Bildnis Lesser Ury [Illustration] : Radierung

Hermann Struck

Lesser Ury

Martin Buber