Chronic osteomyelitis of the small trochanter : posterolateral surgical approach to the small trochanter

Background: Chronic osteomyelitis localized to the lesser trochanter of the femur is an infrequent clinical entity with limited documentation regarding optimal surgical access. Standard approaches to this anatomical region are typically described for oncological resections rather than the management of infectious processes and associated fistulous tracts.

Objective: This report describes the clinical presentation, diagnostic workup, and surgical management of chronic osteomyelitis of the lesser trochanter using a modified posterior-lateral surgical approach.

Key Points: A 40-year-old female presented with chronic pain and persistent fistulae on the lateral thigh. Radiographic and fistulographic imaging confirmed chronic osteomyelitis of the right lesser trochanter. A modified Gibson approach was utilized, involving a 12-cm incision distal to the greater trochanter. The dissection proceeded between the tensor fasciae latae and the gluteus maximus, extending along the superior border of the quadratus femoris to reach the lesser trochanter. Intraoperative findings revealed complete detachment of the iliopsoas tendon and necrotic bone. Surgical intervention consisted of lesser trochanter resection and thorough necroectomy. This approach avoids major neurovascular bundles and large muscle groups, though it requires precise identification of the quadratus femoris to protect the adjacent sciatic nerve.

Conclusion: The modified posterior-lateral approach provides effective, atraumatic exposure of the lesser trochanter for the treatment of chronic osteomyelitis. This technique facilitates complete debridement and resection while minimizing soft tissue disruption, resulting in primary wound healing and resolution of clinical symptoms.