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A review of the current literature identified two primary causes of avulsion of the lesser trochanter: strenuous flexion of the hip in adolescent athletes with open epiphyses2,5-9,11,15,16 and pathological fracture associated with a metastatic lesion of bone3,14. In both cases, stress concentration at the site of the iliopsoas muscle leads to a tensile failure of either the apophysis or the lesser trochanter. Typically, the force necessary to avulse an otherwise normal apophysis is much greater than that required to produce a pathological fracture, and the latter mechanism is rarely associated with a history of trauma20. We report the cases of four patients who had an avulsion fracture of the lesser trochanter secondary to a primary malignant tumor of bone. To our knowledge, this is the first report in which a pathological fracture of the lesser trochanter was the presenting symptom leading to the diagnosis of such a tumor. In the absence of a traumatic event, an isolated fracture of the lesser trochanter should suggest an underlying pathological process, particularly a primary or metastatic tumor. To avoid inappropriate operative procedures, a pathological diagnosis must be made by means of a biopsy before internal fixation is attempted. CASE 1. A forty-four-year-old man was first seen by us in June 1985 because of a two-week history of pain in the left hip without antecedent trauma. The pain had been insidious in onset and was aggravated by flexion of the hip. The patient had noted an acute worsening of the pain while sailing. At the time of presentation, he also reported pain in the groin and weakness in the left lower extremity. Clinical examination demonstrated weakness and an inability to flex the left hip against resistance secondary …