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A healthy adolescent sustained an isolated fracture of the greater trochanter after falling from a height. He was treated nonoperatively. After 10 weeks of improvement, the pain recurred, and osteonecrosis of the femoral head was diagnosed. Core decompression and a bone-marrow injection were performed. Transient relief was achieved, followed by deterioration to end-stage hip arthritis.To our knowledge, 19 other cases of isolated fractures of the greater trochanter in adolescents have been reported since 1905. All high-energy injuries (10 cases) progressed to osteonecrosis, independent of the intervention; none of the low-energy cases progressed to osteonecrosis. We advocate vigilance and early magnetic resonance imaging for these injuries to detect and treat osteonecrosis in its early stages.