Mechanism
Rapid muscle contracture
Typically seen in adolescent athletes
Injuries
Calderazzi et al Acta Biomed 2018
- systematic review of apophyseal avulsion fractures of the pelvis
- mean age 14.5
AIIS avulsion 46%
ASIS avulsion 32%
Ischial tuberosity avulsion 12%
Iliac crest avulsion 11%
Lesser trochanter avulsion 2%
Pubic symphysis avulsion 1%
ASIS Avulsion
Attachments
Sartorius & Tensor fascia lata
Imaging
Management
Good results reported with nonoperative treatment of both minimally displaced and displaced
Results
Kautzner et al Int Orthop 2014
- 10 patients with minimally displaced avulsions treated nonoperatively
- 13 patients with displaced fractures treated with surgery
- complete union and full return to sports in all patients at comparable times
- faster recovery in operative groups
- 5 minor cases of heterotopic ossification in operative group
Cai et al Orthop Traumatol Surg Res 2020
- compared operative v nonoperative treatment of ASIS displaced > 1.5 cm
- faster return to sport with operative group
- no difference between two groups at 6 months
Technique
Surgical technique PDF ASIS avulsion
AIIS Avulsion
Attachment
Rectus femoris
Nonoperative Management
- 5 cases managed nonoperatively
- all patients reported pain relief and full return to activities
Issues
1. Can develop hip impingement / subspine impingment
2. Heterotopic ossification
Ischial Tuberosity avulsion
Attachments
Semimembranosus / Conjoint tendon / +/- adductor magnus
Xray
MRI
Indications for surgery
> 1.5 cm displacement
Results
- 45 patients
- small lateral fragments had semi-membranosus and conjoint
- larger fragments also had adductor magnus attachment
- 50% nonunion rates
- 4 patients with displacement < 15 mm treated nonoperatively all did well
- 2/4 patients with displacement > 15 mm treated nonoperatively did well despite pseudoarthrosis
Vadhera et al J Paediatr Orthop B 2022
- systematic review of 90 cases of bony avulsion ischial tuberosity
- average age 15
- return to sport with operative management 95%
- return to sport with nonoperative management 73%
Technique
Arthroscopy Technique Ischial Tuberosity Avulsion
Lesser trochanter avulsion
Attachment
Iliopsoas tendon
Results
- 31 cases with average 5 mm displacement
- average age 14
- 100% return to sport at mean of 2.5 months
Technique
Arthroscopic lesser trochanter avulsion repair
Iliac crest apophysis avulsion
Attachment
External oblique / transversus / internal oblique
Typically minimal displacement
Indications for surgery
Significant displacement
Results
- ORIF of 10 patients with avulsion of iliac crest apophysis
- cannulated screws
- all good outcomes