Pelvic Avulsion Fractures
Although some clues for diagnosis exist in patient's history, these injuries are still a big dilemma with their diagnosis and also treatment. Most of these injuries are misdiagnosed as strain and only medication was the treatment modality that causes delay in return to sports - Sancar Serbest MD
HWN Suggests
Pelvic Avulsion Fractures
Before you diagnosis a “hip sprain,” consider the age, mechanism, and those tricky growth plates! Kids are less likely to “sprain” and more likely to avulse a growth plate.
The adolescent athlete has the perfect storm of physical activity, strong muscles, and weak growth plates. Keep pelvic avulsion fracture on your differential for the adolescent with thigh, hip, and pelvic pain that occurs after sporting activity.
Featured
Pelvic Avulsion Fractures
Pop goes the apophysis! In teenage athletes the apophyseal cartilage is the weak point along the pelvic rim. Learn about these common injuries in this edition of PEM Currents, the Pediatric Emergency Medicine podcast.
Articles of Interest
Anterior Inferior Iliac Spine Avulsion Fracture
Avulsion fracture of a pelvic apophysis in an adolescent athlete is a rare entity due to high stress of a violent forceful muscle contraction. Adolescent sport injuries are becoming a bigger problem with their increasing frequency and importance; 3% to 5% of all sport injuries are seen around groin region. These injuries are occurring mostly in competitive sports with hitting, running, and sudden direction changes in sprinting.
Apophyseal Avulsion Fractures of the Hip and Pelvis
Apophyseal avulsion fractures of the hip and pelvis are injuries that usually occur in the adolescent athlete. However they may present in a patient as late as the mid-20s.' If not properly diagnosed and treated, these injuries can he debilitating to an adolescent athlete.
Apophyseal Avulsion Injury of the Pelvis
In the adolescent competitive athlete the pelvis is a common location of apophyseal avulsion injury. In a study of 203 avulsion fractures seen on radiographs, the most commonly affected apophyses were: the ischial tuberosity (the origin of the hamstrings); the anterior inferior iliac spine, AIIS (the origin of the straight head of the rectus femoris); the anterior superior iliac spine, ASIS (the origin of the sartorius and some fibers of the tensor fascia lata); and a portion of the pubic symphysis (the origin of the adductor brevis and longus as well as the gracilis).
Avulsion Fracture of the Anterior Superior Iliac Spine in a Young Athlete Detected by Point-Of-Care Ultrasound
Pelvic avulsion fractures (PAFs) are common in adolescents. X-ray is commonly used to diagnose PAF, but the use of point-of-care ultrasound (POCUS) for this purpose in pediatric emergency departments has yet to be published.
Avulsion fractures of the pelvis – a qualitative systematic review of the literature
Avulsion fractures of the pelvis represent a highly prevalent pathology among the adolescent athletic population. A population of skeletally mature patients with history of boney surgical intervention are also at risk.
Commonly Missed Uncommon Orthopedic Injuries
Epiphyseal plates and apophyses are the weakest part of the MSK chain. Because ligaments and tendons are stronger than these bony growth areas in children and young adults, avulsion fractures of these areas can occur in patients under the age of 25. The mechanism of injury is typically a sudden or forceful eccentric muscle contraction during running, jumping or kicking, and so these are usually sports-related injuries.
Pelvic Avulsion Injuries – Emergency Department
Pelvic avulsion injuries are usually seen in the active adolescent patient. Whilst they are technically a fracture of the pelvis, they differ from the other types in that they are not usually caused by a high degree of extrinsic force, instead being caused by a sudden muscle contraction such as may occur during a sporting activity. The vast majority of these injuries have a good outcome with conservative management once diagnosed, though delay to diagnosis has some association with longer term issues. Only a small minority require consideration of surgical management.
The Outcomes of Conservative Versus Surgical Treatment of Pelvic and Hip Avulsion Fractures: A Systematic Review and Meta-Analysis
Avulsion fractures of the pelvis and hip are common injuries in adolescent patients. Avulsion sites include the rectus femoris at the anterior inferior iliac spine (AIIS), the sartorius at the anterior superior iliac spine (ASIS), the hamstrings at the ischial tuberosity, abdominal muscles on the iliac crest (IC), iliopsoas at the lesser trochanter (LT). Although these fractures are commonly treated conservatively, there is no consensus on the preferred treatment modality (conservative vs. surgical fixation) or thresholds for surgical treatment. The published literature is generally limited to small retrospective series, with in some cases conflicting results.
Treatment of avulsion fractures of the pelvis in adolescent athletes: A scoping literature review
Avulsion fractures of the pelvis and hip region are typical injuries in adolescent athletes. Avulsion sites include the muscle tendon origin or insertion, and treating these injuries surgically or conservatively remains a debated issue.
Resources
UMEM Educational Pearls
Avulsion fractures can occur at many areas of the pelvis. A mnemonic is: Alabama’s stoned rappers got ill hunting armadillos...
Radiopaedia
Apophyseal avulsion fractures of the pelvis and hip are relatively common among physically active adolescents and young adults. Pelvic and hip apophyseal injuries typically occur in the 14 to 25 year age range. Kicking sports, such as soccer, and gymnastics are frequently to blame.
