An avulsion fracture is when a tendon or ligament pulls a piece of fractured bone away. There is a gradual onset of pain with no clear history of injury. An avulsion fracture occurs when a tendon or ligament attached to a bone pulls away a fragment of that bone. Avulsion fracture 0more common 0less common anterior superior iliac spine 0 ossification at. This injury is usually seen in adolescents, as an avulsion fracture of the apophyses, a result of sudden vigorous contraction or repetitive contraction of the sartorius and tensor fasciae latae muscles. Jan 28, 2019 a pelvis avulsion fracture occurs due to the strong muscular contraction that pulls away a piece of bone from its connecting point forcing the bone of the pelvis to break. Confusion over terminology has clouded the management of these fractures. Growth plate injuries mo mortazavi, md director, sparcc sports medicine program. The entire length of the fibula should be palpated to rule out an associated proximal fracture maisonneuve injury.
Spontaneous recovery usually occurs within 4to6 weeks. Apophysitis describes a chronic traction injury at the insertion site of a tendon. Avulsion of the anteriorsuperior iliac spine athletes. Avulsion fracture locations fxs occur through apophysis torode i ischial tuberosity 54% aiis 22% asis 19% pubic symphysis 3% iliac crest 1%. Asis avulsion fracture is rarely encountered and constitutes 1. The fracture involved the tensor fascia lata muscle and the external oblique abdominal muscle. Swelling and tenderness in the dorsal midfoot may be a sign of a navicular fracture, lisfranc injury, or other tarsalmetatarsal injury. Pdf surgical treatment of a young athlete with displaced. Avulsion fracture of the anterior inferior iliac spine. We present here an unusual case of a sequential avulsion fracture of the anterior inferior iliac spine aiis, occurring first in the right and then the left aiis, during long jump attempts.
Surgery may be done by putting the bones together using metal pins, screws, or plates. Pdf on apr 29, 2019, poor alexander e and others published surgical treatment of a young athlete with displaced avulsion fracture of the anterior superior iliac spine asis find, read and. M 2011 avulsion fracture of the anterior superior iliac spine with meralgia paresthetica. The case of a 17 year old boy with pain around his right groin, which first occurred during a long jump attempt, is presented. Ct image of pelvic avulsion fracture in our case avulsion fracture occurred in asis due to sudden contraction of sartorius, tensor facia lata and rectus femoris muscles. These may occur in fully grown athletes, although in the pelvis, they tend to occur more commonly in skeletally immature growing athletes. The case of an avulsion fracture occurring in an 18 year old athlete after repeated running is presented. Sports with the highest risk of this injury include running, soccer and ice hockey.
Avulsion fracture of the anterior superior iliac spine and the iliac crest. Sequential avulsion of the anterior inferior iliac spine in. It, aiis, asis, lt, ic, at lower extremity osgood schlatters, severs, slj, islens variable avulsion and arrest risks. Avulsion fracture of the anterior superior iliac spine description avulsion fractures of the anterior superior iliac spine asis are separations of bone resulting from pulls of muscle tendon units. An avulsion fracture happens when you pull too hard on the bones in your ankle, hip, or elbow. These can usually be treated on an outpatient basis with crutches, analgesics, and modified activity. An avulsion fracture is where a fragment of bone is pulled away at the ligamentous or tendinous attachment.
A mindfulness approach to rehabilitation in international journal of athletic therapy and training patti syvertson dat, at 1, russell baker dat, at 2 and alan nasypany edd, at 2. Pelvis fractures pediatric pediatrics orthobullets. Twentytwo of these patients were followed for an average of 44 months. Surgical treatment of a young athlete with displaced avulsion. Apr 04, 2014 an anteriorsuperior iliac spine asis avulsion fracture is an uncommon injury in adolescent athletes. Radiographic examination revealed an avulsion fracture of the right aiis. Avulsion fractures of the anterior superior iliac spine are rare. Avulsion fractures of the pelvis american college of. Overstretching of the muscle may also result in rectus femoris avulsion fracture. It was treated by open reduction and internal fixation with two screws. The patient was a 17yearold adolescent male who was referred to a physical therapist for a chief complaint of anterior right hip pain. Pelvis avulsion fracturecausessymptomstreatment risk. It can be caused by a traumatic traction repetitive longterm or a single high impact traumatic traction of the ligament or tendon. Avulsion fracture of the anterior superior iliac spine.
Project overview powerpoint presentation 5 mins for use in the emergency department to promote the new resource at staff meetings. This happens while bending the knee with the hip in an extended position in such a way that the thigh is moved backwards. Feb 03, 2020 a pelvic avulsion fracture that is severe or does not heal with other treatments may need surgery. Pediatric pelvic ring fractures are uncommon injuries that are usually associated with highenergy trauma and are often associated with cns and abdominal visceral injury.
Comparison of conservative against surgical treatment of. Nonoperative treatment for proximal avulsion of the rectus femoris in professional american football. Hsu cy, wu cm, lin sw, cheng kl 2014 anterior superior iliac spine avulsion fracture presenting as meralgia paraesthetica in an adolescent sprinter. Asis avulsion orthopaedicsone articles orthopaedicsone. Without adequate preventive methods, an avulsion fracture may result.
A radiograph of the pelvis was performed which showed bilateral avulsion of the anterior superior iliac spine asis. Apr, 2017 a fracture is a break or crack in a bone that often results from an injury. Aug 12, 2011 avulsion fractures of the anterior superior iliac spine are rare. Operative versus conservative treatment of apophyseal. A pelvic avulsion fracture that is severe or does not heal with other treatments may need surgery.
It is usually caused by sudden strain on the sartorius muscle or the tensor of the fascia lata during the starting phase of running or jumping 14. Protective gear includes helmets, elbow pads, knee pads, shin pads, and other sports equipment. Avulsion fracture of the anterior inferior iliac spine among. M 2011 avulsionfracture of the anterior superior iliac spine with meralgia paresthetica. Avulsion fractures of the anterior superior iliac spine asis and the anterior inferior iliac spine aiis with indirect mechanism are the consequence of a forceful contraction of the sartorius and the rectus femoris, respectively, with the hip extended and the knee flexed 8, 12. A pelvis avulsion fracture occurs due to the strong muscular contraction that pulls away a piece of bone from its connecting point forcing the bone of the pelvis to break. Aiis avulsions can occur with a concentric or eccentric contraction of the. The patient returned to full training, including long distance running, only four weeks after the operation. This helps return the bones to their normal position.
Avulsion fractures occur as a result of sudden, violent or unbalanced contractions of the muscles with insertions in these areas 3. In over 400 cases of apophyseal avulsion fractures in an adolescent population, 94% were. This type of injury is common in young athletes who will often report a popping or snapping sound at the time of the injury. Fractures of the pelvis and acetabulum in the pediatric. Pelvis avulsion fracturecausessymptomstreatment risk factors. Asis is the site of attachment for sartorius and tensor fascia latae muscles. Emergency management of pelvic fractures trauma international.
Multiple osteochondroses and avulsion fracture of anterior. It can occur at numerous sites in the body, but some areas are more. Subacute or chronic avulsion injuries can be mistaken for a pseudotumor. The basic principles of emergency management, airway, breathing and circulation hold true for pelviacetabular fractures too. Acute avulsion fractures of the pelvis in adolescent competitive athletes. Anterior superior iliac spine asis avulsion injuries typically occur in athletes during forceful muscular contraction. This was diagnosed using plain radiography, and was managed nonsurgically. The case is here reported of an apophyseal avulsion fracture of the anterior superior iliac spine in an adolescent caused by playing football before the end of treatment for. One patient with both a talus and navicular avulsion fracture was misdiagnosed. Pelvic avulsion fractures in children inpatient care what. In a series of 80 pelvic fractures in children seen and managed in the royal liverpool childrens hospital, alder hey, in the last 10 years, 32 avulsion fractures in 25 patients were diagnosed and treated. An anteriorsuperior iliac spine asis avulsion fracture is an uncommon injury in adolescent athletes. They may occur in adolescents, young adults and in elderly people.
The correct diagnosis was made in 12 patients with isolated dorsal talus avulsion fractures, 7 patients were given an incorrect diagnosis after misreading of the radiograph. Anterior superior iliac spine avulsion injury radiology. A condition often treated nonoperatively, the focus of treatment is based on effective. Common presenting symptoms include bruising, swelling, and. Sports, avulsion fracture, iliac crest, adolescent, followup abstract the authors present the case of a sportsrelated avulsion fracture of the iliac crest, which happened in 1987, in an 18year old adolescent. Avulsion fracture of the anterior superior iliac spine and. You can take several steps to minimize the chance that you will have a bone fracture, such as. Gamradt sc, brophy rh, barnes r, warren rf, thomas byrd jw, kelly bt. Avulsion fracture of the anterior superior iliac spine asis is unusual, accounting for only 1. Learningradiology pelvic avulsion fractures, aiis, asis. The asis may suffer from an avulsion fracture as a result of sudden or forceful contractions of the asis muscle and indirect trauma to the area. Anterior inferior iliac spine avulsion injury radiology. Avulsion fractures of the pelvic apophyses typically occur in adolescent athletes due to a sudden strong muscle contraction while growth plates are still open.
Feb 03, 2020 a pelvic avulsion fracture frakchur occurs when a piece of pelvic hip bone breaks and tears away. Rectus femoris avulsion fracturecausessymptomstreatment. In this article, we look at the causes, treatments, and outlook. Avulsion injuries of the apophyses of the pelvis are mainly athletic injuries and are usually seen in adolescents. An awardwinning, radiologic teaching site for medical students and those starting out in radiology focusing on chest, gi, cardiac and musculoskeletal diseases containing hundreds of lectures, quizzes, handout notes, interactive material, most commons lists and pictorial differential diagnoses. Rectus femoris avulsion fracture is a condition, which occurs due to an explosive or strong contraction of the muscle. This occurs as tendons can bear more load than the bone. However there are certain practical tips and principles that will help in getting better results in these situations.
Pelvic avulsion fractures in children inpatient care. Results of nonoperative and operative management of. Treatment of an avulsion fracture at the base of the 5th metatarsal. A fracture is a break or crack in a bone that often results from an injury. Sequential avulsion of the anterior inferior iliac spine. Axial t2weighted fatsaturated magnetic resonance image of the pelvis 3 months after the completion of the magnetic resonance imaging seen in figure 2, demonstrating a healing avulsion fracture of the right anterior superior iliac spine and a marked reduction in edema in the surrounding soft tissues arrow compared to the edema seen in figure 2. Occasionally, surgical intervention is required to remove painful fragments or to regain. Outcome of conservative management of athletic chronic groin injury diagnosed as pubic bone stress injury. Avulsion fracture of the asis is an uncommon injury, accounting for only 1.
Surgical treatment of a young athlete with displaced. Place these posters in your clinical areas as a visual reminder of the resources available. Avulsion fracture of the anterior superior iliac spine following apophysitis. Acetabulum fractures, pelvis fracture, emergency management.
Four patients with a dorsal navicular avulsion fracture were given the correct diagnosis. Excision of the apophyseal fragment was the intervention pursued for 48% of cases, with the mean time to union of 4. Use protective gear while exercising or playing sports. Anterior inferior iliac spine aiis avulsion injuries are one of the six main types of pelvic apophyseal avulsion fractures. This happens when a tendon or ligament connected to the hip bone tightens so hard it pulls off part of the bone. Pelvic avulsion fractures in adults inpatient care. With an avulsion fracture, an injury to the bone occurs near where the bone attaches to a tendon or ligament. An anterior iliac spine avulsion is a type of pelvic ring fracture, so you should choose 27193 closed treatment of pelvic ring fracture, dislocation, diastasis or subluxation.