Avulsão indireta da epífise da crista ilíaca: uma rara lesão

Abstract

A avulsão da cartilagem da crista ilíaca é uma lesão infreqüente e raramente é descrita na literatura. Atletas jovens e adolescentes são os indivíduos mais predispostos à lesão. O trauma indireto causado pela contração da musculatura aderida à crista ilíaca e o movimento de angulação do tronco em sentido oposto ao da contração é o mecanismo mais comum de arrancamento da cartilagem. Como na maioria dos casos não existe trauma direto, esses podem não ser diagnosticados se não considerarmos essa possibilidade de lesão. Relatamos dois casos atendidos em nosso Serviço, que apresentaram lesão na cartilagem devido a um trauma indireto (contração muscular abrupta). Ambos foram tratados de maneira incruenta, com excelente evolução.

Avulsion fracture of the iliac crest in a child

“…Thus, over the intervening time period, the ossified cartilage is subject to direct or indirect trauma that could cause its displacement. 6 , 7 , 8 …”

“…Indirect trauma is generally the commonest mechanism, due to abrupt contraction of the musculature that is inserted in the iliac crest (transverse abdominal, internal oblique and external oblique muscles), in association with rotational movement or inclination of the trunk toward the opposite side. 7 , 8 Such trauma may result not only from active abrupt contraction, but also from passive traction, acceleration, jumping and repetitive muscle stress. There are authors who believe that because the trunk and hip do not present synchronized movement at the time of muscle contraction, this serves as a very important element in the mechanism of the injury.…”

“…After this period, patients are released for progressive resumption of weight-bearing, with a return to physical activities after four weeks. 7 , 8 Two studies on adolescents with pelvic avulsion fractures showed good results among patients who were treated conservatively and returned in a normal manner to their activities at pre-injury levels. 2 , 3 Avulsion of the apophysis of the iliac crest may present displacements of greater or lesser degree.…”

“…6 , 7 , 8 It generally results from indirect trauma caused by traction of the musculature inserted in this region (external and internal oblique muscles and the transverse muscle of the abdomen). 8 , 9 , 10 It is a diagnosis that is clinically difficult to suspect, since these are low-energy injuries that are rarely caused by direct trauma. Conservative treatment using conventional analgesics and restriction of weight-bearing is generally chosen.…”