Avulsion fracture of anterior inferior iliac spine complicated by hypertrophic malunion causing femoroacetabular impingement: Case report

Abstract

HighlightsHypertrophic malunion of anterior inferior iliac spine causing impingement.Failed conservative management.Surgical excision of hypertrophic fragment have been done to relieve the symptom.First case in Qatar.

Should proximal ruptures of the anterior rectus femoris muscle be treated surgically?

“…Twenty-five articles reported surgical treatment in a total of 67 patients. 2 , 5 , 7 , 14 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 Numerous surgical techniques were utilized without any comparative study between them.…”

“…When surgical treatment was proposed as second-line treatment after failure of conservative treatment (15 articles with 41 patients), 2 , 9 , 14 , 17 , 19 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 it was carried out as proximal tendon reconstruction (1 case of synthetic graft, no cases of autologous graft), 2 , 9 , 14 , 17 , 19 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 resection of scar tissue alone (23 cases, including 16 by arthroscopy), 5 , 35 or resection of the fibrous stump with a local myo-tendinous suture (6 cases). 26 For cases of bone avulsion treated secondarily by surgery (9 cases), either bone resection alone (7 cases, including 1 by arthroscopy) 14 , 27 , 28 , 29 , 30 or reduction and fixation by screwing (2 cases) 17 , 31 was performed. In 2 cases, second-line surgery was resection of a symptomatic labral lesion.…”

The case of ‘A Rhino Horn’: case report and proposal for modification to the Hetsroni and Kelly classification

“…Our patient indulged in weightlifting practice since childhood, confirming our suspicion about a chronic injury to the rectus femoris insertion in both hips. However, acute injury with a displaced avulsion of the AIIS has also been described as a cause of SIS [ 15–17 ]. In our case, we ruled out an acute displaced avulsion as the cause of the ‘rhino horn’ morphology.…”

Hip Impingement after Anterior Inferior Iliac Spine Avulsion Fractures: A Case Report with Review of the Literature

“…Only articles in the English language were considered for inclusion. The following MeSH words were linked “anterior inferior iliac spine” OR “AIIS” AND “avulsion.” We identified 8 manuscripts accounting for 9 cases of failed conservative management due to femoroacetabular impingement, pain with hip flexion, or subspinal impingement and reviewed the type of surgical approach, time to return to sport, and improvement in range of motion [ 4 , 10 , 12 – 17 ]. We believe the following questions are relevant for guiding future research: (1) Is arthroscopic or open excision of heterotopic ossification superior, (2) Is fixation of the fragment superior to excision, (3) Is there an improvement in range of hip motion after surgery, and (4) Do symptoms leading to surgical treatment affect patient outcomes ( Table 1 )?…”

“…These fractures can be difficult to diagnose since they are often not visible on standard pelvis X-rays, and a high degree of clinical suspicion is required. Although previous case reports have demonstrated AIIS avulsion fractures months to years after the injury with excessive callus formation and minor decreases in range of motion, other patients have severely limited motion [ 3 , 4 ]. A combination of the failure to diagnose an acute pelvic avulsion fracture with X-ray and the acquired heterotopic ossification, which can mimic other more dire diagnoses, makes an initial diagnosis of the pelvic avulsion fracture integral in properly treating these patients [ 5 ].…”