Avulsion fracture of the anterior superior iliac spine: misdiagnosis of a bone tumour

Purpose Avulsion fracture of the anterior-superior iliac spine is an uncommon injury. It is mostly seen in adolescent sprinters, distance runners and soccer players. Most cases are unilateral. We present a cohort of patients and the strategy for their treatment. Methods During the period 2005-2012, we treated 23 (19 male, four female) patients with an average age of 15.1 years (4-17). Ten patients with minimally displaced fractures were treated conservatively, and 13 patients with greater fragment dislocation were treated surgically. All patients underwent the standardised rehabilitation protocol. We evaluated range of motion (ROM), X-ray six weeks and one year postoperatively, length of bed rest, return to activity and complication rates (infection, heterotopic ossification). Results All patients returned to sports at the preinjury level. Surgically treated patients showed faster recovery and better compliance with rehabilitation protocols. The time interval for X-ray union was comparable between groups, as was full recovery. There was no deep infection; however, there were five minor heterotopic ossifications, none of which required further treatment. Conclusion We emphasise that the indication for surgical treatment is mainly determined by the grade of fragment displacement and the patient's sporting activity. Although long-term results were comparable between treatment methods, surgery carries the risk of higher complication rates and the need for osteosynthetic material extraction.

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“…It is also important in differential diagnosis of rare bone tumors, which may simulate clinical findings of an avulsion fracture [11].…”

Section: Discussionmentioning

confidence: 99%

Comparison of conservative against surgical treatment of anterior–superior iliac spine avulsion fractures in children and adolescents

Kautzner

Trč

Havlas

2014

International Orthopaedics (SICOT)

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“…Treatment for these fractures is generally conservative and good results have been reported with rest, analgesic and anti-inflammatory drugs. 2,8 Surgical treatment can be planned when it is necessary to speed up the healing process or when there is a displaced fragment. 2 Avulsion fractures with callus formation during the healing period may be confused with osteosarcoma or Ewing' s sarcoma.…”

Section: Discussionmentioning

confidence: 99%

“…1 The radiological appearance of these fractures during the healing period may be confused with bone tumors. 2 The aim of this report is to emphasize apophysial fracture of the anterior inferior iliac spine for awareness of this injury, appropriate interpretation of imaging findings and for avoidance of unnecessary biopsy.…”

Section: Introductionmentioning

confidence: 98%

Avulsion Fracture of the Anterior Inferior Iliac Spine Mimicking a Bone Tumor: A Case Report

İncedayı¹,

Özyürek²,

Aribal³

et al. 2014

Oman Med J

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This is a case of a 17-year-old boy who was admitted to the clinic suffering from right hip-inguinal region pain which began after a soccer match. He had an avulsion fracture in the anterior inferior iliac spine and CT/MR images showed similarities to a bone tumor. These fractures are especially seen in the apophyses which are within the ossification process. The radiological appearance of these fractures during the healing period may be involved with bone tumors. In the control MRI of the patient after one year, the fracture was almost healed completely. Treatment is generally conservative. Good results have been reported with rest, analgesic and anti-inflammatory drugs. Familiarity with radiological findings of these avulsion fractures in this region not only protects the patient from invasive procedures but also avoids the involvement of the practitioner in legal consequences resulting from a misdiagnosis of sarcoma.

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“…An isolated pincer-type impingement, even in female subjects, is an uncommon finding, with mixed-type impingement being more common (68). (66). In avulsion fractures of the lesser trochanter in adults without a substantial traumatic event, metastatic disease should be suspected (67).…”

Section: State Of the Art: Hip Imaging In Athletes Agten Et Almentioning

confidence: 99%

Hip Imaging in Athletes: Sports Imaging Series

et al. 2016

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Hip or groin pain in athletes is common and clinical presentation is often nonspecific. Imaging is a very important diagnostic step in the work-up of athletes with hip pain. This review article provides an overview on hip biomechanics and discusses strategies for hip imaging modalities such as radiography, ultrasonography, computed tomography, and magnetic resonance (MR) imaging (MR arthrography and traction MR arthrography). The authors explain current concepts of femoroacetabular impingement and the problem of high prevalence of cam-and pincer-type morphology in asymptomatic persons. With the main focus on MR imaging, the authors present abnormalities of the hip joint and the surrounding soft tissues that can occur in athletes: intraarticular and extraarticular hip impingement syndromes, labral and cartilage disease, microinstability of the hip, myotendinous injuries, and athletic pubalgia. Hip or groin pain in athletes is common and clinical presentation is often nonspecific. Imaging is a very important diagnostic step in the work-up of athletes with hip pain. This review article provides an overview on hip biomechanics and discusses strategies for hip imaging modalities such as radiography, ultrasonography, computed tomography, and magnetic resonance (MR) imaging (MR arthrography and traction MR arthrography). The authors explain current concepts of femoroacetabular impingement and the problem of high prevalence of cam-and pincer-type morphology in asymptomatic persons. With the main focus on MR imaging, the authors present abnormalities of the hip joint and the surrounding soft tissues that can occur in athletes: intraarticular and extraarticular hip impingement syndromes, labral and cartilage disease, microinstability of the hip, myotendinous injuries, and athletic pubalgia. After reading the article and taking the test, the reader will be able to:n Describe biomechanical implications of torsional malalignment and other atypical forms of hip impingement n Describe the most common MR imaging findings in femoroacetabular impingement and identify anatomic variants n Describe imaging characteristics of a Morel-Lavallée lesion and identify the anatomic compartment where this lesion typically occurs n Identify common stress fractures around the hip joint in athletes and discuss potential complications n Describe features of myotendinous injuries around the hip n Describe the anatomic relationship of the sacrotuberous ligament and the origin of the hamstring tendons n Describe the anatomic structures involved in an athletic pubalgia Accreditation and Designation Statement The RSNA is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The RSNA designates this journal-based SA-CME activity for a maximum of 1.0 AMA PRA Category 1 Credit ™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity. Disclosure StatementThe ACCME requires that the RSNA, as an accredited prov...

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Avulsion fracture of the anterior superior iliac spine: misdiagnosis of a bone tumour

Cited by 30 publications

References 5 publications

Comparison of conservative against surgical treatment of anterior–superior iliac spine avulsion fractures in children and adolescents

Comparison of conservative against surgical treatment of anterior–superior iliac spine avulsion fractures in children and adolescents

Avulsion Fracture of the Anterior Inferior Iliac Spine Mimicking a Bone Tumor: A Case Report

Hip Imaging in Athletes: Sports Imaging Series

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