Avulsion fractures of the ischial tuberosity in the pediatric athlete: a systematic review and return to sport analysis

Abstract

Apophyseal avulsion fractures of the ischial tuberosity (AFIT) in pediatric athletes are relatively uncommon injuries with treatment and return to sport (RTS) outcomes being largely unknown. The purpose of this review is to perform a systematic review analyzing RTS and predictors of successful RTS for pediatric athletes sustaining AFIT. Studies reporting on athletes strictly under the age of 18 years sustaining an AFIT with reported RTS status were included. RTS was analyzed based on injury acuity, mechanism, and management, whereas the incidence of any complications was recorded. A total of 33 studies comprising 90 cases of AFIT were identified. The mean age of athletes sustaining injuries was 14.7 + 1.4 years (range, 9–17 years), most commonly participating in soccer (n = 25), sprinting (n = 21), and gymnastics (n = 7). Acute trauma during sporting activities was responsible for 74.4% (n = 77/90) of injuries. A total of 82% (n = 74/90) of athletes reported successful RTS at an average of 7.0 + 5.0 months. Athletes undergoing surgery had a significantly higher RTS rate (n = 36/38, 94.7%) compared with athletes treated nonoperatively (n = 38/52, 73.08%; P = 0.008). When reported, a high rate of misdiagnosis was reported (39.4%, n = 28/71). Complications were reported in 15.8% (n = 7/38) and 32.7% (n = 17/52) of athletes managed surgically and conservatively, respectively. As such, the high rate of misdiagnosis and subsequent high rate of complications and poor rate of RTS highlight the importance of accurate diagnosis and treatment. Future prospective studies evaluating patient outcomes based on fracture displacement, sporting activity, and management strategies are warranted to better treat pediatric athletes. Study design: Level IV, systematic review.

Surgical treatment of an old avulsion fracture of the ischial tuberosity and ischial ramus: A case report

“…Avulsion fractures of ischial tuberosity almost always occur in adolescents, in whom the vulnerable unfused epiphysis can be easily avulsed with a sudden and forceful eccentric contraction of the hamstrings[ 5 ]. Avulsion fractures are usually incurred during competitive sports, such as soccer, sprinting, and gymnastics[ 6 ], when the affected leg is forced into hyperflexion of the hip with full extension of the knee[ 7 ]. Avulsion fractures sustained in the course of dancing are uncommon, because dancers often have higher flexibility than athletes who play other competitive sports that require greater strength[ 8 , 9 ].…”

“…Nearly all avulsion fractures can be identified with standard pelvic X-rays[ 11 ]. Nevertheless, the aspecificity of reported symptoms and the lack of awareness of these injuries frequently result in them being misdiagnosed as muscular strains or tendinous tears[ 1 , 6 ]. CT and magnetic resonance imaging scans are useful for the differential diagnosis of avulsion fractures with no or minimal displacement from muscular or tendinous tears[ 12 ].…”

What’s New in Pediatric Orthopaedics

“…A systematic review evaluating pediatric ischial tuberosity avulsion fractures found that 82% of athletes returned to sport at a mean of 7 months after the injury, with those treated surgically returning at a higher rate of 95% compared with 73% in those treated conservatively. The complication rates were 16% for those patients treated surgically and 33% for those patients treated conservatively 78 .…”

Apophyseal ilium avulsion fractures in young athletes: a systematic review and return to sport analysis

“…Categories for data collection for each of the articles meeting inclusion/exclusion criteria included: (a) article information, (b) patient demographics, (c) fracture management, (d) surgical technique, (e) fracture acuity, (f) incidence of nonoperative and surgical complications, as described in prior reviews on apophyseal avulsions [9,10], and (g) RTS rate and timing following injury. The primary outcomes were weighted RTS rates and timing.…”

“…Intraclass correlation coefficients (ICCs) using a two-way random-effects model were calculated to compare Pierson and MINORS scores between two authors (blinded for peer review) to assess study quality consistency. All analyses and pooling of outcomes from included case reports and series were conducted in Stata 14.0 (Stata Corp., College Station, Texas, USA) similar to that of prior literature [9][10][11].…”