Avulsion Fractures of the Ischial Tuberosity and Resulting Ischiofemoral Impingement – a Case Report with Literature Review

Abstract

Introduction Apophyseal avulsion fractures of the ischial tuberosity are rare injuries and therefore often not diagnosed in a timely manner. Healing may then result in massive hypertrophic ischial tuberosity. This can cause ischiofemoral impingement symptoms. Due to the low incidence and scarce literature, the optimal treatment and surgery is unclear. Materials and Methods A literature search was carried out using the online medical database “PubMed”. The findings of the literature were then applied to a clinical case of delayed diagnosis of the apophyseal avulsion fracture of the ischial tuberosity. Results There is no gold standard in the literature for the treatment of avulsion fractures on the ischial tuberosity. Nearly 90% are treated conservatively and a fragment dislocation of more than 2 cm is often the indication for surgical care. However, the surgical procedures described are very diverse. An ischiofemoral impingement symptom may result from excessive ossification of the ischial tuberosity, bringing the ischiofemoral distance to the critical limit of 2 cm. Conclusions The timely correct diagnosis and initiation of a therapy is crucial for the later outcome of the patient. Ischiofemoral impingement symptoms may be the indication of bony displacement of the ischial tuberosity as a result of injury. Therapy is then surgical with partial resection of the ischial tuberosity and plate osteosynthesis.

Pronounced Heterotopic Ossifications after Traumatic Hamstring Rupture: Is an Ossification Prophylaxis Useful?

“…Rutetzki et al reported the case of an avulsion fracture of the ischial tuberosity with excessive ossification. The resulting impingement was eliminated by partial bony resection of ischial tuberosity and the hamstring tendons were reattached to the remaining bony fragment by plate osteosynthesis 26 . Rutetzki et al recommended ossification prophylaxis in this case.…”

“…Rutetzki et al berichteten über den Fall einer Avulsionsfraktur am Tuber ischiadicum mit überschießender Ossifikation. Das resultierende Impingement wurde durch eine partielle knöcherne Resektion des Sitzbeines beseitigt und die Hamstring-Sehnen mit dem verbleibenden knöchernen Fragment mittels Plattenosteosynthese refixiert 26 . Rutetzki et al empfahlen in dem Fall eine Ossifikationsprophylaxe.…”

Interpretation of ischiofemoral impingement via a clinical test using hip triaxial dynamic magnetic resonance imaging

“…Hip instability, pelvic/spinal instability, abductor/adductor imbalance, and other related factors are recent focal points for researchers (8). Injuries, extreme hip motion, iatrogenic diseases, necrosis of the femoral head, and peri-hip tumors are also associated with IFI (9,10).…”