Avulsion Fractures of the Ischial Tuberosity: Progress of Injury, Mechanism, Clinical Manifestations, Imaging Examination, Diagnosis and Differential Diagnosis and Treatment

Liu, Heng; Zhang, Yiqun; Rang, Moujie; Li, Qiang; Zheng, Jiang; Xia, Jidong; Zhang, Mingyi; Gu, Xuan; Zhao, Cheng

doi:10.12659/msm.913799

Cited by 17 publications

(21 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There is no consensus on the treatment of these injuries. The decision for conservative versus surgical treatment is often based on the degree of fracture displacement, 17 but this is not always the case. A meta-analysis reviewing 596 patients concluded that surgical patients had a better rate of return to sports, advising consideration of surgery for "fragment displacement greater than 15 mm and high functional demands."…”

Section: Discussionmentioning

confidence: 99%

Pelvic Region Avulsion Fractures in Adolescent Athletes: A Series of 242 Cases

Moeller

Galasso

2020

Clinical Journal of Sport Medicine

View full text Add to dashboard Cite

Objective: The objective of this descriptive study was to evaluate pelvic region avulsion fractures in adolescents, including age of injury, location of injury, activity and mechanism at time of injury, treatments used, duration of treatment, and outcomes. Design: This was a retrospective chart review of patients who presented with pelvic region avulsion fracture over a 19-year period. Setting: Private practice, primary care sports medicine clinic. Patients: All patients younger than 20 years of age diagnosed with an acute pelvic region avulsion fracture. Interventions: There was no set intervention protocol. A variety of interventions and combination of interventions were used and determined by the treating physician on a case-by-case basis. Main Outcome Measures: Clearance for return toward sport activities. Results: Of the 242 cases, 162 were male. Soccer was the most common sport at the time of injury, and running/sprinting was the most common mechanism. Males were generally older at presentation and were more likely than females to have anterior inferior iliac spine injuries, whereas females were more likely to have iliac crest avulsions. Conservative treatment was effective in all cases. Males were treated for a shorter duration than females, but this difference was not statistically significant. Conclusions: Pelvic avulsion fractures are a rare injury in adolescent athletes. Males are twice as likely to experience these injuries and are older at presentation compared to females. Conservative management leads to successful outcomes in most cases.

show abstract

Section: Discussionmentioning

confidence: 99%

Pelvic Region Avulsion Fractures in Adolescent Athletes: A Series of 242 Cases

Moeller

Galasso

2020

Clinical Journal of Sport Medicine

View full text Add to dashboard Cite

show abstract

“…Moon et al [44] advocated for early ORIF regardless of displacement to avoid exacerbating injury symptoms and displacement, as has been reported in multiple case reports [4,20,44,45]. Conversely, Liu et al [8] reported that the decision to operate should be based on the patient's individualized requirements for functional recovery, such as early RTS, in addition to the degree of fracture displacement. However, less than a fourth of the athletes included specific information regarding fracture displacement, with a reported average of 2.5 cm.…”

Section: Discussionmentioning

confidence: 99%

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

Vadhera

Knapik²,

Gürsoy³

et al. 2022

Journal of Pediatric Orthopaedics B

View full text Add to dashboard Cite

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.

show abstract

“…Current literature recommends surgical management of proximal hamstring if conservative therapy fails and the patient desires to return to higher level of competition/function, or there are complications including nerve involvement. 3,4,9 When operative repair is indicated, open reduction and internal fixation is generally the preferred method. 1e4,9…”

Section: Discussionmentioning

confidence: 99%

Chemoprotection with botulinum toxin following proximal hamstring-Ischial tuberosity avulsion fracture repair

Shilt

McHorse

Moisiuc

et al. 2021

Journal of Clinical Orthopaedics and Trauma

View full text Add to dashboard Cite

Introduction: Surgical treatment for avulsion injuries of the proximal hamstrings has gained increasing popularity over the past decade. Despite good outcomes, early failures have been noted and have been attributed to slipping and falling, postoperative muscle spasm, or early mobilization. In a recent review of hamstring repair rehabilitation protocols, it was shown that there is marked variability in post-operative management. Post-operative bracing with limiting knee extension and hip flexion is the standard of care in most early rehabilitation protocols. Braces with limitation of hip flexion and knee locked in 90 0 flexion can be awkward, cumbersome and create fall risk. Chemoprotection has more recently been proposed to be an alternative approach to prevent tendon repair failure and controlled mobilization which has been shown to be superior to complete immobilization. We present the first case series of the use of botulinum toxin for chemo-protection of the proximal hamstring ischial avulsion repair, demonstrating its safety and efficacy. Methods: Retrospective case series at a tertiary children's hospital which included patients <18 years of age who underwent interventional treatment for proximal hamstring avulsion injuries of the ischium utilizing botulinum toxin as a chemoprotective agent. Data collected included demographic data, injury and treatment details, imaging, post-operative rehabilitation and return to activity. Descriptive statistical analysis was conducted. Results: Five male patients with mean age 14 years (12e17) were included in the study. All were sports related non-contact injuries. Radiographs showed displaced avulsion fractures in all 5 patients. All patients had failed conservative management initially; mean time to surgery from initial injury was 34.4 weeks. 4 patients underwent open reduction and internal fixation (ORIF), 1 patient with less displacement had bone marrow aspirate (BMA) injection; all had chemoprotection using botulinum toxin injected in the hamstrings. No patient required hip immobilization or knee immobilization locked to 90 . We elected to use a brace locked at 20 knee flexion in 2/5 patients. All patients underwent supervised physical therapy and achieved symmetric knee range of motion (ROM). Post-operative radiographs confirmed healing of the avulsion fracture in all 5 patients and they all returned to previous level of activity at mean 32 weeks (21e43) from surgery. None of the patients had a hamstring re-injury at mean follow up of 27 months (11e42). Conclusion: Our case series is the first in literature that shows the safety and efficacy of chemoprotection with botulinum toxin for the post-operative management of avulsion injuries of proximal hamstrings, by minimizing the need for cumbersome bracing and allowing controlled motion during physical therapy.

show abstract

Avulsion Fractures of the Ischial Tuberosity: Progress of Injury, Mechanism, Clinical Manifestations, Imaging Examination, Diagnosis and Differential Diagnosis and Treatment

Cited by 17 publications

References 34 publications

Pelvic Region Avulsion Fractures in Adolescent Athletes: A Series of 242 Cases

Pelvic Region Avulsion Fractures in Adolescent Athletes: A Series of 242 Cases

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

Chemoprotection with botulinum toxin following proximal hamstring-Ischial tuberosity avulsion fracture repair

Contact Info

Product

Resources

About