Chronic (Ten Years) Ischial Tuberosity Avulsion Fracture Nonunion Treated with Fragment Excision and Simultaneous Primary Repair of the Hamstring Tendon

Dailey, Steven K.; Branam, Barton R.; Archdeacon, Michael T.

doi:10.2106/jbjs.cc.m.00176

Cited by 7 publications

(11 citation statements)

References 12 publications

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“…In general, the ITAF is associated with strenuous exercises, such as running, soccer, and other competitive sports. [11,12] Rossi and Dragoni reported that the average age of pelvic avulsion fractures is 13.8 years, [13] mainly due to the characteristics of bone development at this time. [14,15] However, although the bones of the elderly are matured, there are reports of ITAF in the elderly, in which case, pathologic fractures are considered.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment for acute ischial tuberosity avulsion fracture

Liu

Shi

et al. 2019

Medicine

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Rationale: Ischial tuberosity avulsion fracture (ITAF) is a very rare sports injury, and there is currently no consensus on its diagnosis and treatment. Although conservative treatment is adequate for most patients, those with large displacement of the fracture need surgical management. Patient concerns: A 13-year-old male athlete experienced tearing pain in the right hip during a sprint. Radiographic examination showed an avulsion fracture of the right ischial tuberosity. Diagnosis: Right ITAF. Interventions: On the 3rd day of injury, the patient was treated with open reduction and internal fixation of ITAF under general anesthesia. Outcomes: The patient received a systematic postoperative exercise in 2 weeks, and the fracture healed 4 weeks later. After 8 months, the patient returned to the field to participate in the competition. Lessons: Early surgical treatment can bring about good results in the treatment of ITAF with large displacement. The longitudinal incision and subgluteal approach is an ideal choice for the operative procedure.

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Section: Discussionmentioning

confidence: 99%

Surgical treatment for acute ischial tuberosity avulsion fracture

Liu

Shi

et al. 2019

Medicine

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“…The rarity of this report lies in the surgical method for treating the ischial tuberosity avulsion fracture with nonunion. Other reported procedures are plate fixation [10], bone transplantation [6], repair of the hamstring tendon with suture anchors after fragment excision [5], and surgical fenestration [4,11]. We applied cancellous screws and suture anchors to fix the bone fragment, which led to the bony union.…”

Section: Case Reports In Orthopedicsmentioning

confidence: 99%

“…Their incidence in males is reported to be twice as high as that in women [4]. They are often misdiagnosed as hamstring injuries because of the similarities in the mechanism of the injury and the sites of pain [5,6]. As a result of delayed diagnosis or conservative treatment, many cases often develop nonunion, leading to chronic pain and leg-muscle weakness [7].…”

Section: Introductionmentioning

confidence: 99%

Surgically Treated Nonunion following Ischial Tuberosity Avulsion Fracture of a 14-Year-Old Athlete

Nakamatsu

Fukui

et al. 2020

Case Reports in Orthopedics

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A 14-year-old girl experienced acute left buttock pain during a sprint. At the local hospital, she was diagnosed with an avulsion fracture of the left ischial tuberosity. She was kept for observation for about 10 months; however, the buttock pain persisted, and the bone fragments did not unite. She was referred to our hospital approximately 11 months after the injury. Plain radiography revealed an increased transposition of the bone fragment, from 12 mm immediately after the injury to 23 mm. Twelve months after the injury, she underwent osteosynthesis using two cannulated cancellous screws and three suture anchors. Following postoperative rehabilitation, the power in her left hamstring recovered, and she was able to run at full speed and returned to athletics 9 months after the surgery. The operative indications for avulsion fractures of the ischial tuberosity are unclear. Careful follow-up is required as the rate of nonunion after conservative treatment tends to be high. This needs to be identified in order to provide timely treatment that allows for early return to sport. Although she had significant chronic pain and muscle weakness, the surgery successfully treated the fracture, and her muscle power recovered, leading to her return to sports.

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“…The ischial tuberosity is the starting point of the hamstring muscle, which includes the long head of the biceps femoris, semitendinosus, and semimembranosus of the biceps femoris. The semitendinosus and biceps femoris have a common tendon on the ischial bone, and the semimembranosus originates from the outside of the ischial tuberosity [12,13]. Furthermore, the long head of the biceps femoris ends in the capitulum fibulae, inserts on the fibular head, and has a small branch that inserts on the posterior-lateral aspect of the tubial condyle, and the semitendinosus and semimembranosus terminate in the medial aspect of the tibia with multiple insertion points.…”

Section: Mechanism Of Injurymentioning

confidence: 99%

“…They also indicated that once a neurological injury occurs, either early or late, surgery must be performed. For example, in one case, conservative treatment did not relieve the patient’s sustained pain and neurological symptoms, but the surgery achieved long lasting satisfactory results (observed for 10 years postoperatively) [12]. On the other hand, some investigators [34,35] have considered that since the results of early surgery and late surgery are similar, they suggested that regardless of the size and extent of the fracture, the patient should initially receive conservative treatment, and subsequently choose surgery if the first treatment fails.…”

Section: Surgical Indicationmentioning

confidence: 99%

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

et al. 2018

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Avulsion fracture of the ischial tuberosity (AFIT) is a rare adolescent sports injury. At present, there is no consensus on its therapeutic paradigm, but conservative treatment appears to be the predominate choice. Furthermore, the degree of fracture displacement (DFD) remains as an important factor in determining whether AFIT needs internal fixation. The aim of the present study was to review and update the injury mechanism, clinical manifestations, imaging examination, diagnosis and differential diagnosis, and treatment of AFIT.A literature search was performed on a variety of databases using text words, and the results were limited to the English language.This review provides an important reference for the diagnosis and treatment of AFIT.AFIT can be easily misdiagnosed. Therefore, a detailed medical history and imaging examination are crucial for a correct diagnosis and differential diagnosis. For the choice of treatment of AFIT, it is necessary to consider not only the size of the fracture and DFD, but also the long-term functional needs of the patient.

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Chronic (Ten Years) Ischial Tuberosity Avulsion Fracture Nonunion Treated with Fragment Excision and Simultaneous Primary Repair of the Hamstring Tendon

Cited by 7 publications

References 12 publications

Surgical treatment for acute ischial tuberosity avulsion fracture

Surgical treatment for acute ischial tuberosity avulsion fracture

Surgically Treated Nonunion following Ischial Tuberosity Avulsion Fracture of a 14-Year-Old Athlete

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

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