Diagnosis and Treatment of Apophyseal Injuries of the Pelvis in Adolescents

Abstract

An avulsion fracture occurs when the growth plate of an apophysis is injured due to a sudden and forceful contraction of the attaching musculotendinous unit. Usually it is adolescents who sustain these injuries, and a significant male preponderance has been found. Even though apophyseal fractures have been described in a variety of locations, the apophyses of the pelvis and hip are more prone to these injuries. Due to their rarity, avulsion fractures of the pelvis are often misdiagnosed. Additionally, patients can present late, and other pathologies are suspected initially. In most acute cases conservative treatment is successful. However, some cases require operative intervention. To plan an optimal treatment regimen, it is important to be familiar with the typical pathomechanism, the typical clinical findings, and the most commonly applied imaging modalities of these injures. The present review analyzes the currently available literature on the most frequently encountered apophyseal injuries of the pelvis in adolescent patients. Some case examples are also presented.

Surgical fenestration and rehabilitation of a sports traumatic non-union ischial tuberosity fracture – Case report

“…Singer and colleagues [ 16 ] assumed avulsion fractures with a displacement >15 mm can be considered an indication for open reduction and osteosynthesis, whereas patients with a fragment displacement <15 mm can be treated conservatively and an excellent outcome can be expected. The novelty of the percutaneous K-wire method, in repairing a non-union may therefore be seen as a possible supplement to avulsion fractures with a displacement <15 mm, where conservative treatment has shown to be unsuccessful.…”

Avulsion injuries: an update on radiologic findings

“…The ASIS is the attachment site of the sartorius and tensor fascia lata, while the AIIS is the origin of the straight head of the rectus femoris. Avulsion injuries of the ASIS and AIIS are commonly believed to result from forceful extension of the hip and flexion of the knee during sports activities, especially during the kicking phase of soccer or rugby and the starting phase of running or jumping [15,16]. Direct trauma or chronic traction rarely causes avulsion injuries.…”

“…Avulsion injury of the iliac crest is uncommon and results from the sudden contraction of the abdominal muscles, including the external and internal abdominal oblique, transverse abdominis, gluteus medius, and tensor fascia latae muscles [ 15 ]. The iliac crest apophysis remains cartilaginous until adolescence; the fusion of the ossified apophysis to the iliac bone begins at approximately 15 years of age [ 19 ], increasing the vulnerability to overuse and acute and chronic trauma.…”

“…Relatively good clinical outcomes are achieved by conservative treatment alone. Surgical treatment can be performed in cases with a fragment displacement of >3 cm or persistent symptoms [ 15 , 20 ].…”

“…However, it may also occur acutely, such as when two soccer players kick the ball simultaneously [ 1 ]. The most sensitive imaging modality for these lesions is MRI because these injuries do not often result in a displaced fragment but rather present as a soft tissue injury [ 3 , 15 ]. There are no specific treatment guidelines for pubic symphysis avulsions.…”