Displaced avulsion of the ischial apophysis: a hamstring injury requiring internal fixation.

Servant, Chris; Jones, Christopher B.

doi:10.1136/bjsm.32.3.255

Cited by 50 publications

(35 citation statements)

References 12 publications

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“…While this is too uncommon an injury to propose a randomised prospective study, there are a few other examples of similar cases in the literature where operative treatment has been carried out for displaced non-unions with good results. 4,11 Patients 7-11 demonstrate clearly that a normal X-ray does not exclude serious injury to the hamstring origin, especially in the older, skeletally mature patient. MRI scanning has been shown to be a sensitive test for hamstring avulsion, 12,13 and should be carried out expeditiously so as not to delay surgery.…”

Section: Discussionmentioning

confidence: 99%

Avulsion Injuries of the Hamstring Origin – A Series of 12 Patients and Management Algorithm

Gidwani

Bircher

2007

annals

118

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INTRODUCTION Injuries to the origin of the hamstring muscles usually occur in athletes and can result in an avulsion fracture of the ischium, an avulsion of the ischial apophysis, or a pure avulsion of the hamstring tendons themselves, depending on the patient's age. These are rare injuries in the general population and are often initially misdiagnosed as a simple 'hamstring pull', leading to the development of chronic pain and disability.PATIENTS AND METHODS We present a retrospective case series of the 12 patients with such injuries who presented or were referred consecutively to the senior author between 1997 and 2006.RESULTS There was a significant delay (5 months to 12 years) in the diagnosis of the injury in 8 of the 12 patients. Five of these 8 patients required more extensive surgery than would otherwise have been required as a result of this delay, but all recovered well. The sporting career of one of the remaining three patients had already been brought to an end by her injury and the subsequent disability, and she elected not to have surgery. Of the four patients who were diagnosed acutely, three required surgery, and all four had an excellent result.CONCLUSIONS Injuries to the hamstring origin are rare and are often initially misdiagnosed as a simple 'hamstring pull', leading to the development of chronic pain and disability. Displaced injuries of the ischial apophysis and pure tendon avulsions are probably best treated surgically in the acute setting. As a result of our experience with these patients, we have produced a management algorithm.

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Section: Discussionmentioning

confidence: 99%

Avulsion Injuries of the Hamstring Origin – A Series of 12 Patients and Management Algorithm

Gidwani

Bircher

2007

annals

118

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“…Hence, most strains are effectively managed conservatively. Surgical repair is reserved for avulsion injury [4,5], particularly if displaced [6], which most commonly occurs proximally [7]. Distal avulsion is a rare injury [8].…”

Section: Introductionmentioning

confidence: 97%

Imaging of hamstring injuries: therapeutic implications

Koulouris

Connell

2006

Eur Radiol

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Though recent research into the diagnosis and management of hamstring disorders has resulted in early and accurate recognition of injury, hamstring strain remains the most common form of muscle injury in the active population. With prompt recognition of hamstring strain, an appropriate rest and rehabilitation routine may be devised by the sports clinician in the hope of avoiding future and possibly more debilitating injury. As such, imaging has played a pivotal role in assisting athletes, both elite and recreational, in returning to activity expeditiously.

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“…To our knowledge, three years is the longest time span reported in the literature between ischial tuberosity avulsion fracture injury and nonunion repair 1,2,8,9,11,12 . We present a case of a chronic ischial tuberosity avulsion fracture nonunion with a ten-year delay between the initial injury and definitive surgical management via fragment excision and primary hamstring repair.…”

mentioning

confidence: 96%

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

Dailey

Branam

Archdeacon

2013

JBJS Case Connector

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Displaced avulsion of the ischial apophysis: a hamstring injury requiring internal fixation.

Cited by 50 publications

References 12 publications

Avulsion Injuries of the Hamstring Origin – A Series of 12 Patients and Management Algorithm

Avulsion Injuries of the Hamstring Origin – A Series of 12 Patients and Management Algorithm

Imaging of hamstring injuries: therapeutic implications

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

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