Hip Impingement after Anterior Inferior Iliac Spine Avulsion Fractures: A Case Report with Review of the Literature

Abstract

Avulsion fractures of the anterior inferior iliac spine (AIIS) are rare injuries in adolescent athletes. We present a case of a 15-year-old male who sustained an avulsion injury to his right AIIS when kicking a soccer ball. The patient had chronic pain and extra-articular subspinal impingement leading to decreased hip flexion and rotation. The injury occurred 1.5 years prior to symptom onset, and we were the first health care providers to manage the injury. We attempted six months of nonoperative management including activity modifications and nonsteroidal anti-inflammatory (NSAID) therapy without improvement. Although this injury can often be managed nonoperatively, his symptoms required excision of the AIIS and associated heterotopic ossification. He had an excellent outcome with return to soccer and no pain at his final follow-up visit two years after surgery. Due to the limited literature guiding the surgeon’s management of AIIS avulsion injuries with associated heterotopic ossification, we provide a review of the literature detailing pre- and postoperative ranges of motion, surgical approach, fixation or excision of the avulsion fragment, and return to sport in this patient population.

Apophyseal ilium avulsion fractures in young athletes: a systematic review and return to sport analysis

“…1). Following application of the inclusion and exclusion criteria, a total of 70 studies [2,5,12–79] (all levels IV–V) comprising 279 athletes with 286 apophyseal injuries were included. The weighted mean age of included athletes was 14.5 + 1.3 years (range, 8–18 years).…”

Heterotopic Ossification Secondary to Motor Vehicle Collision Trauma Leading to Femoroacetabular Impingement Syndrome: A Case Report

“…None have investigated the relationship between blunt trauma and the etiology of hip HO resulting in impingement symptoms. Traumatic HO of the hip is historically common following orthopedic procedures, and can be approached in three ways based on clinical evaluation; through conservative treatment, surgical intervention, or a combined approach [ 1 , 9 , 15 ]. HO of the magnitude recorded in this case can contribute to several associated sequelae.…”

“…Adequate margins of excision were confirmed by fluoroscopy to reduce the risk of recurrent HO formation, especially as there is an increased incidence of HO following orthopedic surgery [ 1 , 9 , 15 ]. Imaging confirmed excision of the anterior HO lesion, however, imaging also demonstrated additional minimal lateral ossification, not easily accessible through the anterior approach and not affecting the range of motion of the hip.…”

Endoscopic Assisted Percutaneous Fixation of Anterior Inferior Iliac Spine Avulsion Fracture, Surgical Technique

“…Most pelvic avulsion fractures, including AIIS, are treated successfully nonoperatively, using analgesics, bed rest, immobilization of the affected muscle group, physical rehabilitation, and crutches for at least 3–6 weeks post-injury [ 1 , 6 – 8 ]. Although, avulsion fractures of the pelvis have been biologically assimilated to epiphyseal fractures and are naturally prone to bone healing [ 4 ], repetitive traumatism, due to muscle traction over the avulsed fragment, often leads to hypertrophic healing, bulking, and appearance that may mimic bone tumours, especially when a delayed diagnosis or no supervised conservative treatment is made [ 5 ]. Open reduction and internal fixation are usually recommended when the avulsion fractures have a displacement of more than 1.5–2 cm on plain radiographs and in athletes who need a faster return to play [ 1 , 3 ].…”