Hip Avulsion Fracture

Aka: Hip Avulsion Fracture, Anterior Superior Iliac Spine Avulsion Fracture, Anterior Inferior Iliac Spine Avulsion Fracture, ASIS Avulsion Fracture, AIIS Avulsion Fracture, Ischial Tuberosity Avulsion Fracture, Anterior Superior Iliac Spine Fracture, Anterior Inferior Iliac Spine Fracture, Ischial Tuberosity Fracture

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II. Epidemiology

  1. Occurs most commonly in Adolescent Athletes

III. Pathophysiology

  1. Unexpected, explosive muscle contraction
    1. Example: "kicking out" at the end of race
    2. Athletes most often affected: Hurdler, Sprinter
  2. Fractures occur at apophyses
    1. ASIS Avulsion Fracture
      1. Rapid sartorius muscle contraction (e.g. jumping)
    2. AIIS Avulsion Fracture
      1. Rapid rectus femoris muscle contraction (e.g. kicking)
    3. Ischial Tuberosity
      1. Rapid hamstring muscle contraction (e.g. sprinting, hurdling)

IV. Symptoms

  1. Sudden onset of Hip Pain
  2. Occurs with sudden burst of intensity (e.g. race end)

V. Signs

  1. Limp may be present
  2. Provocative maneuvers
    1. Pain with passive and active muscle Stretching
    2. Tenderness to palpation
  3. Specific apophysis sites of tenderness
    1. Pain over anterior superior iliac spine
      1. Rapid sartorius contraction in jumping sports
      2. Sartorius tendon avulsion
    2. Pain over anterior inferior iliac spine
      1. Strong rectus femoris contraction in soccer
      2. Rectus Femoris avulsion
    3. Pain over Pubic Symphysis
      1. Adductor muscle group tendon
    4. Pain at iliac crest
      1. Transversus abdominis avulsion
    5. Pain at ischial tuberosity
      1. Violent hamstring contractions in sprint or hurdles
      2. Semitendinosus tendon avulsion
      3. Biceps femoris tendon avulsion (hamstring muscle)
    6. Pain over femoral greater trochanter
      1. Gluteus medius tendon avulsion
      2. Gluteus minimus tendon avulsion
    7. Pain over femoral lesser trochanter
      1. Iliopsoas tendon avulsion

VI. Imaging: Hip XRay

  1. May show avulsed bone fragment
  2. Contrast with calcified tendon in chronic injury

VII. Management

  1. Conservative therapy for ASIS or AIIS avulsion
    1. RICE-M
    2. Cold Therapy
    3. NSAIDs
    4. Crutch walking as needed
    5. Return to sport when able to participate without pain
  2. Orthopedic evaluation for Ischial Tuberosity Fracture
    1. ORIF for large fragments: >1 to 2 cm

VIII. References

  1. (2001) Am Fam Physician 64(8):1405-14 [PubMed]

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Related Studies

Ontology: Closed fracture pelvis, anterior inferior iliac spine (C0435779)

Concepts Injury or Poisoning (T037)
SnomedCT 208183001
English Cls # plvs,ant inf iliiac spn, pelvic fracture ilium closed anterior inferior iliac spine (diagnosis), pelvic fracture ilium closed anterior inferior iliac spine, Closed fracture pelvis, anterior inferior iliac spine, Closed fracture pelvis, anterior inferior iliac spine (disorder)
Spanish fractura no expuesta de pelvis, espina ilíaca anteroinferior (trastorno), fractura no expuesta de pelvis, espina ilíaca anteroinferior
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Closed fracture pelvis, anterior superior iliac spine (C0435781)

Concepts Injury or Poisoning (T037)
SnomedCT 208182006
English Cls # plvs,ant sup iliac spn, pelvic fracture ilium closed anterior superior iliac spine (diagnosis), pelvic fracture ilium closed anterior superior iliac spine, Closed fracture pelvis, anterior superior iliac spine, Closed fracture pelvis, anterior superior iliac spine (disorder)
Spanish fractura no expuesta de pelvis, espina ilíaca anterosuperior (trastorno), fractura no expuesta de pelvis, espina ilíaca anterosuperior
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Fracture of ischial tuberosity (C0435794)

Concepts Injury or Poisoning (T037)
SnomedCT 263221003
English Fracture of ischial tuberosity (diagnosis), pelvic fracture ischium tuberosity, Fracture of ischial tuberosity, Fracture of ischial tuberosity (disorder)
Spanish fractura de tuberosidad isquiática (trastorno), fractura de tuberosidad isquiática
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Closed avulsion fracture of anterior inferior iliac spine of pelvis (C1960515)

Concepts Injury or Poisoning (T037)
SnomedCT 426679004
English Closed avulsion fracture of anterior inferior iliac spine of pelvis (disorder), Closed avulsion fracture pelvis, anterior inferior iliac spine, Closed avulsion fracture of anterior inferior iliac spine of pelvis, pelvic fracture ilium closed anterior inferior iliac spine avulsion (diagnosis), pelvic fracture ilium closed anterior inferior iliac spine avulsion
Spanish fractura por avulsión no expuesta de espina ilíaca anteroinferior de la pelvis, fractura por avulsión no expuesta de espina ilíaca anteroinferior, fractura por avulsión no expuesta de espina ilíaca anteroinferior de la pelvis (trastorno)
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Closed avulsion fracture of anterior superior iliac spine of pelvis (C1997676)

Concepts Injury or Poisoning (T037)
SnomedCT 428723000
English Closed avulsion fracture of anterior superior iliac spine of pelvis, Closed avulsion fracture of anterior superior iliac spine of pelvis (disorder), Closed avulsion fracture pelvis, anterior superior iliac spine, pelvic fracture ilium closed anterior superior iliac spine avulsion, pelvic fracture ilium closed anterior superior iliac spine avulsion (diagnosis)
Spanish fractura no expuesta por avulsión de la espina ilíaca anterosuperior (trastorno), fractura no expuesta por avulsión de la espina ilíaca anterosuperior
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Hip Disorders

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