Iliac crest avulsion

Case contributed by Dr Rajesh Annamalaisamy

Presentation

3 week history of right hip pain and limp following 1500m athletics event. Tender ASIS on examination.

Patient Data

Age: 16 years
Gender: Male
X-ray

Avulsion fracture of the lateral 1/4 of the right iliac crest apophysis.

Case Discussion

Apophyseal avulsion fractures of the pelvis are uncommon.They have been described as occurring at 5 sites in the pelvis,namely in order of prevalence, ischial tuberosity, anteriorinferior iliac spine, anterior superior iliac spine, superior angle ofpubic symphysis and iliac crest.Apophyseal avulsion fractures of the pelvis are uncommon. Acute avulsion fractures typically result from sudden, powerful muscle contractions. The resulting tensile forces are so great that muscle insertions pull the bony or cartilaginousapophyses away from their respective growth plates.4,5 Muscles attaching to the iliac crest are the external oblique, internal oblique and transversus abdominis.

Non-surgical treatment is sufficient in most cases. Evidence suggests an initial period of bed rest along with the application of ice packs and the use of non-steroidal antiinflammatory
agents (NSAIDs). Once pain permits, active and passive range of motion should be initiated, and the patient is allowed up non-weight-bearing with crutches for a period of 2 to 4 weeks. By this time, pain should have subsided and the patient is allowed full weight-bearing and the performance of
normal daily activities. Once routine activities are pain-free, gentle flexibility exercises should be instituted, followed by the introduction of gentle resistive exercise. Stretching and muscle strengthening exercises should slowly be introduced and gradually increased in intensity. Assuming that the patient
is performing the above in a pain-free manner, slow addition of sports should be possible at about 8 weeks followed by the resuming of competitive sports by 12 weeks. Premature return to
sports could result in failure of non-surgical treatment. Surgery is very rarely indicated in these patients, unless persistent pain becomes troublesome. Displacement of >3 centimetres has been described as
being an indication for early intervention in avulsions of the iliac crests.

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Case information

rID: 15290
Case created: 7th Oct 2011
Last edited: 10th Aug 2017
Inclusion in quiz mode: Included

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