Pelvic apophyseal avulsion fractures diagram
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Normal pelvic radiograph demonstrating the common locations for pelvic avulsion fractures listing the bony structure (blue) and associated muscle attachment (red).
Apophyseal avulsion fractures are usually the result of a sudden forceful concentric or eccentric contraction of the muscle attached to the apophysis. Avulsion fractures of the pelvis are most common in young athletes due to the discordance between an increased muscle strength and an unfused physis at the muscle-tendon-bone unit.
The most common locations were the ischial tuberosity (54%), anterior inferior iliac spine (22%) and anterior superior iliac spine (19%). The least common locations were pubic symphysis (3%), and iliac crest (1%)1.
According to one study, soccer and gymnastics were the most common sports related cause of apophyseal avulsion fractures1.
Note should be made that lesser trochanteric fractures are rare in adults and when an isolated nontraumatic lesser trochanteric fracture is seen in an adult, it is highly suspicious for metastatic disease until proven otherwise.
- 1. Rossi F, Dragoni S. Acute avulsion fractures of the pelvis in adolescent competitive athletes: prevalence, location and sports distribution of 203 cases collected. Skeletal Radiol. 2001;30 (3): 127-31. Pubmed citation
- 2. McKinney BI, Nelson C, Carrion W. Apophyseal avulsion fractures of the hip and pelvis. Orthopedics. 2009;32 (1): 42. Pubmed citation
- 3. Bui-Mansfield LT, Chew FS, Lenchik L et-al. Nontraumatic avulsions of the pelvis. AJR Am J Roentgenol. 2002;178 (2): 423-7. doi:10.2214/ajr.178.2.1780423 - Pubmed citation
- 4. Fernbach SK, Wilkinson RH. Avulsion injuries of the pelvis and proximal femur. AJR Am J Roentgenol. 1981;137 (3): 581-4. doi:10.2214/ajr.137.3.581 - Pubmed citation
- 5. James SL, Davies AM. Atraumatic avulsion of the lesser trochanter as an indicator of tumour infiltration. Eur Radiol. 2006;16 (2): 512-4. doi:10.1007/s00330-005-2675-3 - Pubmed citation
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