Rectus femoris avulsion injury

Case contributed by Dr Suman Bandhu

Presentation

Known right hip Perthes. Now left hip pain since 2 weeks. Athletic active child.

Patient Data

Age: 13 years
Gender: Male

Known features of Perthes at right hip. On the left side (side of concern) there is additional bone seen at the anterior inferior iliac spine. This raises the possibility of rectus femoris avulsion fracture.

There is thickening as well as high signal and a small dehiscence in fat saturated images at the site of the direct head of left rectus femoris muscle at the anterior inferior iliac spine. This is consistent with proximal rectus femoris avulsion fracture.

Case Discussion

Immature growth plate/apophysis injuries can occur in adolescents during sporting activity or due to repetitive trauma or overuse. In the pelvis, typical sites include the anterior iliac spines, trochanters, pubis or ischium. On radiographs, the cartilage bone interface fracture and subsequent healing with new bone can lead to bizarre appearances and awareness of these prevents misdiagnosis.

On MRI, there is an apophyseal injury pattern with edema at typical site and thickened apophysis. In some cases, a bony fracture may be seen.

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