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

See also
1. Adductor Strain (Groin Pull)
2. Hip Pain
Epidemiology
1. Occurs most commonly in Adolescent Athletes
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
Symptoms
1. Sudden onset of Hip Pain
2. Occurs with sudden burst of intensity (e.g. race end)
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
Radiology: XRay hip
1. May show avulsed bone fragment
2. Contrast with calcified tendon in chronic injury
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
References
1. (2001) Am Fam Physician 64(8):1405

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 6/1/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.