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

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