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Nonoperative treatment may be successful for most patients with pelvic avulsion fractures
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This retrospective review of patients with pelvic apophyseal avulsion fractures showed 49% of these fractures were anterior inferior iliac spine avulsions and 97% of all fractures were successfully treated with conservative care.
Researchers reviewed the radiographs and clinical records of 225 patients (mean age 14.4 years) with 228 pelvic apophyseal avulsion fractures for demographics, injury mechanisms, side and sport. Radiographs were assessed for Risser’s score, location of pelvic fracture, displacement and skeletal maturity. Researchers also recorded further treatments used, re-injuries, re-fractures, nonunions, persistent pain and surgical interventions. Most of the patients in the study were male.
Of the avulsion fractures, 49% were anterior inferior iliac spine (AIIS) avulsions and 30% were anterior superior iliac spine (ASIS) avulsions. The remaining fractures were ischial tuberosity and iliac crest fractures (11% and 10%, respectively). Avulsion fractures occurred most during sprinting/running followed by kicking a ball.
Results also showed fracture type correlated with sports participation and injury mechanism. Kicking was the most common cause for AIIS avulsion fractures, and 50% of ASIS avulsions were caused by running/sprinting.
Fracture type also correlated with age, gender and skeletal maturity. Investigators found older patients had a higher risk of injuries to the ASIS and iliac crest compared with younger patients who were at a higher risk of AIIS injuries or hamstring avulsion injuries.
There were 14 male patients with multiple pelvic fractures. Future hip pain compared with other avulsion fracture types was 4.47-times more likely to occur in patients with AIIS avulsions.
There were five nonunions, of which four were ischial tuberosity fractures. Compared with patients who had less than 20 mm of initial fracture displacement, patients with greater than 20 mm of displacement were 26 times more likely to have a nonunion. Surgical intervention was needed in 3% of patients, according to researchers. ‒ by Monica Jaramillo
Disclosures: The researchers report no relevant financial disclosures.
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