Best Practice Case Studies-Case 149 Asset 4 Pelvic Avulsion Fractures

Video Transcription

Video Summary

Jim Muller’s lecture on pelvic avulsion fractures explains why adolescents are vulnerable during growth spurts, when pelvic apophyses are weaker than attached muscles and tendons. He reviews pelvic anatomy, key apophyseal sites, muscle attachments, and how traction forces during running, sprinting, kicking, jumping, or falls can cause avulsion fractures. The most common sports are soccer worldwide, and in U.S. cohorts soccer, track/cross-country, and American football. Males are affected about twice as often as females.<br /><br />Common fracture sites include the ASIS, AIIS, and ischial tuberosity, with displacement patterns matching muscle pull. X-rays diagnose over 90% of cases; MRI or CT is rarely needed. Treatment is usually conservative: rest, ice, pain control, activity restriction, home exercises, and sometimes crutches or physical therapy. Average time to clearance for return to sport is about 6.5–7.5 weeks.<br /><br />A second study examined delayed diagnosis. Under half were diagnosed within one week, and diagnosis delays were often due to families waiting to seek care or clinicians misdiagnosing strains without imaging. Ischial tuberosity injuries and basketball cases had the longest diagnostic delays. Delays beyond 2–3 weeks were associated with longer time to return to sport, supporting a two-week threshold for defining delayed diagnosis.

Meta Tag

Edition 4th Edition

Related Case 4th Edition, Case 149

Topic Pelvis

Keywords

4th Edition

4th Edition, Case 149

Pelvis

pelvic avulsion fractures

adolescents

growth spurts

sports injuries

ASIS AIIS ischial tuberosity

X-ray diagnosis

conservative treatment

delayed diagnosis