Best Practice Case Studies-Pelvic Avulsion Fractures

Video Transcription

Hi, I'm Chris Fulmer. I'm one of the faculty members for the Stanford O'Connor Sports Medicine Fellowship.  In this case, we're presented with an adolescent athlete who suffers a hip or pelvis injury that's non-contact in nature, and they also report a POP.  With this type of history, it's important to rule out complete disruption of one of the bony or tendinous anatomic structures.  So I'd like to show you on a skeletal model some of those important bony landmarks.  The first is the anterior superior iliac spine. Next is the anterior inferior iliac spine. And lastly, the ischial tuberosity.  And now I'll demonstrate on our live model. So coming back to those anatomic landmarks that you want to pay close attention to.  Starting with the most proximal part of the pelvis, we have the anterior superior iliac spine, or ASIS, palpating both sides simultaneously.  Looking for the anterior inferior iliac spine, it can sometimes be very difficult to palpate this discreetly.  You can use the rest of the patient's anatomy to help you in this regard.  You can palpate down to the pubic symphysis, and usually the AIIS will be approximately a third of the way from the ASIS to the pubic symphysis.  Otherwise, you can palpate inferiorly from the ASIS and a little medial until you feel some prominence, and that would be corresponding to the anterior inferior iliac spine.  Posteriorly, if you were concerned about an injury in that region, you would want to make sure you pay attention to palpating over the ischial tuberosity.  All of these key anatomic landmarks are sites of origin of different muscles. In reference to the AIIS, that would be the rectus femoris muscle.  The rectus femoris muscle can be further tested with resisted hip flexion.  This can be done in two ways.  One would be to passively flex the hip with the knee extended and gently pressing as the patient resists.  Another way you could do this is just asking the patient to actively elevate their leg and then gently compress to test with resisted hip flexion.  Likewise, if your clinical evaluation makes you suspect injury at the anterior superior iliac spine, which is the origin of the sartorius muscle,  you could test resisted hip flexion with some abduction.  Posteriorly, if you have suspicion for injury at the ischial tuberosity, you could test resisted hamstring action with resisted knee flexion.

Video Summary

Chris Fulmer, a faculty member at Stanford's O'Connor Sports Medicine Fellowship, discusses handling non-contact hip or pelvis injuries in adolescent athletes. He emphasizes identifying disruptions in bony or tendinous structures using skeletal models to pinpoint landmarks like the anterior superior and inferior iliac spines (ASIS and AIIS) and ischial tuberosity. These landmarks indicate muscle origins, aiding in diagnosing injuries through tests like resisted hip flexion for the rectus femoris at the AIIS and resisted actions for the sartorius muscle at the ASIS and hamstring at the ischial tuberosity.

Meta Tag

Edition 2nd Edition

Related Case 2nd Edition, CASE 22

Topic Hip

Keywords

2nd Edition, CASE 22

2nd Edition

Hip

non-contact hip injuries

adolescent athletes

skeletal models

anterior superior iliac spine

sports medicine