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Operative treatment of pelvic apophyseal avulsions in adolescent and young adult athletes: a follow-up study

  • Original Article • PELVIS - PAEDIATRICS
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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Introduction

Pelvic apophyseal avulsion can limit young athletes’ performance for months and may result in permanent disability. Nonoperative treatment is most commonly preferred, while surgical management with reduction and fixation is reserved for selected cases. Our aim was to evaluate outcomes of operative management of pelvic apophyseal avulsions in a series of adolescents and young adult athletes.

Materials and methods

Operative room registries and medical records were reviewed to identify patients who received surgical treatment for pelvic apophyseal avulsions who were younger than 24 years and with a minimum of 12 month follow-up.

Results

Thirty-two patients (16.8 years ± 2.6) were identified. The most common avulsion sites were anterior inferior iliac spine (34.4%, N = 11) and ischial tuberosity (34.4%, N = 11). Other avulsions were five cases (15.6%) of the pubic apophysis, four cases (12.5%) of the anterior superior iliac spine apophysis and one case of the iliac crest apophysis. Seventeen cases (53.1%) underwent surgery early, i.e., during the first 3 months after the acute injury. Twenty-two cases (68.8%) involved reduction with internal fixation, and six cases (18.8%) involved resection of the fragment. Twenty-six athletes (81.3%, N = 26) reported good outcomes and were able to return to preinjury sports level. Six patients (18.8%) had moderate outcome and reported activity limitations during high-level sports. Large displacement (> 20 mm) or delayed (> 3 months) surgery was not associated with inferior outcomes (P = 0.690 and P = 0.392, respectively). Injury side (P = 0.61) or gender (P = 0.345) did not affect outcomes.

Conclusions

Operative management of pelvic apophyseal avulsion results in return to the preinjury sports level in more than 80% of the cases. However, while both acute surgery for large displacement and delayed intervention for failed nonoperative treatment are generally successful in improving sports function in these cases, comparative studies are required to refine criteria for surgery.

Level of evidence

Case series, IV.

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References

  1. Aksoy B, Ozturk K, Ensenyel CZ, Kara AN (1998) Avulsion of the iliac crest apophysis. Int J Sports Med 19:76–78

    Article  CAS  PubMed  Google Scholar 

  2. Anderson K, Strickland SM, Warren R (2001) Hip and groin injuries in athletes. Am J Sports Med 29:521–533

    Article  CAS  PubMed  Google Scholar 

  3. Cimerman M, Smrkolj V, Veselko M (1995) Avulsion of the anterior superior iliac spine in two adolescent sisters: operative versus conservative treatment. Unfallchirurg 98:530–531

    CAS  PubMed  Google Scholar 

  4. Crowninshield R, Johnston R, Andrews J, Brand R (1978) A biomechanical investigation of the human hip. J Biomech 11:75–85

    Article  CAS  PubMed  Google Scholar 

  5. Dean CS, Arbeloa-Gutierrez L, Chahla J, Pascual-Garrido C (2016) Proximal rectus femoris avulsion repair. Arthrosc Tech 5:e545–e549

    Article  PubMed  PubMed Central  Google Scholar 

  6. DeLee JC, Farney WC (1992) Incidence of injury in Texas high school football. Am J Sports Med 20:575–580

    Article  CAS  PubMed  Google Scholar 

  7. Eberbach H, Hohloch L, Feucht M, Konstantinidis L, Südkamp N, Zwingmann J (2017) Operative versus conservative treatment of apophyseal avulsion fractures of the pelvis in the adolescents: a systematical review with meta-analysis of clinical outcome and return to sports. BMC Musculoskelet Disord 18:162

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Fernbach SK, Wilkinson RH (1981) Avulsion injuries of the pelvis and proximal femur. AJR Am J Roentgenol 137:581–584

    Article  CAS  PubMed  Google Scholar 

  9. García VV, Duhrkop DC, Seijas R, Ares O, Cugat R (2012) Surgical treatment of proximal ruptures of the rectus femoris in professional soccer players. Arch Orthop Trauma Surg 132:329–333

    Article  PubMed  Google Scholar 

  10. Gidwani S, Jagiello J, Bircher M (2004) Avulsion fracture of the ischial tuberosity in adolescents—an easily missed diagnosis. BMJ 329:99–100

    Article  PubMed  PubMed Central  Google Scholar 

  11. Gomez E, DeLee JC, Farney WC (1996) Incidence of injury in Texas girls’ high school basketball. Am J Sports Med 24:684–687

    Article  CAS  PubMed  Google Scholar 

  12. Heyworth BE, Bonner B, Suppan CA, Kocher MS, Yen Y, Micheli LJ (2014) Results of non-operative and operative management of apophyseal avulsion fractures of the hip and pelvis in adolescent athletes. Orthop J Sports Med 2(1 suppl):2325967114500010

    Google Scholar 

  13. Irmola T, Heikkilä J, Orava S, Sarimo J (2007) Total proximal tendon avulsion of the rectus femoris muscle. Scand J Med Sci Sports 17:378–382

    CAS  PubMed  Google Scholar 

  14. Kautzner J, Trc T, Havlas V (2014) Comparison of conservative against surgical treatment of anterior–superior iliac spine avulsion fractures in children and adolescents. Int Orthop 38:1495–1498

    Article  PubMed  PubMed Central  Google Scholar 

  15. Kocher MS, Tucker R (2006) Pediatric athlete hip disorders. Clin Sports Med 25:241–253

    Article  PubMed  Google Scholar 

  16. Kujala UM, Orava S (1993) Ischial apophysis injuries in athletes. Sports Med 16:290–294

    Article  CAS  PubMed  Google Scholar 

  17. Lempainen L, Banke IJ, Johansson K, Brucker PU, Sarimo J, Orava S, Imhoff AB (2015) Clinical principles in the management of hamstring injuries. Knee Surg Sports Traumatol Arthrosc 23:2449–2456

    Article  PubMed  Google Scholar 

  18. Li X, Xu S, Lin X, Wang Q, Pan J (2014) Results of operative treatment of avulsion fractures of the iliac crest apophysis in adolescents. Injury 45:721–724

    Article  PubMed  Google Scholar 

  19. Machin JT, Wordsworth DR, Raja S, Burtt S (2012) Hip pain in an adolescent after injury while playing football. BMJ 345:e6265

    Article  PubMed  Google Scholar 

  20. Metzmaker JN, Pappas AM (1985) Avulsion fractures of the pelvis. Am J Sports Med 13:349–358

    Article  CAS  PubMed  Google Scholar 

  21. Moeller JL (2003) Pelvic and hip apophyseal avulsion injuries in young athletes. Curr Sports Med Rep 2:110–115

    Article  PubMed  Google Scholar 

  22. Orava S, Hetsroni I, Marom N, Mann G, Sarimo J, Ben-Zvi O, Lempainen L (2015) Surgical excision of posttraumatic ossifications at the proximal hamstrings in young athletes: technique and outcomes. Am J Sports Med 43:1331–1336

    Article  PubMed  Google Scholar 

  23. Rossi F, Dragoni S (2001) Acute avulsion fractures of the pelvis in adolescent competitive athletes: prevalence, location and sports distribution of 203 cases collected. Skeletal Radiol 30:127–131

    Article  CAS  PubMed  Google Scholar 

  24. Saluan PM, Weiker GG (1997) Avulsion of the anterior inferior iliac spine. Orthopedics 20:558–559

    CAS  PubMed  Google Scholar 

  25. Sanders TG, Zlatkin MB (2008) Avulsion injuries of the pelvis. Semin Musculoskelet Radiol 12:042–053

    Article  Google Scholar 

  26. Sarimo J, Lempainen L, Mattila K, Orava S (2008) Complete proximal hamstring avulsions: a series of 41 patients with operative treatment. Am J Sports Med 36:1110–1115

    Article  PubMed  Google Scholar 

  27. Shanmugam C, Maffulli N (2008) Sports injuries in children. Br Med Bull 86:33–57

    Article  PubMed  Google Scholar 

  28. Singer G, Eberl R, Wegmann H, Marterer R, Kraus T, Sorantin E (2014) Diagnosis and treatment of apophyseal injuries of the pelvis in adolescents. Semin Musculoskelet Radiol 18:498–504

    Article  PubMed  Google Scholar 

  29. Soprano JV (2005) Musculoskeletal injuries in the pediatric and adolescent athlete. Curr Sports Med Rep 4:329–334

    Article  PubMed  Google Scholar 

  30. Sundar M, Carty H (1994) Avulsion fractures of the pelvis in children: a report of 32 fractures and their outcome. Skeletal Radiol 23:85–90

    Article  CAS  PubMed  Google Scholar 

  31. Swischuk LE (2013) Musculoskeletal: what’s different in children? Kicking football: hears a “pop”: pain in hip. Emerg Radiol 22:169–170

    Article  PubMed  Google Scholar 

  32. Weiss JM, Ramachandran M (2006) Hip and pelvic injuries in the young athlete. Clin Sports Med 14:212–217

    Google Scholar 

  33. White KK, Williams SK, Mubarak SJ (2002) Definition of two types of anterior superior iliac spine avulsion fractures. J Pediatr Orthop 22:578–582

    PubMed  Google Scholar 

  34. Widmann RF (2006) Fractures of the pelvis. In: Beaty J, Kasser J (eds) Rockwood and Wilkins’ fractures in children. Lippincott Williams & Wilkins, Philadelphia, pp 833–859

    Google Scholar 

  35. Willinger L, Schanda JE, Lorenz S, Imhoff AB, Buchmann S (2016 (ebup first)) Surgical treatment of two adolescent athletes with dislocated avulsion fracture of the anterior superior iliac spine (ASIS). Arch Orthop Trauma Surg 1–5. https://doi.org/10.1007/s00402-016-2596-4

  36. Yildiz C, Yildiz Y, Ozdemir M, Green D, Aydin T (2005) Sequential avulsion of the anterior inferior iliac spine in an adolescent long jumper. Br J Sports Med 39:e31–e31

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Zionts LE, Vachon LA (1997) Demonstration of avulsion of the triceps tendon in an adolescent by magnetic resonance imaging. Am J Orthop 26:489–490

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatric Surgery and Orthopedics, Oulu University Hospital, POB 23, 90029 OYS, Oulu, Finland

    Juha-Jaakko Sinikumpu & Willy Serlo

  2. Pedego Research Group, Medical Research Center Oulu, Oulu University, Oulu, Finland

    Juha-Jaakko Sinikumpu & Willy Serlo

  3. Mehiläinen Sports Clinic, Oulu, Finland

    Juha-Jaakko Sinikumpu

  4. Department of Orthopedic Surgery, Meir General Hospital, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Iftach Hetsroni

  5. Fortius Clinic, FIFA Medical Centre of Excellence, London, UK

    Ernest Schilders

  6. Leeds Beckett University, Leeds, UK

    Ernest Schilders

  7. Sports Injury Research Center, Hospital NEO, Turku, Finland

    Lasse Lempainen & Sakari Orava

Authors
  1. Juha-Jaakko Sinikumpu
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  2. Iftach Hetsroni
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  3. Ernest Schilders
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  4. Lasse Lempainen
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  5. Willy Serlo
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  6. Sakari Orava
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Contributions

JJS contributed to study design, data collection, analysis and writing; IH contributed to study design, analysis and writing; ES helped in study design, data collection, writing and supervising; LL helped in study design, analysis and writing; WS designed and supervised the study; and SO conceived the study and participated in study design, data collection, writing and supervising. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Juha-Jaakko Sinikumpu.

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The authors declared no competing interests related to this study.

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Sinikumpu, JJ., Hetsroni, I., Schilders, E. et al. Operative treatment of pelvic apophyseal avulsions in adolescent and young adult athletes: a follow-up study. Eur J Orthop Surg Traumatol 28, 423–429 (2018). https://doi.org/10.1007/s00590-017-2074-x

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  • DOI: https://doi.org/10.1007/s00590-017-2074-x

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