IS Case 360: Anterior superior iliac spine avulsion fracture

Neal Young, MD

2009 URMC Imaging Sciences
Publication Date: 2010-03-01

History

Patient is a 13-year-old male presenting to the Emergency Department after experiencing a “popping� sensation in the right hip with sharp pain during a track sprinting event. Further questioning revealed that the event happened when he was accelerating to full sprint and that for the previous week he had been experiencing increasing pain during training.

Findings

Plain AP radiograph shows an avulsion fracture of the left anterior superior iliac spine and open apophyses around the iliac wing.

Discussion

Avulsion fractures of the anterior superior iliac crest are rare, occur in younger patients (11–23 years) and are more common in boys (a ratio of 13:1).

Fractures of the anterior superior iliac spine always occur as an acute onset during exertion. Chronic stress fractures or apophysitis can predispose the patient to fracture. Sudden and forceful pull on the sartorial and tensor fascia lata muscles to the anterior superior iliac can displace the fragment caudally and laterally, and can be mistaken for a fracture of the anterior inferior iliac spine.

Treatment is usually conservative and spontaneous healing occurs in 4-6 weeks. Occasionally, open reduction internal fixation (ORIF) is performed for dislocations of more than 3 cm or in patients requiring a shorter recovery period.

References

  1. Khoury MB, Kirks DR, Martinez S, Apple J. Bilateral avulsion fractures of the anterior superior iliac spine in sprinters. Skeletal Radiol. 1985;13(1):65-7. PMID: 3969580
  2. Pointinger H, Munk P, Poeschl GP. Avulsion fracture of the anterior superior iliac spine following apophysitis. Br J Sports Med. 2003 Aug;37(4):361-2. PMID: 12893727

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