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Abstract

Apophyseal avulsion fractures of the pelvic region are a possibly under diagnosed problem in adolescent athletes. Understanding of the growing skeleton and mechanisms of injury for this problem are vital in raising suspicion for diagnosis. Sport participation is the most common cause of injury, with soccer being the most common sport leading to injury. The act of running/sprinting is the most common mechanism, but many potential mechanisms exist. Any of the pelvic apophyses may avulse, but it is most common are the anterior inferior iliac spine (AIIS), anterior superior iliac spine and ischia tuberosity; avulsions of the pubic symphysis and greater tuberosity are the rarest. Males are twice as likely as females to experience pelvic region avulsion fracture and are generally older at the time of injury regardless of the area involved. Males are significantly more likely to experience AIIS fractures, but females are significantly more likely to experience iliac crest avulsion fractures. Conservative treatment is successful in most cases and kids are commonly cleared to return to advance their sport participation. Surgery may be indicated in some cases but is usually not necessary. Duration of treatment tends to be shorter in males, but not to a significant degree. Delays in diagnosis are not unusual and may be due to a variety of reasons. Basketball is the sport and the ischial tuberosity is the location most associated with diagnostic delay. While delay in diagnosis does not appear to add significant time to the duration of treatment, overall time from diagnosis to clearance for return to play activities may be significantly increased.

Biography

James L. Moeller is a Sports Medicine specialist from Detroit, Michigan and serves as Sports Medicine Fellowship Program Director with Henry Ford Health. He has over 25 years experience caring for athletes of all ages and levels including high school, collegiate, professional and Olympic athletes and served as Chief Medical Officer for the US Winter Olympic Team in 2010. He has served on the Boards of the American Medical Society for Sports Medicine and American College of Sports Medicine. He has been published on a wide variety of topics and has served as editor of two Sports Medicine textbooks.