Apophyseal avulsion in the pelvic region in childhood and adolescence

Abstract

The importance of the apophyseal plates during growth is often underestimated. They act as amuscular insertion and influence the joint mechanics by the load-dependent change in shape. An anatomically functional adaptation occurs as protection from overloading. In special kinds of sports with highly dynamic movements, sudden changes of direction and eccentric/concentric muscle activities the resulting stress may exceed the strength of the apophyseal plate. In adolescence this results in atotal or partial tearing of the apophysis in the sense of an avulsion injury. In the pelvic region the ischial tuberosity, the anterior superior and inferior iliac spine are mainly affected. The medical history and clinical diagnostics are supplemented by conventional radiographic imaging. Sectional imaging diagnostics are usually unnecessary. Conservative management by reduced (partial) weight bearing and physiotherapy represents the gold standard in treatment. In cases with afragment displacement >1.5-2.0 cm and in competitive athletes an open reduction should be considered.