Avulsion Fracture of the Anterior Inferior Iliac Spine in a Soccer Player

Abstract

A 14-year-old male soccer player presented with left groin pain that had started suddenly after kicking the ball during a soccer game the day before. His pain was aggravated during the swing phase of walking and active flexion of the hip. Inspection revealed no swelling or erythema in the inguinal area. Moderate tenderness was noted upon palpation of the right inguinal region. Passive range of motion of the right hip was normal except for limited hip extension. Weakness in hip flexion was attributed to pain. An anteroposterior radiograph of the pelvis showed a displaced avulsion fracture of the anterior inferior iliac spine (AIIS; Figure 1). This finding was confirmed by a pelvic computed tomography scan that revealed a crescent-shaped bone fragment displaced inferiorly about 1.5 cm from the right AIIS (Figure 2). Avulsion fractures of the pelvic apophyses are very uncommon and almost always occur in adolescents before their growth plates close [1]. The most typical locations are the anterior superior iliac spine, AIIS, and ischial tuberosity [2]. These fractures may be overlooked and can be easily confused with an insertional tendinitis or musculotendinous tear. Patient history, as in this case, demonstrates the typical mechanism of injury involving a sudden and forceful muscular contraction during sport activities. The avulsion of the AIIS occurs after forceful contraction of the rectus femoris muscle. The most commonly reported mechanisms are kicking and running [2,3]. Treatment of avulsion fractures of the pelvic apophyses includes surgical and nonsurgical interventions. Surgical treatment, primary open reduction, and internal fixation may be warranted when the fragment is displaced greater than 2 cm or the ischial tuberosity is involved [3]. This young athlete was treated conservatively with 3 weeks of non–weightbearing activity, 3 weeks of partial weight-bearing activity, and then a gradual return to full