Avulsion fracture of the ischium

Abstract

Avulsion of the ischial apophysis is well known to occur from puberty until final fusion at around 25 years of age. The mechanism of injury varies but is usually strenuous, resulting in a high rate of stretch or contraction of the hamstrings. Minimally displaced fractures have a good prognosis when managed non-operatively. Where the fracture separation is wide there is less certainty. Union sometimes occurs but more commonly fibrous non union is the result. Consequently surgical intervention may be appropriate. Authors have suggested that displacements of more than two centimetres should be openly reduced and fixed. Too few cases have been reported to provide definitive management protocols. It remains unlikely that athletes can return to their former standards without surgical intervention but even accurate reduction and internal fixation does not guarantee a return to previous levels of achievement. One author reports of a semi professional American footballer who after excision of the avulsed ischial tuberosity and reattachment of the hamstrings was able to return to the same standard of play. It would be logical to suppose that restoration of the hamstrings to their original length by accurate reduction would make them more efficient. We report the case of a 32 year old athletic male who avulsed his inferior pubic ramus and ischial tuberosity whilst water-skiing who was treated by open reduction and internal fixation.