Abstract
Avulsion fractures of the anterior inferior iliac spine (AIIS) are rare injuries in adolescent athletes. We present a case of a 15-year-old male who sustained an avulsion injury to his right AIIS when kicking a soccer ball. The patient had chronic pain and extra-articular subspinal impingement leading to decreased hip flexion and rotation. The injury occurred 1.5 years prior to symptom onset, and we were the first health care providers to manage the injury. We attempted six months of nonoperative management including activity modifications and nonsteroidal anti-inflammatory (NSAID) therapy without improvement. Although this injury can often be managed nonoperatively, his symptoms required excision of the AIIS and associated heterotopic ossification. He had an excellent outcome with return to soccer and no pain at his final follow-up visit two years after surgery. Due to the limited literature guiding the surgeon's management of AIIS avulsion injuries with associated heterotopic ossification, we provide a review of the literature detailing pre- and postoperative ranges of motion, surgical approach, fixation or excision of the avulsion fragment, and return to sport in this patient population.
Highlights
Avulsion fractures of the adolescent pelvis are a well-known phenomenon, but the incidence is rare
Soccer players are at high risk of avulsion fractures of the anterior inferior iliac spine (AIIS) due to the forceful contracture of the rectus femoris during hip flexion and knee extension when kicking
A combination of the failure to diagnose an acute pelvic avulsion fracture with X-ray and the acquired heterotopic ossification, which can mimic other more dire diagnoses, makes an initial diagnosis of the pelvic avulsion fracture integral in properly treating these patients [5]
Summary
Avulsion fractures of the adolescent pelvis are a well-known phenomenon, but the incidence is rare. Approximately 50% of AIIS avulsion fractures are due to kicking [2] These fractures can be difficult to diagnose since they are often not visible on standard pelvis X-rays, and a high degree of clinical suspicion is required. A combination of the failure to diagnose an acute pelvic avulsion fracture with X-ray and the acquired heterotopic ossification, which can mimic other more dire diagnoses, makes an initial diagnosis of the pelvic avulsion fracture integral in properly treating these patients [5]. The patient and his parents gave informed consent to publish this case report
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