Hip Injury - Soccer

Abstract

ACSM 2018 National Conference Clinical Case Abstract Submission Title: Hip Injury - Soccer Author: James Alex, Heather Gillespie, Maine Medical Center, Portland, ME. Email: [email protected] (Sponsor: Heather Gillespie, FACSM) HISTORY: A 13 year old male soccer player without significant past medical history sustained an acute onset of anterior right hip pain while sprinting during a soccer game. He was immediately unable to walk and was carried off the field by teammates. He developed occasional transient episodes of pain radiating down his right leg without numbness or tingling noted. He was evaluated in the emergency department that evening, given oxycodone for analgesia, crutches to maintain non-weight-bearing status, and was referred to sports medicine for follow-up. PHYSICAL EXAM: Examination in the office 2 days after injury revealed no hip, leg, or abdominal abnormalities on inspection. He was able to bear about 50% of his weight on the right leg without crutches. Mild tenderness to palpation was noted anterior to the right lesser trochanter. Right hip active range of motion was limited to 10 degrees of flexion in the supine position with normal passive range of motion throughout and intolerance of resisted hip flexion. Normal resisted adduction strength was noted. Neurovascular testing of the right lower extremity was normal. DIFFERENTIAL DIAGNOSIS: 1. Iliopsoas strain 2. Apophyseal avulsion fracture: AIIS, ASIS, or lesser trochanter. 3. Adductor strain 4. Femoral neck stress fracture 5. Slipped capital femoral epiphysis TESTS AND RESULTS: 2-view xray of the right hip reveals apophyseal avulsion fracture of the lesser trochanter of the right femur with 20mm of proximal displacement. FINAL DIAGNOSIS: Closed, proximally-displaced apophyseal avulsion fracture of the lesser trochanter of the right femur. TREATMENT AND OUTCOME: 1. Case reviewed with multiple surgeons (sports, trauma, pediatric orthopedics) regarding potential screw fixation. 2. Non-operative management pursued. 3. Stable proximal displacement visualized on repeat xray post-injury day 6. 4. Non-weight-bearing on crutches for 3 weeks. 5. OTC analgesia after post-injury day 3. 6. Gradual weight bearing by week 4. 7. Final return to sport pending at the time of submission.