Abstract
BackgroundAvulsion fractures of the pelvic apophyses typically occur in adolescent athletes due to a sudden strong muscle contraction while growth plates are still open. The main goals of this systematic review with meta-analysis were to summarize the evidence on clinical outcome and determine the rate of return to sports after conservative versus operative treatment of avulsion fractures of the pelvis.MethodsA systematic search of the Ovid database was performed in December 2016 to identify all published articles reporting outcome and return to preinjury sport-level after conservative or operative treatment of avulsion fractures of the pelvis in adolescent patients. Included studies were abstracted regarding study characteristics, patient demographics and outcome measures. The methodological quality of the studies was assessed with the Coleman Methodology Score (CMS).ResultsFourteen studies with a total of 596 patients met the inclusion criteria. The mean patient age was 14.3 ± 0.6 years and 75.5% of patients were male. Affected were the anterior inferior iliac spine (33.2%), ischial tuberosity (29.7%), anterior superior iliac spine (27.9%), iliac crest (6.7%) lesser trochanter (1.8%) and superior corner of the pubic symphysis (1.2%). Mean follow-up was 12.4 ± 11.7 months and most of the patients underwent a conservative treatment (89.6%). The overall success rate was higher in the patients receiving surgery (88%) compared to the patients receiving conservative treatment (79%) (p = 0,09). The rate of return to sports was 80% in conservative and 92% in operative treated patients (p = 0,03). Overall, the methodological quality of the included studies was low, with a mean CMS of 41.2.ConclusionOn the basis of the present meta-analysis, the overall success and return to sports rate was higher in the patients receiving surgery. Especially in patients with fragment displacement greater 15 mm and high functional demands, surgical treatment should be considered.
Highlights
Avulsion fractures of the pelvic apophyses typically occur in adolescent athletes due to a sudden strong muscle contraction while growth plates are still open
The apophyses may fracture at the rectus femoris insertion at the anterior inferior iliac spine (AIIS), the hamstrings insertion at the ischial tuberosity (IT), the sartorius insertion at the anterior superior iliac spine (ASIS), the tensor fasciae latae insertion on the iliac crest (IC), the iliopsoas insertion on the lesser trochanter (LT), or the rectus abdominis insertion at the superior corner of the pubic symphysis (SCPS) [8,9,10]
The inclusion criteria were specified in advance: Clinical studies of all kind and all levels of evidence published in English or German language, reporting clinical outcome after operative or conservative treatment of apophyseal avulsion fractures of the pelvis in the adolescent athlete, published online or in print in a peer-reviewed journal, including the results of at least 5 or more patients
Summary
Avulsion fractures of the pelvic apophyses typically occur in adolescent athletes due to a sudden strong muscle contraction while growth plates are still open. The main goals of this systematic review with metaanalysis were to summarize the evidence on clinical outcome and determine the rate of return to sports after conservative versus operative treatment of avulsion fractures of the pelvis. Apophyseal avulsion fractures of the pelvis are injuries that typically occur in adolescent athletes [1]. The purpose of this systematic review with meta-analysis was to assess and summarize the patient demographics, epidemiology, mechanism of injury, clinical outcome, and return to sports to give support in the decision-making process regarding therapy in adolescent patients with avulsion fractures of the pelvis
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