Anterior Inferior Iliac Spine Avulsion Research Articles

Endoscopic Assisted Percutaneous Fixation of Anterior Inferior Iliac Spine Avulsion Fracture, Surgical Technique

Avulsion fractures of the anterior inferior iliac spine rarely occur in adolescent athletes during rectus femoris contractions or eccentric muscle lengthening while the growth plate is still open. Currently, there are no official guidelines in the literature on the treatment indications of this type of fracture or the type of surgical technique to be used. Nowadays, young and athletic patients desire a quick return to their previous activities, which makes surgical treatment a reasonable choice. Open reduction and internal fixation with an anterior approach are usually recommended when the avulsion fragment has more than 1.5–2 cm displacement on plain radiographs. However, ORIF is associated with a higher risk of heterotopic ossifications and increases the risk of damage to the LFCN. An endoscopic technique was designed to reduce these complications. This technical note describes a procedure of percutaneous fixation to AIIS through 3 endoscopic portals that could potentially minimize complications associated with an open surgical dissection, allowing anatomic reduction under direct visualization.

Management of proximal rectus femoris injuries - do we know what we're doing?: A systematic review.

Rectus femoris (RF) injury is a concern in sports. The management RF strains/tears and avulsion injuries need to be clearly outlined. A systematic review of literature on current management strategies for RF injuries, and to ascertain the efficacy thereof by the return to sport (RTS) time and re-injury rates. Literature search using Medline via PubMed, WorldCat, EMBASE, SPORTDiscus. Eligible studies were reviewed. Thirty-eight studies involving hundred and fifty-two participants were included. Majority (n = 138; 91%) were males, 80% (n = 121) sustained RF injury from kicking and 20% (n = 31) during sprinting. The myotendinous (MT), (n = 27); free tendon (FT), (n = 34), and anterior-inferior iliac spine (AIIS), (n = 91) were involved. Treatment was conservative (n = 115) or surgical (n = 37) across the subgroups. 73% (n = 27) of surgical treatments followed failed conservative treatment. The mean RTS was shorter with successful conservative treatment (MT: 1, FT: 4, AIIS avulsion: 2.9 months). Surgical RTS ranged from 2-9 months and 18 months with labral involvement. With either group, there was no re-injury within 24 months follow-up. With low certainty of evidence RF injury occurs mostly from kicking, resulting in a tear or avulsion at the FT and AIIS regions with or without a labral tear. With low certainty, findings suggest that successful conservative treatment provides a shortened RTS. Surgical treatment remains an option for failed conservative treatment of RF injuries across all subgroups. High-level studies are recommended to improve the evidence base for the treatment of this significant injury.

Apophyseal avulsion fractures of the pelvis. A review.

Background and aim of the work: Fractures of the pelvis classically occur in adolescent during sports activities with forceful and repetitive contractions or passive lengthening acting on not yet ossified growth plates. Their misdiagnosis lead to disability, chronic pain and decrease of performances. Evidence based treatment guidelines do not exist; aim of this paper is to point out clinical outcomes, return to sport rates and complications of surgical and conservative approach. Methods: A systematic search based on MEDLINE database was performed in August 2017 to identify all published articles from 2010 to 2017 reporting outcomes, return to sport and complications rates after surgical and non-operative treatment of avulsion fractures of the pelvis. Results: Mean age was 14,5 years with anterior inferior iliac spine avulsion representing the most common injury (46%), followed by anterior superior iliac spine avulsion (32%), ischial tuberosity avulsion (12%) and iliac crest avulsion (11%). Rates of excellent outcome and return to sports at pre-injury levels were higher after surgical treatment; surgery has a higher risk of heterotopic ossification (9%) compared to conservative treatment (1,8%), whereas the risk of non-unions is lower (0% versus 2,5%). Conclusions: Surgery is preferred for major dislocations and fragment sizes, providing a faster return to pre-injury level of activity, decreasing the risk of pseudoarthrosis. Conservative treatment is advisable for minimally displaced fractures when a rapid recovery is not required; patient and his family should be informed on the risk of non-unions and the eventuality of a delayed surgical approach. (www.actabiomedica.it)

Fracture-avulsion de l’épine iliaque antéro-inférieure et du petit trochanter chez un jeune adolescent

The avulsion fractures of the anterior-inferior iliac spine and lesser trochanter are rare. They occur most often in adolescents during sports activities. The forms in adults are rare. We report a case in a young 15-year-old teenager. He had consulted for pelvic trauma with groin pain and functional impotence of the right lower limb occurred during a recent game in triple jump. Physical examination revealed pain in the mobilization of the right hip in extension. Standard radiography of the pelvis has highlighted an avulsion fracture of the anterior-inferior iliac spine avulsion of the right with small trochanter, which has been confirmed by computed tomography. The patient has been treated orthopedically by rest and landfilling lower limb trauma, evolution was marked the disappearance of pain a few weeks later and resumption of the sporting activity in order to 6months.

Adolescent Femoroacetabular Impingement From Malunion of the Anteroinferior Iliac Spine Apophysis Treated With Arthroscopic Spinoplasty

This article describes a case of an acute anterior inferior iliac spine apophyseal avulsion fracture in an adolescent athlete progressing to secondary symptomatic femoroacetabular impingement from an inferiorly displaced malunion and its arthroscopic management. A 13-year-old boy with an acute minimally displaced avulsion fracture of the anterior inferior iliac spine apophysis had initial symptomatic improvement with conservative treatment and a 3-month symptom-free period but then developed flexion-induced deep anterior groin pain and mechanical symptoms. Radiographs confirmed an inferiorly displaced malunion of the ipsilateral anterior inferior iliac spine apophysis in addition to acetabular retroversion and cam deformity. Surgical treatment, including arthroscopic spinoplasty, was performed. Despite some nonrestrictive heterotopic ossification, the patient had a successful clinical outcome at 18 months, with return to football, and a nonarthritic hip score of 98. Although anterior inferior iliac spine avulsion fractures have historically been considered relatively self-limiting injuries, their malunion may be a previously missed cause of unrelenting or bimodal pain from secondary femoroacetabular impingement with possible degenerative consequences in young athletic patients. Anterior inferior iliac spine avulsion fractures may merit a lower degree of tolerance for displacement in the acute setting and a higher degree of clinical and radiographic scrutiny with surgical intervention, possibly in the form of arthroscopic spinoplasty in the more chronic one.

Avulsion Fracture of Anterior Inferior Iliac Spine in a Skeletally Mature Man; Mimicking Pathologic Bone Lesion

Avulsion fractures of the pelvis occur in both the skeletally immature and adult patient populations the patho-mechanism is the sudden forceful contraction of the related muscle. The case reported here is an overlooked case of anterior inferior iliac spine avulsion fracture in a 25-year-old man, misinterpreted as malignant pathology. Avulsion fractures of the anterior inferior iliac spine can be diagnosed with medical history and radiological methods. The physician must be cautious during the assessment of the patient with complaint in his/her groin and keep in mind the possibility of an anterior inferior iliac spine fracture.

Anterior inferior iliac spine avulsion fracture: a case report in soccer playing adolescent twins

A case of anterior inferior iliac spine fracture in 13-year-old twins is reported. Anterior inferior iliac spine avulsion fracture in adolescent remains a little known entity. We report identical fractures sustained 1 year apart in twin brothers with the same mechanism. Both recovered fully after conservative treatment. A review of the literature retrieved only a few reports of cases. Of interest were the delay between both the fractures and the difference in height between the two individuals. This lesion is likely to be multifactorial with different factors among which are genetics, age, and skeletal maturation, repeat bone stress along with acute indirect trauma.

Avulsionsverletzungen der Spina iliaca anterior inferior bei Fußballern - eine Differenzialdiagnose zum Neoplasma Jahrzehnte nach einem Trauma

Pelvic apophyseal injuries typically involve adolescents, ranging gradually from apophysitis as a chronic traction injury to avulsion fractures after a sudden contraction of a muscle to the immature musculo-skeleton adolescent. While avulsion fractures to the anterior superior iliac spine, the iliac crest and the pubic bone are common, injuries to the anterior inferior iliac spine (AIIS) are only rarely encountered. We report on two 42 and 43-year old male soccer players complaining of groin pain. Both had AIIS avulsion fractures diagnosed by conventional plain x-ray of the pelvis, ultrasound and magnetic resonance imaging. One patient had an acute adductor longus muscle injury with concomitant asymptomatic AIIS avulsion fracture. Conservative treatment of the muscle injury with initial RICE therapy followed by pain-restricted jogging brought him back to sport within four weeks. The other patient had local tenderness and exercise pain at AIIS with a large exostosis on imaging studies mimicking a pseudotumor. Surgical resection was applied and the rectus femoris muscle was reattached. After three months of intensive physical therapy he could be return to sport. Avulsion fractures of the AIIS may cause persistent pain syndrome and mimic a pseudotumor decades after the initial trauma, which can be treated by surgical resection and reattachment of the rectus femoris muscle with good results. Conservative treatment for minor dislocated AIIS avulsion fractures can be effective in sportsmen. Differential diagnosis often involves bony tumors, so patient's soccer history gives important information regarding past avulsion fractures of the pelvis, which often occur during kicking in the adolescence.