ACUTE AVULSION FRACTURE OF THE ANTERIOR SUPERIOR ILIAC SPINE IN A HIGH SCHOOL TRACK AND FIELD ATHLETE

Transcription

1 ACUTE AVULSION FRACTURE OF THE ANTERIOR SUPERIOR ILIAC SPINE IN A HIGH SCHOOL TRACK AND FIELD ATHLETE Christopher Mings, LAT, ATC University of Central Florida Alumnus & Florida Gulf Coast University Graduate Assistant

2 Patient Information 15 year old adolescent male pole vaulter No previous hip injury but history of chronic bilateral hamstring strains Practicing his approach and felt sudden left hemipelvis pain

3 Initial Evaluation The patient was unable to weight bear or ambulate due to pain Muscle spasm and intense localized pain over the left ASIS and radiating down the anterior left thigh No apparent deformity, edema, ecchymosis, erythema, or nerve deficiency

4 Initial Evaluation Compression, bump, and tap (over the ASIS) tests were all negative Decreased range of motion with hip flexion/ extension, lateral rotation of femur, abduction/ adduction, and knee flexion/ extension The athlete reported increased pain with A/PROM in all hip motions

5 Differential Diagnoses Femoral neck, intertrochanteric, pubic rami and/or ASIS avulsion fracture Rectus femoris, sartorius, quadriceps, illiacus, psoas, and/or tensor fasciae latae strain Acute acetabular labral tear Inguinal hernia

6 X-ray & MRI Intact avulsed bone fragment measured 1.6 cm by 1.0 cm Displaced 2.1 cm anterioinferiolaterally

7 Conservative Treatment Initial treatment included Immobilization NWB PRICE until swelling and pain decreased

8 Two Weeks After Initial Evaluation The patient began rehabilitation exercises supported by a hip spica

9 Eight Weeks After Initial Evaluation The patient began sport specific activities

10 Ten Weeks After Initial Evaluation The patient was cleared for full return to participation

11 Uniqueness Avulsion fractures typically occur due to a traumatic event, or during eccentric/ concentric mechanisms such as starting and stopping. This athlete experienced no traumatic injury and the injury occurred during the middle of a sprint.

12 Uniqueness Surgical intervention is recommended to prevent malunion/nonunion anytime an avulsion fracture is displaced more than 2 cm. This athlete had a displacement of 2.1 cm anterioinferolaterally, and was treated successfully with a conservative nonsurgical approach. The athlete returned to play ten weeks following injury.

13 Uniqueness The ASIS generally undergoes ossification along the anterior iliac crest from the ages of years old. Ossification decreases the change of this injury occurring. Therefore, this fifteen year old athlete was on the higher end of the expected age range for this injury.

14 Conclusions Athletic trainers should recognize the signs and symptoms of an avulsion fracture and refer to a physician when suspected. It is important for sports medicine practitioners to use their clinical judgment when determining whether a conservative approach can be successful. Prompt referral, identification, and conservative treatment can lead to a successful outcome.

15 References 1. Marx J, Hockberger R, Walls R. Rosen s Emergency Medicine. 7th ed. Maryland Heights, MO: Mosby; Miller M, Thompson SR. DeLee & Drez s Orthopaedic Sports Medicine: Principles and Practices. 3rd ed. Philadelphia, PA: Saunders; 2009.

16 Questions?