Kicking it.

 Young bloke presents after footy practice last week. Kicking when had sudden pain in his right groin. Did what most do and ignored but still painful and has not improved with rest.

He had been reviewed by the team physio and given a diagnosis of a sprain and persisted playing through his pain.

O/E
Fit young man.
Tender on even passive motion at the hip. Power of hip flexion and knee extension both reduced due to pain.

Clinical suspicion leads you to order a pelvic X-ray.

HIP

 

HIP 2
The above films show an avulsion fracture of the Anterior inferior iliac spine. with minor separation.

 

Avulsion fractures of the pelvis.

Points to remember:

Pelvic avulsion fractures are seen in patients aged 14 to 25.

This fracture is due to forced hip flexion often eccentric breaking the physis.

Most common are Ischial tuberostiy approx 50% (sprinters/tennis players)

Anterior inferior iliac spine (15-20%) (kicking as above)

Anterior superior iliac spine (15-20%) (also sprinting)

Treatment is conservative unless significant (1.5cm+) seperation has occured. very important to slowly return to activity as re-injury is common.

I have a low threshold for imaging young atheletes with injuries sustained at times of maximum effort as these fractures are common and do follow a different course to a standard sprain. (slower and more painful generally)

A beautiful summary image of these fractures from learning radiology

IMG_0273-0.JPG

Refs: http://www.learningradiology.com/archives06/COW%20205-Ischial%20Avulsion%20Fx/avulseischiumcorrect.htm

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2465275/

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