MINORS MANUAL
Avulsion fractures around the pelvis occur when a tendon or ligament, subjected to extreme force or sudden contraction, pulls off a fragment of the bone to which it is attached. These fractures commonly affect muscle attachments in the pelvis, such as the hamstrings, quadriceps, or adductors, and are more frequent in adolescents and young athletes due to the relative weakness of their growing apophyses.
Diagnosis
Diagnosis is made based on the clinical history, with the patient reporting acute pain following a sudden movement or intense physical activity (e.g., running, jumping, kicking). Common avulsion sites include the anterior superior iliac spine (where the sartorius muscle inserts), the anterior inferior iliac spine (rectus femoris), and the ischial tuberosity (hamstrings).
The diagnosis is confirmed by X-rays showing the avulsed bone fragment, and additional imaging such as magnetic resonance imaging (MRI) may be required to assess soft tissue damage.
Differential Diagnosis
Pathology | Key Characteristics |
|---|---|
Muscle tear | Muscle pain without evidence of bone fragments on imaging |
Hip fracture | Pelvic or hip pain without history of acute muscle contraction |
Trochanteric bursitis | Lateral hip pain, no history of trauma or sudden contraction |
Stress fracture | Gradual onset of pelvic or hip pain, no acute traumatic event |
Emergency Management
Pain control: Administer analgesics such as NSAIDs (ibuprofen or paracetamol) to relieve acute pain.
Rest: Relative rest is recommended, avoiding physical activities that place stress on the affected muscles.
Ice and elevation: Apply ice to the affected area to reduce inflammation, especially in the first 48 hours.
Diagnostic imaging: Request X-rays of the pelvis and hip to confirm the diagnosis of an avulsion fracture and assess the displacement of the bone fragment.
Immobilisation: For minimally displaced avulsions, use immobilisation devices (such as crutches) to limit weight-bearing on the affected limb.
Referral to a specialist: In cases of significant displacement or diagnostic uncertainty, refer the patient to an orthopaedic specialist for further evaluation.
Definitive Treatment
Definitive treatment is typically conservative for most avulsion fractures without significant displacement. This includes rest, progressive physical therapy to regain strength and mobility, and a rehabilitation programme lasting 4 to 6 weeks.
If the avulsed bone fragment is significantly displaced (>2 cm) or conservative management fails to achieve healing, surgery may be considered to fix the fragment and restore function. Complete recovery is expected with proper treatment, although it may take several weeks before the patient can return to intense physical activity.
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