Detaillierte Beitrags-Information
| Beitragstitel | Transitional Salter type II like avulsion fracture of the apophysis of the iliac crest in an adolescent. |
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| Beitragscode | P083 |
| Autoren | |
| Präsentationsform | Poster |
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| Abstract |
Introduction Avulsion fractures of pelvic apophyses occur mostly in adolescent males. The main mechanism is a sudden maximal muscle contraction during sports activities combined with the relative mechanical weakness of the apophyseal growth plate. Regularly, standard radiographs are sufficient for the diagnosis. CT-scan may be needed to define the extent and displacement of such apophyseal lesions. Depending on localization and displacement non- or operative treatment is indicated. Methods Report of a case and literature review. Results A 17-year-old man presented after a judoka fight competition in our emergency department with immobilizing pain above his left hip joint. Physical examination revealed a hematoma and severe pain at the left iliac crest. Hip flexion and abduction against resistance was painful, while passive mobility of the left hip joint was found to be normal. Standard radiographs and CT-scan imaging showed a partial avulsion fracture of the apophysis of the iliac crest. The anterior superior iliac spine (ASIS) and the posterior half of the iliac crest remained undisturbed. Due to the observed minimal displacement a non-operative treatment was followed with restriction of sports activities for six months. Conclusion Apophyseal avulsions are relatively frequent in the pelvic ring of adolescents. The ASIS, anterior inferior iliac spine (AIIS), ischial tuberosity and the symphyseal body are concerned with decreasing frequency. In our case the apophysis of the iliac crest was closed in its anterior part close to the ASIS and thus remained in place like in a transitional fracture. Posteriorly, the apophysis was avulsed presenting a little displaced fracture towards the remaining and intact posterior part of the crest (comparable with a Salter type II lesion in the epiphyseal area). The displacement was purely lateral. Thus, it must be concluded that parts of the external oblique abdominal and of the gluteus medius muscles remained still attached to the avulsed fragment avoiding its displacement. The treatment of apophyseal avulsions depend on the localization and the extent of displacement. Displaced injuries of the ASIS and the iliac crest are forgiving and can be treated non-operatively. Displacement of the ischial tuberosity can lead to an oblique sitting position, and displacement of the AIIS to an extra-articular anterior impingement of the hip. Thus, in these regions only little displacement can be tolerated without later functional impairment. |