A 15-year-old male football player presented an acute onset of anterior hip pain provoked by striking a football. It was immediately painful and he could not continue.
On examination the player walked with an antalgic gait. There was pain and weakness with resisted hip flexion. He also had localised tenderness about the anterior hip.
An avulsion fracture from the anterior inferior iliac spine (AIIS) was well demonstrated on an AP and oblique x-ray view. This is the site of origin of the reflected head of the rectus femoris. No further imaging studies were obtained.
The player was managed initially with crutches, early movement and analgesia. As his symptoms improved he was able to progressively return to activity over an eight-week period.
Acute apophyseal injuries often occur around the hip. Common sites are the ASIS (sartorius) AIIS (rectus femoris) and the ischial tuberosity (hamstrings). These injuries generally occur during sprinting or with kicking a ball. They are usually very painful. X-rays generally demonstrate an avulsion fracture however if the initial images are unremarkable they may be repeated after 10 days. If the diagnosis remains unclear a clinician may elect to simply treat the patient, or to confirm the diagnosis with an MRI.
In the younger athlete, these fractures are the equivalent of an acute muscle strain. As a result, the treatment is identical to that for a muscle strain in an adult. Rest, ice, compression and elevation (RICE), restoration of full ROM with passive stretching and active ROM exercises are generally all that is required. The prognosis is generally good after adequate treatment. Reattachment of the avulsed fragment is rarely necessary. Ischial tuberosity fractures are the only real exception as they may be at an increased risk of non-union. Surgery is often advocated if there is separation of fragments of 2cm or more.
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