Asis Avulsion Fracture

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Asis Avulsion Fracture

Authors, Editors, Case Information Author: Zachary Noll, BS Affiliation: Rowan Virtua School of Osteopathic Medicine Co Author(s): Altamash Raja, DO, RMSK, CSCS Clinical Vignette: A 14-year-old female high school soccer player presented with 5 months of right anterior hip pain without any clear mechanism of injury. Pain was located over the anterior superior iliac spine and worsened with running, kicking, and jumping. Type of Probe Used: 15-4 MHz Linear Transducer Unlabeled Short Axis View of the Right ASIS Unlabeled Short Axis View of the Right ASIS Labeled Short Axis View of the Right ASIS Labeled Short Axis View of the Right ASIS showing marked cortical irregularity. Pain with sonopalpation at this site. Normal appearing sartorius and tensor fascia latae tendons. Unlabeled Long Axis View of the Right ASIS Unlabeled Long Axis View of the Right ASIS Labeled Long Axis View of the Right ASIS Labeled Long Axis View of the Right ASIS showing marked cortical irregularity. Pain with sonopalpation at this site. Normal appearing sartorius tendon. Unlabeled Long Axis View of the Right ASIS with Doppler Unlabeled Long Axis View of the Right ASIS with Doppler Labeled Long Axis View of the Right ASIS with Doppler Labeled Long Axis View of the Right ASIS with Doppler no hyperemia. Unlabeled Long Axis View of the Uninjured Left ASIS Unlabeled Long Axis View of the Uninjured Left ASIS Labeled Long Axis View of the Uninjured Left ASIS Labeled Long Axis View of the Uninjured Left ASIS Unlabeled Short Axis View of the Uninjured Left ASIS Unlabeled Short Axis View of the Uninjured Left ASIS Labeled Short Axis View of the Uninjured Left ASIS Labeled Short Axis View of the Uninjured Left ASIS Unlabeled AP Pelvis radiographs Unlabeled AP Pelvis radiographs Labeled AP Pelvis rardiographs Labeled AP Pelvis rardiographs Unlabeled MRI Right Pelvis Coronal STIR sequence Unlabeled MRI Right Pelvis Coronal STIR sequence Labeled MRI Right Pelvis Coronal STIR sequence Labeled MRI Right Pelvis Coronal STIR sequence Unlabeled MRI Right Pelvis Coronal T1 sequence Unlabeled MRI Right Pelvis Coronal T1 sequence Labeled MRI Right Pelvis Coronal T1 sequence Labeled MRI Right Pelvis Coronal T1 sequence Unlabeled Frog Leg View radiographs Unlabeled Frog Leg View radiographs Labeled Frog Leg View radiographs Labeled Frog Leg View radiographs #19 - Video View Video Short axis cine of the right ASIS proximal to distal revealing normal sartorius and tensor fascia latae tendons and marked cortical irregularity with a probable step-off deformity. #20 - Video View Video Long axis cine of the right ASIS medial to lateral revealing normal sartorius tendon and marked cortical irregularity with a probable step-off deformity. Interpretation Image Interpretation: Marked cortical irregularity with a probable step-off deformity is noted at the anterior superior iliac spine with accompanying tenderness to sonopalpation and no associated hyperemia, suggestive of a chronic anterior superior iliac spine avulsion fracture. The Sartorius tendon is normal. The Tensor fascia latae is normal. The Gluteus Medius tendon origin is normal. Teaching Pearl: Pelvic avulsion fractures are uncommon injuries seen primarily in active adolescents after forceful muscular contraction during sprinting, kicking, or cutting. The ASIS, AIIS, and ischial tuberosity are common sites, and ultrasound can show cortical step-off, periosteal elevation, hematoma, and focal tenderness at the apophysis. Point-of-care ultrasound can rapidly identify the injury and measure displacement when radiographs are delayed or equivocal. Radiographs and orthopedic input remain important when displacement is large or return-to-sport decisions are complex. References: 1. Ferraro SL, Batty M, Heyworth BE, Cook DL, Miller PE, Novais EN. Acute pelvic and hip apophyseal avulsion fractures in adolescents: a summary of 719 cases. J Pediatr Orthop. 2023;43(4):204-210. doi:10.1097/BPO.0000000000002355 2. Di Maria F, Testa G, Sammartino F, Sorrentino M, Petrantoni V, Pavone V. Treatment of avulsion fractures of the pelvis in adolescent athletes: a scoping literature review. Front Pediatr. 2022;10:947463. doi:10.3389/fped.2022.947463 3. Mori T, Ihara T, Nomura O. Avulsion fracture of the anterior superior iliac spine in a young athlete detected by point-of-care ultrasound. POCUS J. 2022;7(1):140-143. doi:10.24908/pocus.v7i1.15096
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Phone: 913.327.1415

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Authors, Editors, Case Information

Unlabeled Short Axis View of the Right ASIS

Labeled Short Axis View of the Right ASIS

Unlabeled Long Axis View of the Right ASIS

Labeled Long Axis View of the Right ASIS

Unlabeled Long Axis View of the Right ASIS with Doppler

Labeled Long Axis View of the Right ASIS with Doppler

Unlabeled Long Axis View of the Uninjured Left ASIS

Labeled Long Axis View of the Uninjured Left ASIS

Unlabeled Short Axis View of the Uninjured Left ASIS

Labeled Short Axis View of the Uninjured Left ASIS

Unlabeled AP Pelvis radiographs

Labeled AP Pelvis rardiographs

Unlabeled MRI Right Pelvis Coronal STIR sequence

Labeled MRI Right Pelvis Coronal STIR sequence

Unlabeled MRI Right Pelvis Coronal T1 sequence

Labeled MRI Right Pelvis Coronal T1 sequence

Unlabeled Frog Leg View radiographs

Labeled Frog Leg View radiographs

#19 - Video

#20 - Video

Interpretation

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