•        Pelvic avulsion fractures are injuries that occur at the tendon or bone at a tendinous insertion site. They may be due to a single or continuous traumatic myotendinous contraction.

•        Avulsion fractures of the pelvis and hip may occur at the iliac crest, anterosuperior iliac spine, anteroinferior iliac spine, ischial tuberosity, pubic ramus, greater and lesser trochanters.

•        These injuries are most common in the adolescent age group and occur in the setting of violent muscular contraction during strenuous physical activity. Additionally, avulsion fractures can also occur in adults secondary to pathological lesions such as metastatic disease.

•        Pelvic avulsion fractures account for 13.4% of pediatric pelvic fractures.

•        These lesions can be diagnosed with conventional radiography; however, CT or MRI help identify the extent of these fractures.

•        In the adolescent population, these injuries occur secondary to weakness across unfused apophysis, resulting in separation and retraction of the partially ossified apophysis.

Clinical Presentation

•        Focal pain at the avulsion site.

•        Patient usually feels a “pop” during strenuous exercise.

•        On physical exam patient presents with pain and weakness of affected muscle when placed under stress. A palpable mass or discoloration secondary to hematoma formation may be seen.

Treatment

•        Most of these injuries are treated conservatively.

•       Initial non-weight bearing with crutches, ice and antinflammatories is recommended.

•       Physical therapy goals are gradual strengthening and progressive weight bearing.

•        There is a risk of reinjury related to premature resumption of activities.

•       Surgery is reserved for patients with avulsed fragment displaced > 1 cm or patients with chronic pain.