Understanding Avulsion Fractures: The Impact on Young Athletes
Next up in our blog series looking at and breaking down pain and injury in young people and youth athletes, Avulsion Fractures.
Understanding Avulsion Fractures
Have you ever heard of an Avulsion Fracture?
An avulsion fracture is a type of fracture or break of the bone. Avulsion fractures occur at the attachment of a ligament or a large tendon to the bone. (1) Avulsion fractures of the hip and pelvis are common injuries in adolescent athletes during high intensity sport. (2)
Causes of an Avulsion Fracture
The cause of an Avulsion Fracture is often an unpredictable traumatic event caused during sport or intense physical activity. Avulsion fractures can occur with either contact or non contact events.
A traumatic contact avulsion fracture can often occur when the force of the ligament tear can cause a fracture to our bone such as at the ankle.
However, it is most common for children and adolescent athletes to have a non-contact avulsion fracture due to the pulling of a major muscle tendon on the bone.
This can often occur during growth spurts in which a child’s bone will grow faster than the muscle tendon that attaches to it. As a result, a young athlete’s growth plates are subsequently weaker than the musculotendinous unit that attaches to it, unbeknownst to the athlete, coach or parents which can cause the fracture. (2,3)
Where can this occur in the Young Athlete?
As stated above, common sites of avulsion fractures occur at the attachment of large musculotendinous units of the lower limb. Therefore, this puts an adolescents pelvis at a greater risk than other areas of the body. Most frequently involved is the rectus femoris (Quad Muscle Tendon) insertion at the anterior inferior iliac spine (AIIS) (31%), the sartorius insertion at the anterior superior iliac spine (ASIS) (37%) and hamstring insertion at the ischial tuberosity (IT) (14%). (2)
See the picture below for further clarification.
Symptoms and Diagnosis of Avulsion Fracture
A subjective examination of the athlete will commonly present with a history of a sudden pain during forceful muscle contraction such as kicking a ball, sprinting or jumping. It may be associated with a ‘cracking/popping’ sound or sensation. (2)
Objectively, the patient will often present with an increase of pain with movement that will subsequently decrease with rest. The young athlete will have local tenderness and pain at the site exacerbated by contraction of the associated muscle groups to the suspected region of fracture.
The gold standard for diagnosis of an avulsion fracture is for a Pelvis X-Ray to be ordered when suspicious of fracture. An MRI is typically not indicated when a fracture is confirmed via X-Ray.
Treatment and Rehab of an Avulsion Fracture
There are currently no guidelines for the best treatment of pelvic avulsion fractures. The lack of accepted criteria may contribute to the variability in the treatment decisions. (2)
Therefore, it is important to seek professional and collaborative medical treatment by both a Physiotherapist and a Medical Doctor.
For most cases surgery is not typically indicated. Therefore, a period of 4-6 weeks of partial/non weight bearing is essential to allow the bone to heal effectively. This period of altered weight bearing is partnered with a rehabilitation strengthening program to regain full range of motion, strength and to allow the young athlete to return to sport as best as they can. (1)
Do you have any questions about Avulsion Fractures? Do you or your child/young athlete have an injury?
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Brukner, Peter. & Brukner, Peter. & Khan, Karim. (2017). Brukner & Khan’s clinical sports medicine
Di Maria, F., Testa, G., Sammartino, F., Sorrentino, M., Petrantoni, V., & Pavone, V. (2022). Treatment of avulsion fractures of the pelvis in adolescent athletes: A scoping literature review. Frontiers in pediatrics, vol. 10, 947463.
Sanders, T. G., & Zlatkin, M. B. (2008). Avulsion injuries of the pelvis. Seminars in musculoskeletal radiology, vol.12, 1, 42–53.