Pediatric Pelvis and Hip Apophyseal Avulsion Fracture

  • Etiology: Forceful and repetitive contractions of attaching muscles at apophyses where avulsion of insertion of muscle leads to avulsion fracture
  • Imaging Radiograph:
    — Ischial tuberosity avulsion (54%) due to hamstring adductor insertion
    — Anterior inferior iliac spine avulsion (22%) due to rectus femoris muscle insertion
    — Anterior superior iliac spine avulsion (19%) due to sartorius muscle insertion
    — Pubic symphysis avulsion (3%) – superior due to rectus abdominis muscle insertion, inferior due to adductor group insertion
    — Iliac crest avulsion (1%) due to oblique muscles (internal and external) and transversis abdominus muscles insertion, can be difficult to differentiate from normal variant clefts in iliac crest in adolescents so look for fragment to be distracted from donor site
    — Greater trochanter avulsion due to gluteal muscle insertion
    — Lesser trochanter avulsion (less than 1%) due to iliopsoas muscle insertion
  • DDX:
  • Complications:
  • Treatment:
  • Clinical: Avulsion and iliac wing fractures are more common than acetabular fractures and sacroiliac joint malalignment

Radiology Cases of Pelvis and Hip Apophyseal Avulsion Fracture

Radiology Cases of Pelvis and Hip Apophyseal Avulsion Fracture of the Lesser Trochanter

Radiograph of avulsion of the lessor trochanter
AP radiograph of the pelvis shows avulsion of the apophysis of the right lesser trochanter.
Radiograph of pelvis and hip apophyseal fracture of the lesser trochanter.
AP radiograph of the left hip shows avulsion of the apophysis of the lesser trochanter.

Radiology Cases of Pelvis and Hip Apophyseal Avulsion Fracture of the Anterior Superior Iliac Spine and Fracture of the Right Iliac Crest

Radiograph of a pelvis apophyseal avulsion fracture of the right anterior superior iliac spine and a pelvis fracture of the right iliac crest
AP radiograph of the pelvis shows an apophyseal avulsion fracture of the right anterior superior iliac spine and a laterally displaced fracture of the right iliac crest.