AVULSION FRACTURES OF THE ANTERIOR ILIAC SPINE IN CHILDREN AND ADOLESCENTS: CLINICAL OUTCOMES OF NON-OPERATIVE TREATMENT

Aleksandar  Božović; Saša Jovanović; Dušan Petrović; Predrag Denović; Dejan Tabaković; Oliver Dulić; Milan Milinkov; Ivica Lalić

doi:10.5937/sanamed0-61604

Aleksandar Božović 1.University of Priština in Kosovska Mitrovica, Faculty of Medicine, Kosovska Mitrovica, Serbia; 2. Clinical Hospital Center Kosovska Mitrovica, Department of Orthopedic Surgery and Traumatology, Kosovska Mitrovica, Serbia
Saša Jovanović 1. University of Priština in Kosovska Mitrovica, Faculty of Medicine, Kosovska Mitrovica, Serbia; 2. Clinical Hospital Center Kosovska Mitrovica, Department of Orthopedic Surgery and Traumatology, Kosovska Mitrovica, Serbia
Dušan Petrović 1. University of Priština in Kosovska Mitrovica, Faculty of Medicine, Kosovska Mitrovica, Serbia; 2. Clinical Hospital Center Kosovska Mitrovica, Department of Orthopedic Surgery and Traumatology, Kosovska Mitrovica, Serbia
Predrag Denović Clinical Hospital Center Kosovska Mitrovica, Department of Orthopedic Surgery and Traumatology, Kosovska Mitrovica, Serbia
Dejan Tabaković 1. University of Priština in Kosovska Mitrovica, Faculty of Medicine, Kosovska Mitrovica, Serbia; 2.Clinical Hospital Center Priština, Gračanica, Serbia
Oliver Dulić 1. University Clinical Center of Vojvodina, Clinic for Orthopedic Surgery and Traumatology, Novi Sad, Serbia; 2. University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Milan Milinkov 1. University Clinical Center of Vojvodina, Clinic for Orthopedic Surgery and Traumatology, Novi Sad, Serbia; 2. University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Ivica Lalić University Business Academy, Faculty of Pharmacy, Novi Sad, Serbia

DOI: https://doi.org/10.5937/sanamed0-61604

Keywords: avulsion fractures, pelvis, adolescent, Children, treatment

Abstract

Objective: Avulsion fractures of the anterior iliac spine are injuries typically seen in physically active children and adolescents. There is no clear consensus regarding the optimal treatment, particularly concerning the degree of fragment displacement that warrants surgical intervention.

Aim: The aim of this study was to analyze the clinical outcomes of non-operative treatment of pelvic avulsion fractures in adolescents and to examine the relationship between patient age and rehabilitation duration.

Patients and Methods: A retrospective study was conducted on 12 adolescent patients with radiographically confirmed pelvic avulsion fractures. Data on age, fracture location, injury mechanism, treatment, and rehabilitation duration were collected and analyzed. All patients underwent non-operative management consisting of rest, analgesics, and crutch-assisted ambulation, followed by physical therapy.

Results: All patients were male, with a mean age of 12 years. The most common fracture site was the anterior inferior iliac spine (66.6%). All fractures healed without complications. Rehabilitation duration tended to be shorter in younger patients. Functional outcomes were excellent, with all patients returning to their pre-injury activity levels.

Conclusion: Non-operative treatment is an effective and safe approach for managing pelvic avulsion fractures in adolescents, even in cases with fragment displacement up to 15 mm. It provides excellent functional recovery without complications, supporting its use as the first-line treatment in this population.

References

Schiller J, DeFroda S, Blood T. Lower extremity avulsion fractures in the pediatric and adolescent athlete. J Am AcadOrthop Surg. 2017;25(4):251-9. doi:10.5435/jaaos-d-15-00328.

Ghanem IB, Rizkallah M. Pediatric avulsion fractures of pelvis: current concepts. Curr Opin Pediatr. 2018;30(1):78-83. doi: 10.1097/mop.0000000000000575.

Orthobullets. Pediatric pelvis fractures [Internet]. Orthobullets; 2025 [cited 2025 Oct 26]. Available from: https://www.orthobullets.com/pediatrics/3000/pelvis-fractures--pediatric

DeFrancesco CJ, Sankar WN. Traumatic pelvic fractures in children and adolescents. Semin Pediatr Surg. 2017;26(1):27-35. doi:10.1053/j.sempedsurg.2017.01.006.

Vlahek P, Matijević V. Lower extremity injuries in novice runners: incidence, types, time patterns, sociodemographic and motivational risk factors in a prospective cohort study. Acta Clin Croat. 2018;57(1):31–8. doi:10.20471/acc.2018.57.01.04.

Calderazzi F, Nosenzo A, Galavotti C, Menozzi M, Pogliacomi F, Ceccarelli F. Apophyseal avulsion fractures of the pelvis: a review. Acta Biomed. 2018;89(4):470–6. doi: 10.23750/abm.v89i4.7632.

Anduaga I, Seijas R, Perez-Bellmunt A, Casasayas O, Alvarez P. Anterior iliac spine avulsion fracture treatment options in young athletes. J Invest Surg. 2020;33(2):159–63. doi: 10.1080/08941939.2018.1483447.

Eberbach H, Hohloch L, Feucht MJ, Konstantinidis L, Sudkamp NP, Zwingmann J. Operative versus conservative treatment of apophyseal avulsion fractures of the pelvis in adolescents: a systematic review with meta-analysis of clinical outcome and return to sports. BMC Musculoskelet Disord. 2017;18(1):162. doi:10.1186/s12891-017-1527-z.

Willinger L, Schanda JE, Lorenz S, Imhoff AB, Buchmann S. Surgical treatment of two adolescent athletes with dislocated avulsion fracture of the anterior superior iliac spine (ASIS). Arch Orthop Trauma Surg. 2017;137(2):173–7. doi: 10.1007/s00402-016-2596-4.

Best R, Meister A, Huth J, Becker U, Meier M. Surgical repair techniques, functional outcome, and return to sports after apophyseal avulsion fractures of the ischial tuberosity in adolescents. Int Orthop. 2021;45(8):1853–61. doi: 10.1007/s00264-021-04959-w.

Longo UG, Ciuffreda M, Locher J, Maffulli N, Denaro V. Apophyseal injuries in children's and youth sports. Br Med Bull. 2016;120(1):139-57. doi: 10.1093/bmb/ldw041.

Sinikumpu JJ, Hetsroni I, Schilders E, Lempainen L, Serlo W, Orava S. Operative treatment of pelvic apophyseal avulsions in adolescent and young adult athletes: a follow-up study. Eur J Orthop Surg Traumatol. 2018;28(3):423–9. doi: 10.1007/s00590-017-2074-x

Caine D, DiFiori J, Maffulli N. Physeal injuries in children's and youth sports: reasons for concern? Br J Sports Med. 2006;40(9):749-60. doi: 10.1136/bjsm.2005.017822.

Cirimele V, D'Amone G, Stellato L, Ferrini A, Gregori P, Faiella E. Magnetic resonance imaging in the evaluation of avulsion injuries of the pelvis and hip in adolescent professional footballers: a case series. J Orthop Case Rep. 2024;14(5):147-52. doi: 10.13107/jocr.2024.v14.i05.4466.

Schuett DJ, Bomar JD, Pennock AT. Pelvic apophyseal avulsion fractures: a retrospective review of 228 cases. J Pediatr Orthop. 2015;35(6):617–23. doi: 10.1097/bpo.0000000000000328.

Malina RM, Peña Reyes ME, Eisenmann JC, Horta L, Rodrigues J, Miller R. Height, mass and skeletal maturity of elite Portuguese soccer players aged 11-16 years. J Sports Sci. 2000;18(9):685–93. doi: 10.1080/02640410050120069.

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):204–10. doi: 10.1097/bpo.0000000000002355.

Ruffing T, Rückauer T, Bludau F, Hofmann A, Muhm M, Suda AJ. Avulsion fracture of the lesser trochanter in adolescents. Injury. 2018;49(7):1278–81. doi: 10.1016/j.injury.2018.04.030.

Gidwani S, Jagiello J, Bircher M. Avulsion fracture of the ischial tuberosity in adolescents - an easily missed diagnosis. BMJ. 2004;329(7457):99-100. doi: 10.1136/bmj.329.7457.99.

Otto A, Banke IJ, Mehl J, Beitzel K, Imhoff AB, Scheiderer B. Retrograde fixation of the lesser trochanter in the adolescent: new surgical technique and clinical results of two cases. Arch Orthop Trauma Surg. 2019;139(4):537–45. doi: 10.1007/s00402-018-3091-x.

Cai W, Xie Y, Su Y. Comparison of non-surgical and surgical treatment using absorbable screws in anterior-superior iliac spine avulsion fractures with over 1.5 cm displacement. OrthopTraumatol Surg Res. 2020;106(8):1299–304. doi: 10.1016/j.otsr.2020.02.014.

Metzmaker JN, Pappas AM. Avulsion fractures of the pelvis. Am J Sports Med. 1985;13(5):349–58. doi: 10.1177/036354658501300510.

Kjellin I, Stadnick ME, Awh MH. Orthopaedic magnetic resonance imaging challenge: apophyseal avulsions at the pelvis. Sports Health. 2010;2(3):247-51. doi: 10.1177/1941738109347976.

Yanagisawa Y, Yamazaki M. Rehabilitation for returning to sports in individuals with sports-induced pelvic injuries—a narrative review. J Phys Fitness Sports Med. 2024;13(4):125-9. doi: 10.7600/jpfsm.13.125.

Čengić T, Jurković D, Hajsok H, Smoljanović T, Novosel L, Rotim K, et al. Hip arthroscopy: residual cam deformity combined with loose bony fragment in hip capsule. Acta Clin Croat. 2021;60(4):777-82. doi:10.20471/acc.2021.60.04.28.

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.

Novais EN, Riederer MF, Provance AJ. Anterior inferior iliac spine deformity as a cause for extra-articular hip impingement in young athletes after an avulsion fracture: a case report. Sports Health. 2018;10(3):272–6. doi: 10.1177/1941738117744547.

Ferlic PW, Sadoghi P, Singer G, Kraus T, Eberl R. Treatment for ischial tuberosity avulsion fractures in adolescent athletes. Knee Surg Sports Traumatol Arthrosc. 2013;22(4):893–7. doi:10.1007/s00167-013-2570-4.

Su Y, Chen K, Qin J. Retrospective study of open reduction and internal fixation of lateral humeral condyle fractures with absorbable screws and absorbable sutures in children. Medicine (Baltimore). 2019;98(44):e17850. doi: 10.1097/md.0000000000017850.