Download Avulsion fractures of the pelvis

Database: Current Contents, MEDLINE
Search Strategy: (Avulsion fractures of the pelvis)
------------------------------------------------------------------------------1
exp Fractures/ (76895)
2
avulsion.tw. and 1 (788)
3
exp Pelvis/ (9404)
4
2 and 3 (6)
5
limit 4 to (human and english language) [Limit not valid in:
Current Contents; records were retained] (5)
6
(avulsion and fracture$ and pelvi$).af. (126)
7
limit 6 to english language (101)
8
(sport$ or athlet$).af. (68404)
9
7 and 8 (35)
10
5 or 9 (38)
11
remove duplicates from 10 (28)
12
from 11 keep 1-28 (28)
***************************
<1>
Database
MEDLINE
Unique Identifier
6974473
Medline Identifier
82020796
Authors
Fernbach SK. Wilkinson RH.
Title
Avulsion injuries of the pelvis and proximal femur.
Source
AJR. American Journal of Roentgenology. 137(3):581-4, 1981 Sep.
Abstract
Twenty cases of avulsion fractures of the apophyses of the pelvis and
proximal femur were reviewed. Most occurred in male adolescents engaged
in active sports. Pain, often with little external evidence of trauma,
was the most frequent presenting symptom. Conservative, nonsurgical
treatment was successful in all the patients. The radiographic appearance
of each type of apophyseal injury is demonstrated. Recognition of the
initial deformity and of the patterns of repair is important to avoid
unnecessary evaluation (tomography, radionuclide scans) and inappropriate
therapy. While productive changes with healing are most likely to occur
in the region of the ischium, any of the other sites may heal with
abundant bone and may mimic neoplasm. In the proper clinical setting,
bony changes at these sites should prompt the radiologist to consider a
traumatic etiology.
Publication Type
Journal Article.
Entry Date
19811118. Revision Date: 20001218. Update Date: 20020107.
<2>
Database
MEDLINE
Unique Identifier
11517070
Medline Identifier
21407500
Authors
Anderson MW. Kaplan PA. Dussault RG.
Institution
Department of Radiology, University of Virginia Health Sciences Center,
Box 170, Charlottesville, VA 22908, USA.
Title
Adductor insertion avulsion syndrome (thigh splints): spectrum of MR
imaging features.
Source
AJR. American Journal of Roentgenology. 177(3):673-5, 2001 Sep.
Abstract
OBJECTIVE: "Thigh splints," also known as the adductor insertion
avulsion syndrome, is a painful condition affecting the proximal to mid
femur at the insertion of the adductor muscles of the thigh.
Scintigraphic findings in this syndrome have been described; we report a
spectrum of MR imaging abnormalities involving this portion of the femur
in a group of patients presenting with hip, groin, or thigh pain.
CONCLUSION: Symptoms of vague hip, groin, or thigh pain may be associated
with stress-related changes in the proximal to mid femoral shaft (thigh
splints). When interpreting MR imaging studies of the pelvis in patients
presenting with these symptoms, careful attention should be directed to
this portion of the femur. This is especially important because the
findings may be subtle, and this region is often at the distal edge of
most MR imaging studies of the pelvis and hip.
Publication Type
Journal Article.
Entry Date
20010920. Update Date: 20020107.
<3>
Database
MEDLINE
Unique Identifier
10537384
Medline Identifier
20005776
Authors
O'Kane JW.
Institution
Department of Orthopaedics, University of Washington School of
Medicine, Seattle 98195-4060, USA.
Title
Anterior hip pain.
Source
American Family Physician. 60(6):1687-96, 1999 Oct 15.
Abstract
Anterior hip pain is a common complaint with many possible causes.
Apophyseal avulsion and slipped capital femoral epiphysis should not be
overlooked in adolescents. Muscle and tendon strains are common in
adults. Subsequent to accurate diagnosis, strains should improve with
rest and directed conservative treatment. Osteoarthritis, which is
diagnosed radiographically, generally occurs in middle-aged and older
adults. Arthritis in younger adults should prompt consideration of an
inflammatory cause. A possible femoral neck stress fracture should be
evaluated urgently to prevent the potentially significant complications
associated with displacement. Patients with osteitis pubis should be
educated about the natural history of the condition and should undergo
physical therapy to correct abnormal pelvic mechanics. "Sports hernias,"
nerve entrapments and labral pathologic conditions should be considered
in athletic adults with characteristic presentations and chronic
symptoms. Surgical intervention may allow resumption of pain-free
athletic activity.
Publication Type
Journal Article.
Entry Date
19991104. Revision Date: 20001218. Update Date: 20020107.
<4>
Database
MEDLINE
Unique Identifier
11681783
Medline Identifier
21537872
Authors
Morelli V. Smith V.
Institution
Department of Family Medicine, Louisiana State University School of
Medicine, New Orleans, USA.
Title
Groin injuries in athletes.
Source
American Family Physician. 64(8):1405-14, 2001 Oct 15.
Abstract
Groin injuries comprise 2 to 5 percent of all sports injuries. Early
diagnosis and proper treatment are important to prevent these injuries
from becoming chronic and potentially career-limiting. Adductor strains
and osteitis pubis are the most common musculoskeletal causes of groin
pain in athletes. These two conditions are often difficult to
distinguish. Other etiologies of groin pain include sports hernia, groin
disruption, iliopsoas bursitis, stress fractures, avulsion fractures,
nerve compression and snapping hip syndrome.
Publication Type
Journal Article.
Entry Date
20011204. Update Date: 20020109.
<5>
Database
MEDLINE
Unique Identifier
4051093
Medline Identifier
86023359
Authors
Metzmaker JN. Pappas AM.
Title
Avulsion fractures of the pelvis.
Source
American Journal of Sports Medicine. 13(5):349-58, 1985 Sep-Oct.
Abstract
Avulsion fractures of the pelvic apophyses are seen infrequently but
they show a consistent pattern in mechanism, patient's age, symptoms,
physical findings, and roentgenographic appearance. Some disagreement
exists in the literature concerning the treatment of these fractures.
This study indicates that early diagnosis and a carefully directed
nonoperative treatment program will produce positive results for avulsion
fractures of the pelvis. Twenty-seven cases of acute avulsion fracture of
the pelvis were successfully treated in a directed nonoperative program.
Publication Type
Journal Article.
Entry Date
19851028. Revision Date: 20001218. Update Date: 20020107.
<6>
Database
MEDLINE
Unique Identifier
7081523
Medline Identifier
82203926
Authors
Tehranzadeh J. Kurth LA. Elyaderani MK. Bowers KD.
Title
Combined pelvic stress fracture and avulsion of the adductor longus in
a middle-distance runner: a case report.
Source
American Journal of Sports Medicine. 10(2):108-11, 1982 Mar-Apr.
Publication Type
Journal Article.
Entry Date
19820708. Revision Date: 20001218. Update Date: 20020107.
<7>
Database
MEDLINE
Unique Identifier
8517577
Medline Identifier
93297774
Authors
Lambert MJ. Fligner DJ.
Institution
Department of Emergency Medicine, Christ Hospital and Medical Center,
Oak Lawn, Illinois.
Title
Avulsion of the iliac crest apophysis: a rare fracture in adolescent
athletes.
Source
Annals of Emergency Medicine. 22(7):1218-20, 1993 Jul.
Abstract
We report a case of an iliac apophyseal fracture in a 15-year-old boy,
sustained while swinging a baseball bat. He presented with right hip pain
one hour after the injury occurred. Diagnosis was made on the basis of
radiographs of the pelvis. Pelvic avulsion fractures are uncommon
injuries, seen almost exclusively in adolescent athletes. The iliac crest
is an unusual site of injury for this avulsion fracture. Only one other
well-described case of an acute, noncontact fracture of the iliac
apophysis with a similar mechanism of injury has been reported.
Publication Type
Journal Article.
Entry Date
19930721. Revision Date: 20001218. Update Date: 20020107.
<8>
Database
MEDLINE
Unique Identifier
7574136
Medline Identifier
96013326
Authors
Thanikachalam M. Petros JG. O'Donnell S.
Institution
Department of Surgery, St Elizabeth's Medical Center of Boston,
Massachusetts, USA.
Title
Avulsion fracture of the anterior superior iliac spine presenting as
acute-onset meralgia paresthetica.
Source
Annals of Emergency Medicine. 26(4):515-7, 1995 Oct.
Abstract
Avulsion fracture of the anterior superior iliac spine is rare. Most
cases occur in adolescents involved in competitive sports or vigorous
exercise in which the sartorius and tensor fascia lata muscles are
contracted strongly and suddenly against a hyperextended trunk. Patients
who sustain this injury usually experience acute pain in the anterior
pelvic region. We describe a patient with avulsion of the anterior
superior iliac spine who presented with meralgia paresthetica. The
symptoms resolved with conservative treatment.
Publication Type
Journal Article.
Entry Date
19951026. Revision Date: 20001218. Update Date: 20020107.
<9>
Database
MEDLINE
Unique Identifier
10233569
Medline Identifier
99252509
Authors
Venn SN. Greenwell TJ. Mundy AR.
Institution
Institute of Urology, London, UK.
Title
Pelvic fracture injuries of the female urethra.
Source
Bju International. 83(6):626-30, 1999 Apr.
Abstract
OBJECTIVE: To review pelvic fracture urethral injuries in women,
generally regarded as rare and thus discussed infrequently. PATIENTS AND
METHODS: Twelve patients (age range 7-51 years) with such injuries were
reviewed; most had associated injuries, generally more severe than seen
in males with urethral injuries. RESULTS: Patients with milder injuries,
perhaps damaging just the innervation of the urethra, presented with
incontinence; more severe injuries seemed to cause a longitudinal tear in
the urethra but again patients presented mainly with incontinence
problems. The most severe injuries were associated with complete rupture
of the urethra and a distraction defect suggesting an avulsion injury.
These problems were difficult to treat both reconstructively and in
providing continence. CONCLUSIONS: Pelvic fracture urethral injuries
occur in females, but less often than in males. The female urethra seems
relatively resistant to injury; differing degrees of severity of pelvic
trauma cause different types of urethral injury but in general, a more
severe injury is needed to damage it than is necessary in males.
Publication Type
Journal Article.
Entry Date
19990623. Revision Date: 20001218. Update Date: 20020107.
<10>
Database
MEDLINE
Unique Identifier
884433
Medline Identifier
77222974
Authors
Orava S. Ala-Ketola L.
Title
Avulsion fractures in athletes.
Source
British Journal of Sports Medicine.
Abstract
11(2):65-71, 1977 Jun.
34 cases of avulsion fractures are described. Each fracture took place
during athletic training or competition. Excepting six sportsmen
participating in a general fitness programme, every patient was an active
competitive athlete. There were six women and 28 men; their average age
was 20.1 years, raised by a few middle-aged "fitness sportsmen". Most
avulsion fractures took place in sprinters and hurdlers; next were middle
and long distance renner, footballers, fitness joggers, skiers and icehockey players. The most usual location of a fracture was the anterior
pelvic spines; avulsion fractures were also detected in various parts of
lower limbs. There were fewer avulsion fractures in the area of the trunk
and upper extremities. Roetgenologically, the diagnosis of an avulsion
fracture is generally easy to make. However, the diagnosis is facilitated
by knowing the mechanism of the injury, the technique of the athletic
event, and some of the training methods. Generally, a fracture heals
well, even if it requires both sufficient immobilisation and some delay
in resuming physical exertion.
Publication Type
Journal Article.
Entry Date
19770922. Revision Date: 20001218. Update Date: 20020107.
<11>
Database
Current Contents/All Editions
Accession Number
119HF-0025
Authors
Servant CTJ. Jones CB.
Title
DISPLACED AVULSION OF THE ISCHIAL APOPHYSIS - A HAMSTRING INJURY
REQUIRING INTERNAL FIXATION
Source
British Journal of Sports Medicine. 32(3):255-257, 1998 Sep.
Abstract
A case is reported of an adolescent sprinter who was chronically
disabled by pain after non-operative management for an acute hamstring
injury. He had sustained an avulsion fracture of the ischial apophysis
with displacement of 2.5 cm. Avulsion fractures of the ischial apophysis
with displacement of 2 cm or more are unusual, but they frequently result
in a symptomatic non-union, and early diagnosis, open reduction, and
internal fixation is to be encouraged. [References: 16]
Publication Type
Article
Institution
Reprint available from:
Servant CTJ
ROYAL UNITED HOSP
INST SPORTS MED
DEPT ORTHOPAED
COMBE PK
BATH BA1 3NG
AVON
ENGLAND
<12>
Database
Current Contents/All Editions
Accession Number
320VE-0005
Authors
Fon LJ. Spence RAJ.
Title
Sportsman's hernia [Review]
Source
British Journal of Surgery. 87(5):545-552, 2000 May.
Abstract
Background: Sportsman's hernia is a debilitating condition which
presents as chronic groin pain. A tear occurs at the external oblique
which may result in an occult hernia. The definition, investigation and
treatment of this condition remain unclear.
Methods: A systematic Medline search was performed and all literature
pertaining to chronic groin pain, groin injury, sportsman's hernia and
sportsman's groin from 1962 to 1999 was retrieved for analysis.
Results: The costs of computed tomography and magnetic resonance
imaging are such that their routine use for assessment of patients with
groin pain cannot be justified. They may, however, be employed in
difficult cases to help define the anatomical extent of a groin injury.
Plain radiography, ultrasonography and scintigraphy should be the usual
first-line investigations to supplement clinical assessment. Herniography
may help in situations of obscure chronic groin and pelvic pain. There is
no consensus view supporting any particular surgical procedure for
sportsman's hernia. A number of reports have been published describing
different repairs of the posterior inguinal wall deficiency. Appropriate
repair of the posterior wall results in therapeutic benefit in selected
cases.
Conclusion: The diagnosis of sportsman's hernia is difficult. The
condition must be distinguished from the more common osteitis pubis and
musculotendinous injuries. Early surgical intervention is usually,
although not always, successful when conservative management has failed.
[References: 81]
Publication Type
Review
Institution
Reprint available from:
Spence RAJ
Belfast City Hosp, Dept Surg, Gen Surg Unit
Lisburn Rd
Belfast BT9 7AB
Antrim
North Ireland
Belfast City Hosp, Dept Surg, Gen Surg Unit
Belfast BT9 7AB
Antrim
North Ireland
<13>
Database
MEDLINE
Unique Identifier
3333929
Medline Identifier
89195299
Authors
Pavlov H.
Institution
Hospital for Special Surgery, Cornell University Medical College, New
York, New York.
Title
Roentgen examination of groin and hip pain in the athlete. [Review] [32
refs]
Source
Clinics in Sports Medicine. 6(4):829-43, 1987 Oct.
Abstract
Stress fractures and reactions of the pubic ramus, pubic symphsitis,
gracilis syndrome, pelvic avulsion injuries, femoral stress fractures,
degenerative osteoarthritis, discogenic pain, and spondylolysis are among
the multiple conditions causing groin pain in the athlete. These
conditions occasionally have uncertain etiologies and are contributed to
by poor training techniques and ill-repaired running shoes, combined with
minor congenital anomalies that may have been silent prior to the demands
of athletic competition. Roentgen documentation of the specific injury
enables early appropriate treatment and minimal "down time". [References:
32]
Publication Type
Journal Article. Review. Review, Tutorial.
Entry Date
19890518. Revision Date: 20011102. Update Date: 20020107.
<14>
Database
MEDLINE
Unique Identifier
3042159
Medline Identifier
88295204
Authors
Waters PM. Millis MB.
Institution
Department of Orthopaedic Surgery, Children's Hospital Medical Center,
Harvard Medical School, Boston, Massachusetts.
Title
Hip and pelvic injuries in the young athlete. [Review] [27 refs]
Source
Clinics in Sports Medicine. 7(3):513-26, 1988 Jul.
Abstract
Hip and pelvic injuries are relatively rare in the young athlete.
Contusions and musculotendinous sprains are the most common injuries
about the hip and pelvis. Apophyseal avulsion fractures and stress
fractures are the most frequently encountered skeletal injuries. Each of
these entities can be successfully treated with guided physical therapy
following conservative management with rest, anti-inflammatory
medications, and ice massage until the patient is pain free. Epiphyseal,
diaphyseal, or pathologic fractures are rare entities that are secondary
to violent trauma. These injuries are severe and often require operative
intervention. Femoral neck fractures have a high rate of complications
from avascular necrosis, nonunion, or malunion. Pelvic fractures have
frequent associated genitourinary, abdominal, neurologic, and
musculoskeletal injuries. Pathologic fractures are most commonly
secondary to benign lesions, such as unicameral bone cysts, and less
likely owing to malignancy. Finally, in children with hip pain during
athletic activities, even with antecedent trauma, the sports clinician
must screen for slipped capital femoral epiphysis, Perthes' disease,
congenital subluxation of the hip, toxic synovitis, systemic neoplasia,
or infectious process. [References: 27]
Publication Type
Journal Article. Review. Review, Tutorial.
Entry Date
19880921. Revision Date: 20011102. Update Date: 20020107.
<15>
Database
MEDLINE
Unique Identifier
9652502
Medline Identifier
98314610
Authors
De Paulis F. Cacchio A. Michelini O. Damiani A. Saggini R.
Institution
Department of Diagnostic Imaging-CT Service, S. Maria di Collemaggio,
L'Aquila Hospital, Pettino-L'Aquila, Italy.
Title
Sports injuries in the pelvis and hip: diagnostic imaging. [Review] [30
refs]
Source
European Journal of Radiology. 27 Suppl 1:S49-59, 1998 May.
Abstract
We discuss the role of imaging techniques in examining the athletes
with sports injuries involving the pelvis and the hip. Pelvis and hip
pain is of difficult clinical clarification because of the various
athletic injuries which may affect the bone or soft tissues at different
anatomic sites. Moreover, the symptoms of pelvis and hip injuries are
similar in most cases and they are often diffuse and atypical. Diagnostic
imaging can play an essential role because treatment success depends on a
correct diagnosis and these techniques can actually differentiate the
most frequent causes of pelvis and hip sports injuries such as groin
strain, osteitis pubis, ischial intersection syndrome, snapping hip,
stress fractures, hernias and avulsion fractures. Finally, we discuss the
role of magnetic resonance imaging in detecting the causes of hip pain
other than sports injuries, such as avascular necrosis, reflex
sympathetic dystrophy syndrome, herniation pit, acetabular labrum
injuries. To conclude, diagnostic imaging techniques currently permit the
direct and noninvasive depiction of pelvis and hip conditions.
Particularly, magnetic resonance imaging is very helpful in detecting
injury site, extent and characteristics; it can also predict the time
period an athlete will be disabled and help define the best treatment
planning. [References: 30]
Publication Type
Journal Article. Review. Review, Tutorial.
Entry Date
19980902. Revision Date: 20011102. Update Date: 20020107.
<16>
Database
MEDLINE
Unique Identifier
4202277
Medline Identifier
74044919
Authors
Harris WR. Rathbun JB. Wortzman G. Humphrey JG.
Title
Avulsion of lumbar roots complicating fracture of the pelvis.
Source
Journal of Bone & Joint Surgery. 55(7):1436-42, 1973 Oct.
Publication Type
Journal Article.
Entry Date
19740131. Revision Date: 20001218. Update Date: 20020107.
<17>
Database
MEDLINE
Unique Identifier
8854325
Medline Identifier
97007050
Authors
Rosenberg N. Noiman M. Edelson G.
Institution
Department of Orthopaedic Surgery A, Rambam Medical Center, Haifa,
Israel.
Title
Avulsion fractures of the anterior superior iliac spine in adolescents.
Source
Journal of Orthopaedic Trauma. 10(6):440-3, 1996.
Abstract
We present two cases of traumatic avulsion of the apophysis of the
anterior superior iliac spine after sports activity in adolescents. Non-
operative treatment resulted in excellent functional outcome for this
relatively unusual fracture.
Publication Type
Journal Article.
Entry Date
19961224. Revision Date: 20001218. Update Date: 20020107.
<18>
Database
MEDLINE
Unique Identifier
8739720
Medline Identifier
96310306
Authors
Lazovic D. Wegner U. Peters G. Gosse F.
Institution
Medical School Hannover, Clinic of Orthopedics, Germany.
Title
Ultrasound for diagnosis of apophyseal injuries.
Source
Knee Surgery, Sports Traumatology, Arthroscopy. 3(4):234-7, 1996.
Abstract
Avulsion injuries of the apophysis is a problem in young athletes. A
correct diagnosis is necessary for establishing the appropriate treatment
and the rehabilitation program. However, it is often difficult to
distinguish between a simple muscle strain and an avulsion fracture. The
X-ray examination is helpful only when an ossification center of the
apophysis exists. Ultrasonography is considered the suitable diagnostic
tool for these cases. From June 1988 to June 1993, 243 young athletes
were seen with an anamnestic and clinically suspected apophyseal injury
of the lower extremity. In all cases X-ray examination and ultrasound
examination were performed. In 80 cases the diagnosis was confirmed by Xray examination and in 97 by ultrasonography. Four criteria were defined
for the sonographic examination: (a) a hypoechogenic zone, (b) increased
distance to the apophysis, (c) dislocation of the apophysis, and (d)
mobility of the apophysis on dynamic examination. These criteria are
correlated to (a) edema, (b) lysis, (c) avulsion, and (d) unstable
avulsion of the apophysis. Ultrasonography is a proven technique for the
detection of apophyseal injuries. In comparison to X-ray examination, it
has the advantages of no radiation exposure, early detection even without
ossification center, and dynamic examination.
Publication Type
Journal Article.
Entry Date
19960919. Revision Date: 20001218. Update Date: 20020107.
<19>
Database
Current Contents/All Editions
Accession Number
TV612-0001
Authors
Gomez JE.
Title
BILATERAL ANTERIOR INFERIOR ILIAC SPINE AVULSION FRACTURES
Source
Medicine & Science in Sports & Exercise. 28(2):161-164, 1996 Feb.
Abstract
A case of bilateral groin pain of sudden onset in a 14-yr-old boy is
presented. The patient reported sudden onset of pain in both inguinal
regions during a 100-m dash. He presented a week later to the clinic
where physical examination revealed a shuffling gait, bilateral hip
flexion contractures, limited active and passive hip extension, and
bilateral weakness of hip flexion and knee extension. Plain radiographs
of the pelvis revealed avulsion fragments minimally displaced from both
anterior inferior iliac spines (AIIS). Pain relief in the acute phase was
achieved by limiting ambulation until weight bearing was painless. The
patient was treated conservatively and returned to full speed running in
10 wk. Only one case of bilateral AIIS avulsion fractures has previously
been reported. AIIS avulsion fractures that are not widely displaced may
be treated conservatively. Following a careful program of rehabilitation,
full functional recovery following AIIS avulsion fractures may be
achieved in 3-6 wk. [References: 29]
Publication Type
Article
Institution
Reprint available from:
Gomez JE
UNIV TEXAS
HLTH SCI CTR
DEPT PEDIAT
SPORTS & ADOLESCENT CLIN
7703 FLOYD CURL DR
SAN ANTONIO, TX 78284
USA
<20>
Database
MEDLINE
Unique Identifier
11770088
Medline Identifier
21620218
Authors
Muscato M. Lim-Dunham J. Demos TC. Lomasney LM.
Institution
Department of Radiology, Loyola University Medical Center, Maywood, Ill
60153, USA.
Title
Avulsion fracture of the apophysis of the ischial tuberosity.
Source
Orthopedics. 24(12):1127, 1198-200, 2001 Dec.
Publication Type
Journal Article.
Entry Date
20020307.
Update Date: 20020308.
<21>
Database
Current Contents/All Editions
Accession Number
390HV-0006
Authors
Browning KH.
Title
Hip and pelvis injuries in runners - Careful evaluation and tailored
management [Review]
Source
Physician & Sportsmedicine. 29(1):23-+, 2001 Jan.
Abstract
Injuries to the hip and pelvis make up a small but significant
proportion of painful conditions in runners. Most of these injuries are
due to overuse and some, such as femoral neck stress fracture, may
involve significant morbidity. Apophyseal injuries are becoming more
prevalent and should be considered in the skeletally immature athlete.
Stress fractures and soft-tissue injuries occur in all age-groups, often
because of excessive mechanical stress without adequate recovery periods.
A systematic approach to evaluation and treatment-combined with knowledge
of indications for surgical referral, training principles, and shoe-wear
patterns-allows the physician to individualize the athlete's
rehabilitation and return to running, and to help the athlete prevent reinjury. [References: 27]
Publication Type
Review
Institution
Reprint available from:
Browning KH
USHC Phys Inc
1611 S Green Rd,Ste 260
S Euclid, OH 44122
USA
Case Western Reserve Univ, Dept Med
Cleveland, OH 44106
USA
<22>
Database
MEDLINE
Unique Identifier
10336196
Medline Identifier
99267238
Authors
Stevens MA. El-Khoury GY.
Institution
Kathol MH.
Brandser EA.
Chow S.
Department of Radiology, University of Iowa Hospitals and Clinics, Iowa
City 52242, USA.
Title
Imaging features of avulsion injuries.
Source
Radiographics. 19(3):655-72, 1999 May-Jun.
Abstract
Avulsion injuries are common among participants in organized sports,
especially among adolescent participants. Imaging features of both acute
and chronic avulsion injuries of the pelvis, knee, ankle and foot,
shoulder, and elbow were evaluated to help distinguish these injuries
from more serious disease processes such as neoplasm and infection. At
radiography, acute injuries (ie, those resulting from extreme,
unbalanced, often eccentric muscular contractions) may be associated with
avulsed bone fragments, whereas subacute injuries have an aggressive
appearance that may include areas of mixed lysis and sclerosis. Chronic
injuries (ie, those resulting from repetitive microtrauma or overuse) or
old inactive injuries may be associated with a protuberant mass of bone
and may bear a striking resemblance to a neoplastic or infectious
process. Although not usually required, computed tomography is helpful in
the diagnosis if radiographic findings are equivocal or if the injury is
not in the acute phase. MR imaging is best suited for the evaluation of
injuries to muscles, tendons, and ligaments. Recognition of
characteristic imaging features and familiarity with musculotendinous
anatomy will aid in accurate diagnosis of avulsion injuries.
Publication Type
Journal Article.
Entry Date
19990702. Revision Date: 20001218. Update Date: 20020107.
<23>
Database
Current Contents/All Editions
Accession Number
XA591-0013
Authors
Elkhoury GY. Daniel WW. Kathol MH.
Title
ACUTE AND CHRONIC AVULSIVE INJURIES
Source
Radiologic Clinics of North America. 35(3):747 ff., 1997 May.
Abstract
Avulsive injuries are common traumatic lesions, especially in young
athletes. They can be acute, resulting from excessive tensile forces, or
chronic, due to overuse. Avulsion injuries can resemble osteomyelitis or
neoplasm and, therefore, familiarity with the radiographic patterns as
well as the different muscle attachments is helpful for the clinician to
arrive at the correct diagnosis. This article discusses acute and chronic
avulsive injuries in the pelvis, knee, elbow, shoulder, and foot.
[References: 42]
Publication Type
Article
Institution
Reprint available from:
Elkhoury GY
UNIV IOWA HOSP & CLIN
DEPT RADIOL
200 HAWKINS DR
IOWA CITY, IA 52242
USA
UNIV
COLL
DEPT
IOWA
USA
IOWA
MED
RADIOL
CITY, IA 52242
<24>
Database
MEDLINE
Unique Identifier
8191306
Medline Identifier
94248774
Authors
Sundar M. Carty H.
Institution
Department of Orthopaedics, Royal Liverpool Children's NHS Trust, UK.
Title
Avulsion fractures of the pelvis in children: a report of 32 fractures
and their outcome.
Source
Skeletal Radiology. 23(2):85-90, 1994 Feb.
Abstract
Avulsion injuries of the apophyses of the pelvis are mainly athletic
injuries and are usually seen in adolescents. In a series of 80 pelvic
fractures in children seen and managed in The Royal Liverpool Children's
Hospital, Alder Hey, in the last 10 years, 32 avulsion fractures in 25
patients were diagnosed and treated. Twenty-two of these patients were
followed for an average of 44 months (range 4-120 months). Eight (33%)
were girls, a higher proportion than in other published series. The
average age of the children was 13.8 years. These fractures, though
generally regarded as trivial injuries, have left disability persisting
into adult life, with limitation of sporting ability in 10 of the 22
patients and persistent symptoms in 6, mostly in those with ischial
avulsion injuries. Fourteen patients with acute injuries needed
hospitalisation, with an average stay of 5 days. The other 11 were
suffering from chronic traction injuries sustained in sport. This
distinction between acute and chronic injuries has not been emphasized in
the other reviews. The radiological appearances, diagnostic problems and
morbidity are discussed in order to increase awareness of these injuries.
Publication Type
Journal Article.
Entry Date
19940620. Revision Date: 20001218. Update Date: 20020107.
<25>
Database
MEDLINE
Unique Identifier
3969580
Medline Identifier
85115464
Authors
Khoury MB. Kirks DR. Martinez S. Apple J.
Title
Bilateral avulsion fractures of the anterior superior iliac spines in
sprinters.
Source
Skeletal Radiology. 13(1):65-7, 1985.
Abstract
Three cases of bilateral pelvic avulsion fractures in adolescent
sprinters are reviewed. An-acute avulsion fracture of the anterior
superior iliac spine (ASIS) occurred during active running in three
teenaged sprinters. Radiography confirmed a healed fracture of the
contralateral ASIS. The clinical features and radiologic appearances are
characteristic. The pathophysiology of this type of unique pediatric
fracture is discussed. Conservative treatment is successful.
Publication Type
Journal Article.
Entry Date
19850319. Revision Date: 20001218. Update Date: 20020107.
<26>
Database
MEDLINE
Unique Identifier
11357449
Medline Identifier
21257101
Authors
Rossi F. Dragoni S.
Institution
Sports Science Institute, Via dei Campi Sportivi, 46, 00197 Rome,
Italy.
Title
Acute avulsion fractures of the pelvis in adolescent competitive
athletes: prevalence, location and sports distribution of 203 cases
collected.
Source
Skeletal Radiology. 30(3):127-31, 2001 Mar.
Abstract
OBJECTIVE: To describe the prevalence, location and sports distribution
of pelvic avulsion fractures in adolescent competitive athletes. DESIGN
AND PATIENTS: One thousand two hundred and thirty-eight radiographs of
the pelvis taken for focal traumatic symptoms in athletes with an age
range of 11-35 years over a period of 22 years were reviewed. RESULTS:
One hundred and ninety-eight adolescent athletes were affected by 203
avulsion fractures of the pelvic apophyses (five cases presented multiple
locations). The localisation was the ischial tuberosity (IT) in 109
cases, anterior inferior iliac spine (AIIS) in 45 cases, anterior
superior iliac spine (ASIS) in 39 cases, superior corner of pubic
symphysis (SCPS) in 7 cases and iliac crest (IC) in 3 cases. Soccer (74
cases) and gymnastics (55 cases) were the sports with the highest number
of avulsion fractures documented. CONCLUSIONS: Apophyseal avulsion
fractures of the pelvis in adolescent competitive athletes are most
common in soccer and gymnastics. The lesions are usually the consequence
of sudden and forceful muscle-tendon contractions during sport
activities. Plain radiographs, are determinant for the diagnosis.
Publication Type
Journal Article.
Entry Date
20010927. Update Date: 20020107.
<27>
Database
MEDLINE
Unique Identifier
9453104
Medline Identifier
98115194
Authors
Major NM. Helms CA.
Institution
Department of Radiology, Duke University Medical Center, Durham, NC
27710, USA.
Title
Pelvic stress injuries: the relationship between osteitis pubis
(symphysis pubis stress injury) and sacroiliac abnormalities in athletes.
Source
Skeletal Radiology. 26(12):711-7, 1997 Dec.
Abstract
OBJECTIVE: To demonstrate with radiographic imaging the association
between pubic stress injury and sacroiliac abnormalities in athletes.
DESIGN AND PATIENTS: Eleven athletes (9 men and 2 women), comprising
seven male long-distance runners, one male soccer player, one male and
two female basketball players, were imaged with plain films for
complaints of pubic symphysis pain, sciatica, groin pain, or a
combination of these complaints. In addition to the plain films, four
patients were imaged with CT, two patients had MR imaging, and a bone
scan was performed in three patients. Anteroposterior plain films of the
pelvis of 20 patients without back pain or pubic pain were evaluated for
comparison as a control group (ages 18-72 years, average 49 years; 11
women and 9 men). RESULTS: All athletes showed plain film evidence of
either sclerosis, erosions or offset at the pubic symphysis. Four had
avulsion of cortical bone at the site of insertion of the gracilis
tendon. Four patients demonstrated sacroiliac joint abnormalities on
plain films consisting of sclerosis, erosions and osteophytes, and in one
of these athletes, bilateral sacroiliac changes are present. Two patients
with normal sacroiliac joints on plain films had a bone scan showing
increased radionuclide uptake bilaterally at the sacroiliac joints. One
patient with both plain film and CT evidence of sacroiliac abnormalities
had an MR examination showing abnormal signal at both sacroiliac joints
and at the pubic symphysis. A sacral stress fracture was found on CT in
one patient with complaints of sciatica. In the control group, six
patients, all over the age of 55 years, had mild sclerosis of the
symphysis, but no plain film evidence of sacroiliac abnormalities.
CONCLUSION: We have found a group of athletes in whom stress injuries to
the pubic symphysis are associated with changes in the sacroiliac joint
as demonstrated by degenerative changes or in the sacrum as manifested as
a sacral stress fracture. These findings are probably due to abnormal
stresses across the pelvic ring structure that lead to a second
abnormality in the pelvic ring. The abnormality in the sacrum is not
always well seen with conventional imaging. Recognition of the
association of stress injury of the symphysis with back pain is important
in that it can help avoid inappropriate studies and diagnostic confusion.
Publication Type
Journal Article.
Entry Date
19980309. Revision Date: 20001218. Update Date: 20020107.
<28>
Database
MEDLINE
Unique Identifier
10492031
Medline Identifier
99419780
Authors
Lynch SA. Renstrom PA.
Institution
Department of Orthopaedics, Penn State University, Hershey Medical
Center, Pennsylvania, USA.
Title
Groin injuries in sport: treatment strategies.
Source
Sports Medicine. 28(2):137-44, 1999 Aug.
Abstract
Groin pain in athletes is a common problem that can result in
significant amounts of missed playing time. Many of the problems are
related to the musculoskeletal system, but care must be taken not to
overlook other more serious and potentially life threatening medical
cases of pelvis and groin pain. Stress fractures of the bones of the
pelvis occur, particularly after a sudden increase in the intensity of
training. Most of these stress fractures will heal with rest, but femoral
neck stress fractures can potentially lead to more serious problems, and
require closer evaluation and sometimes surgical treatment. Avulsion
fractures of the apophyses occur through the relatively weaker growth
plate in adolescents. Most of these will heal with a graduated physical
therapy programme and do not need surgery. Osteitis pubis is
characterised by sclerosis and bony changes about the pubic symphysis.
This is a self-limiting disease that can take several months to resolve.
Corticosteroid injection can sometimes hasten the rehabilitation process.
Sports hernias can cause prolonged groin pain, and provide a difficult
diagnostic dilemma. In athletes with prolonged groin pain, with increased
pain during valsalva manoeuvres and tenderness along the posterior
inguinal wall and external canal, an insidious sports hernia should be
considered. In cases of true sports hernia, treatment is by surgical
reinforcement of the inguinal wall. Nerve compression can occur to the
nerves supplying the groin. In cases that do not respond to
desensitisation measures, neurolysis can relieve the pain. Adductor
strains are common problems in kicking sports such as soccer. The
majority of these are incomplete muscle tendon tears that occur just
adjacent to, the musculotendinous junction. Most of these will respond to
a graduated stretching and strengthening programme, but these can
sometimes take a long time to completely heal. Patience is the key to
obtain complete healing, because a return to sports too early can lead to
chronic pain, which becomes increasingly difficult to treat. Management
of groin injuries can be challenging, and diagnosis can be difficult
because of the degree of overlap of symptoms between the different
problems. By careful history and clinical examination, with judicious use
of special tests and good team work, a correct diagnosis can be obtained.
Publication Type
Journal Article.
Entry Date
19991021. Revision Date: 20001218. Update Date: 20020107.