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MoMortazavi,MD (520)222-8076 www.sparcctucson.com ApophysitisandAvulsionFractures APOPHYSITIS Whatisapophysitis? Anapophysisisasecondarygrowthcenteronboneswheremusclesattach.Thesegrowthcentersaremadeof cartilagethatisgrowingintobone,andthusarefragileandvulnerabletorecurrenttractionforcesfrom overuseoftightpowerfulmusclesthatattachthere.Recurrenttractionforcescanultimatelycreate inflammation,edema,andcartilagebreakdownintheapophysis,whichcreatespainwithactivityinvolvingthe apophysis.Thisiscalledapophysitisandcanresultinanavulsionfractureifnottreated. Whatarethesymptoms? Symptomsofapophysitismayvaryforeachperson,someoftheseinclude: § Painandsometimesmildswellingatthesiteofapophysitis. § Worseningpainwithuseofinvolvedapophysisandattachedmuscle. § Paininitiallyafteractivity,thenduringandafteractivityasconditionprogresses. Howdoyoudiagnoseit? Thisisaclinicaldiagnosisthatyourdoctormakesbasedonthehistoryandexam.X-raymaybeneededto checkforanabnormalapophysisoravulsioninjury.Sometimes,MRIorCTscanmaybeorderedtoestablish diagnosis,howeverthesestudiesareusuallynotneeded. Howisittreated? Usuallyapophysitisistreatedwithacombinationofaperiodofrestfromaggravatingactivityfollowedby physicaltherapy.Completehealingusuallytakes4-8weeksdependingofstageofprogression.Physical therapyisfocusedonflexibility,optimalbiomechanics,strengthandfunctionofthebodypartonceenough healinghastakenplace. AVULSIONFRACTURES Whatisanavulsionfracture? Anavulsionfractureisacommontypeoffractureinwhichafragmentofboneispulledawayfromtherestof thebonebyatendonorligament.Thesefracturesoccurwhenalargeamountofforceisplacedonatendon orligamentand,insteadoftearing,itpullsawayfromthebonetakingapieceofbonewithit.Ingrowing childrenandadolescents,ligamentsandtendonsareoftenstrongerthanthesurroundingbone,causingalittle ofthebonetobepulledawayatitsweakestpoint.Avulsionfracturesoccurcommonlyinthefingersandtoes but,inyoungathletes,theycanalsooccurinthepelvis,elbowandfootwheretendonsattachtogrowth centers.Thesegrowthcentersaremadeofweaker,softercartilageandcanbepulledawayduringaforceful contractionofthemuscle. Whatarethesignsandsymptoms? Symptomsofavulsionfracturemayvaryforeachperson,someoftheseinclude: § Painandswellingatthesiteofinjury.Bruisingmayappearafewdaysafter. § Strongpainthatdoesnotgoawayfollowingasudden,forcefulinjury. § Unwillingnesstousetheinjuredjointorextremity. § Apopmaybeheardorfeltatthetimeofinjury. Howdoyoudiagnoseit? Likemostfractures,theonlywaytotrulydiagnoseanavulsionfractureiswithanx-ray.Yourdoctorwillorder severalviewsoftheareatodetermineifanyfractureispresent.Anavulsionfracturewillappearasasmall fleckofbonerestingnexttothelargerbonefromwhichithasbeenpulled.Sometimes,anMRIorCTscanmay beorderedtofurtherchecktheinjury,howeveradditionalstudiesarenotoftenneeded. Howisittreated? Careofanavulsionfracturedependsonthesizeofthepiecethathasbeenpulledoffandhowfarawayfrom theboneithasbeenpulledaway.Mostavulsionfracturescanbetreatedwithoutsurgerywithrest,painand swellingcontrolandbracingorsplinting.Thesefracturesusuallydonotrequireacast,butkeepingthebody partimmobilizedandprotectediskeytoproperhealing.Insomerarecases,surgerymaybeneededtoplace thebonebackincorrectalignmentuntilenoughhealinghasoccurred.Completehealingcantake4-8weeks. Yourdoctormayorderphysicaltherapytohelpgetbackmotion,strengthandfunctionofthebodypartonce enoughhealinghastakenplace. References: Children’sHospitalColoradoSportsMedicineProgramforyoungathletes AmericanAcademyofPediatrics AmericanMedicalSocietyofSportsMedicine
