Case report of combined iliac crest and ASIS apophysis avulsion fracture in an adolescent footballer
A 15-year-old boy presented to our emergency department unable to weight-bear and complaining of severe right hip pain following a non-contact injury while playing football. He described a sudden onset of right hip and groin pain when he over-stretched for a ball with his right leg; his trunk rotated, hip flexed, knee fully extended and his foot internally rotated. He was unable to mobilize or weight-bear and required an ambulance to present to our institution. On physical examination, he had pain on all hip movements with limited hip flexion and internal rotation. There was bony tenderness on palpation along the anterior aspect of the hip and IC. Sensation within the dermatome of the lateral cutaneous femoral nerve (LCFN) was intact.\nThe anterior–posterior plain film X-Ray of pelvis demonstrated an avulsion fracture of the right ASIS and IC apophysis with 1.5 cm displacement (). Lateral view of the hip showed no extension into the joint. There was no radiological evidence of chronic overuse or previous injury. Computed tomography (CT) imaging was performed to better identify the injury; 3D volume reconstruction clearly demonstrated the unique fracture pattern of an ASIS avulsion in addition to an avulsion of the distal iliac apophysis extending ~5 cm with the described displacement (–).\nAfter discussion of the surgical risks of fixation, including hardware irritation and LCFN dysfunction, a shared decision to treat the patient conservatively was reached. The patient was instructed to mobilize with crutches and attempt weight-bearing as comfort allowed. At a 4-week follow-up review, the patient presented with complete resolution of symptoms, full active hip range of motion, nil palpable tenderness and the ability to mobilize independently without walking aids. Radiographs performed showed significant callous formation between the pelvis and the fragment (). Return to sport was achieved by 8 weeks as per medical advice following a period of closed-chain exercises and self-directed rehabilitation.