Treatment of pelvic avulsion fractures in children and adolescents

Česká verze

Authors: A. Stančák; J. Kautzner; T. Trč; V. Havlas
Authors place of work: Klinika dětské a dospělé ortopedie a traumatologie 2. LF Univerzity Karlovy a FN Motol, Praha přednosta: prof. MUDr. T. Trč, CSc., MBA
Published in the journal: Rozhl. Chir., 2017, roč. 96, č. 4, s. 156-162.
Category: Původní práce

Úvod:
Avulzní zlomeniny jsou u dětí a dospívajících vzácné úrazy vznikající následkem prudké kontrakce svalového úponu příslušného výběžku pánve, který je u rostoucího skeletu jeho nejslabší komponentou. Léčba avulzních zlomenin může být konzervativní nebo operační.

Summary

Introduction:
Paediatric avulsion fractures of the pelvis and hip joint are rare injuries most commonly associated with a rapid muscle contraction of the respected apophysis, which is the weakest component of the growing skeleton. The chosen therapy option can be either conservative or surgical.

Methods:
We present a cohort of 69 patients treated for an apophyseal avulsion fracture of the anterior superior / inferior iliac spine, the lesser and greater trochanters iliac crest and the ischial tubercle. We compared the treatment outcomes, treatment time, need for immobilisation, and complications of conservative vs. surgical treatment.

Results:
The mean time to mobilisation was 24.5 days in the conservative and 8.5 days in the surgical group of patients. In the group of surgically treated patients, healing signs were observed as early as in week 6. As of month 4, no difference was observed between the groups in terms of the clinical and radiological outcomes.

Conclusions:
The treatment outcomes of both methods are comparable in the long term. Surgery is indicated in dislocations exceeding 1 cm. Faster recovery and return to sports activities is the main advantage of the surgical treatment method. Disadvantages include the necessity of general anaesthesia as well as the risk of infection and the need of the osteosynthetic material removal. The choice of the treatment method remains individual depending on the type of injury and habitual practice of the centre.

Key words:
avulsion fracture – child – pelvis – treatment – outcome

Zdroje

1. Aksoy E, Uludag M, Ozbayarak M, et al. Anterior inferior iliac spine avulsion fracture. Am J Phys Med Rehabil 2014;93:1018.

2. Havlas V, Gaheer RS, Trc T, et al. Simultaneous bilateral avulsion fracture of the anterior superior iliac spine in a young athlete. Injury Extra 2007;38:352–5.

3. Mckinney BI, Nelson C, Carrion W. Apophyseal avulsion fractures of the hip and pelvis. Orthopedics 2009;32:42.

4. Oldenburg FP, Smith MV, Thompson GH. Simultaneous ipsilateral avulsion of the anterior superior and anterior inferior iliac spines in an adolescent. J Pediatr Orthop 2009;29:29–30.

5. Rajasekhar C, Kumar KS, Bjamra MS. Avulsion fractures of the anterior inferior iliac spine: the case for surgical intervention. Int Orthop 2001;24:364–5.

6. Rosenberg N, Noiman M, Edelson G. Avulsions fractures of the anterior superior iliac spine in adolescents. J Orthop Trauma 1996;10:440–3.

7. Rossi F, Dragoni S. Acute avulsion fractures of the pelvis in adolescent competitive athletes: prevalence, location and sports distribution of 203 cases collected. Skeletal Radiol 2001;30:127–31.

8. Schröter F. Aspects of expert opinions of avulsion fractures. Orthopade 2016;45:242–8.

9. Bendeddouche I, Jean-Luc B, Poiradeau S, et al. Anterior superior iliac spine avulsion in a young soccer player. Ann Phys Rehabil Med 2010; 53:584–90.

10. Moeller JL. Pelvic and hip apophyseal avulsion injuries in young athletes. Curr Sports Med Rep 2003;2:110–5.

11. Stančák A, Kautzner J, Havlas V. Porovnání výsledků konzervativní a operační léčby zlomenin spina iliaca anterior superior a spina iliaca anterior inferior u dětí a dospívajících. Acta Chir orthop Traum čech 2016;83:38–42.

12. Uzun M, Alpan B, Ozger H. Avulsion fractures involving the straight and reflected heads of the rectus femoris. Hip Int 2014;24:206–9.

13. Naylor JA, Goffar SL, Chugg J. Avulsion fracture of the anterior superior iliac spine. J Orthop Sports Phys Ther 2013;43:195.

14. Reina N, Accadbled F, De Gauzy JS. Anterior inferior iliac spine avulsion fracture: a case report in soccer playing adolescent twins. J Pediatr Orthop B 2010;19:158–60.

15. Frank M, Dědek T. Operační léčba avulze apofýzy sedacího hrbolu – kazuistika. Acta Chir orthop Traum čech 2014;81,292–4.

16. Schuett DJ, Bomar JD, Pennock AT. Pelvic apophyseal avulsion fractures: A retrospective review of 228 cases. J Pediatr Orthop 2015;35:617–23.

17. Linni K, Mayr J, Höllwarth ME. Apophyseal fractures of the pelvis and trochanter minor in 20 adolescents and 2 young children. Unfallchirurg 2000;103:961–4.

18. Dhinsa BS, Jalgaonkar A, Mann B, et al. Avulsion fracture of the anterior superior iliac spine: misdiagnosis of a bone tumour. J Orthop Traumatol 2011;12:173–6.

19. Mortati RB, Borghi Mortati L, Silva Teixeira M, et al. Avulsion fracture of the iliac crest in a child. Rev Bras Ortop 2014;49:309–12.

20. Tchanikachalam M, Petros JG, O’Donell S. Avulsion fracture of anterior superior iliac spine presenting as acute-onset meralgia paresthetica. Ann Emerg Med 1995;26:515–7.

21. Pointinger H, Munk P, Poeschl GB. Avulsion fracture of the anterior superior iliac spine following apophysitis. Br J Sports Med 2003;37:361–2.