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Lower Extremity Avulsion Fractures in the Pediatric and Adolescent Athlete

Schiller, Jonathan MD; DeFroda, Steven MD, ME; Blood, Travis MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: April 2017 - Volume 25 - Issue 4 - p 251–259
doi: 10.5435/JAAOS-D-15-00328
Review Article

Lower extremity avulsion fractures are uncommon in the pediatric population and can be misdiagnosed without proper imaging and/or clinical suspicion for these injuries. The most common locations of avulsion injuries are the ischial tuberosity, anterior superior iliac spine, and anterior inferior iliac spine. Less often, avulsion fractures occur in the tibial tubercle, calcaneus, and greater and lesser trochanters. When treated properly with rest and altered weight bearing, most of these injuries heal without complication. Although surgical intervention is rarely necessary, it has a high degree of success when it is used. However, avulsion injuries are often misdiagnosed as muscle strains or apophysitis and are mistakenly treated with early range of motion. An error in diagnosis and/or management can cause nonunion or further displacement, which may require surgery. Improper identification of these injuries can also lead to nerve irritation, chronic pain, and gait dysfunction. Awareness of these injuries and their natural history is important because healed avulsion fractures may resemble neoplastic bone on radiographs.

From the Department of Orthopaedics, The Warren Alpert Medical School of Brown University, Providence, RI.

Dr. Schiller or an immediate family member serves as a paid consultant to DePuy Synthes. Neither of the following authors nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. DeFroda and Dr. Blood.

Received June 28, 2015

Accepted May 27, 2016

© 2017 by American Academy of Orthopaedic Surgeons
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