Avulsion Fracture of the Anterior Superior Iliac Spine

Description

Avulsion fractures of the anterior superior iliac spine (ASIS) are separations of bone resulting from pulls of muscle–tendon units. These may occur in fully grown athletes, although in the pelvis, they tend to occur more commonly in skeletally immature (growing) athletes. This is due to the relative weakness of the growth plate compared with the bone, muscle, and tendon. Injury to the growth plate commonly occurs with repeated stress or vigorous exercise, and an avulsion in the growing athlete is thus a separation of bone at the growth plate (a similar injury in adults is a muscle–tendon strain). Because the pelvic growth plates close at skeletal maturity, avulsion fracture of the ASIS is uncommon in persons who are fully grown.

The ASIS is the attachment of the sartorius, a thigh muscle that is important in bending the hip and knee.

Common signs and symptoms

• A slightly swollen, warm, and tender area of the pelvis where the bone pulled off

• Pain with activity, especially when stretching the muscle or having to contract the muscle to perform its function, such as forceful bending of the hip or knee or stretching the thigh muscles by straightening the hip and knee

• Pain with walking, often walking with a limp

• A popping sound in the area at the time of injury

• Crepitation (a crackling sound) when the area is touched

• Bruising in the thigh 48 hours after the injury

• Weakness when bending the hip

Causes

Avulsion fracture of the ASIS is caused by a powerful contraction of the sartorius muscle, such as with jumping and running sports, with force exceeding the strength of the growth plate.

Factors that increase risk

• Sports that require jumping, such as basketball, volleyball, or high or long jumps

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