In this article, we will discuss hip impingement after a tear fracture of the inferior anterior iliac spine.
A split fracture of the inferior anterior iliac spine is a well-known condition that occurs mainly in soccer players, but it is not a frequent fracture.
However, it is not a frequent fracture. I have only seen one case, so I would like to study the outcome of the case I am going to introduce. I have only seen one case, so let's learn what the outcome was in this case.
What is a cleavage fracture of the inferior anterior iliac spine?
Avulsion fractures of the pelvis in adolescents are well known, but are considered to be rare in incidence.
High-risk sports and characteristics include adolescent soccer players, track and field athletes, gymnasts, and tennis players.
The location of the avulsion depends on the nature of the sport, but soccer players are at higher risk for avulsion fractures of the inferior anterior iliac spine (AIIS) due to the powerful contraction of the rectus femoris muscle during hip flexion and knee extension during kicking.
In fact, approximately 50% of AIIS avulsion fractures are caused by the shooting motion.
These fractures can be difficult to diagnose because they are often not visible on standard pelvic X-rays and require a high degree of clinical suspicion.
Cases
A 15-year-old male with right hip pain and hip motion.
He came to our hospital complaining of right hip pain and decreased range of motion of the hip joint.
He recalled his injury 18 months ago when he was playing in a soccer game, and detailed counseling was given on the mechanism of injury at that time.
He felt a muscle pull at the base of his right leg and stopped playing but resumed playing after a 10-minute break.The pain persisted, and he apparently stopped playing that day.
The following year he noticed that squatting and kicking made it difficult for him to flex his hip joint, which in turn increased his pain.
Eighteen months after his initial injury, he went to the hospital for an examination.
On physical examination, there was a large mass in his right groin area and hip flexion was limited to 70 degrees on the affected side compared to 120 degrees on the opposite side.And the external rotation angle on the affected side was 0° degree, while the internal rotation angle was 40° degree.
Radiographic imaging was remarkable for a large ectopic bone mass of the AIIS extending 117 mm distal to the AIIS with a maximum lateral distance of 64 mm.
Computed tomography (CT) images were obtained, confirming the suspected diagnosis of an AIIS avulsion fracture with a bone "mass" of 117 mm x 65 mm.
(and 3). The patient failed 6 months of conservative treatment including physical therapy, activity modification, and non-steroidal anti-inflammatory drugs (NSAIDs).
Therefore, surgical treatment for resection of the mass was to be performed.
The operating room took the form of removing the heterotopic ossification through an anterior Smith-Peterson approach to the hip joint.
A large portion of the origin of the rectus femoris muscle was found to still be attached to the distal aspect of the mass and was detached and tenodesed.
Postoperatively, the patient was placed on indomethacin for one month and returned to competition at the two-month follow-up.
At the 1-year follow-up, postoperative radiographs showed no new bone deposits, and at the 2-year follow-up, the patient had 120 degrees of hip flexion and full internal and external range of motion.
During this course, the patient rated her pain as 0/10 at the 2-month, 12-month, and 24-month postoperative visits.
Lambrechts MJ, Gray AD, Hoernschemeyer DG, Gupta SK. Hip Impingement after Anterior Inferior Iliac Spine Avulsion Fractures: A Case Report with Review of the Literature. Review of the Literature. Case Rep Orthop. 2020;2020:8893062. published 2020 Oct 20. doi:10.1155/2020/8893062
Conclusion
This was a rare case of impingement in addition to the syndrome.
First of all, I felt from the text that conservative treatment would not be suitable, but as a matter of fact, I have heard of one case with a similar problem that was treated conservatively.
However, as a matter of reality, I have heard of one similar case where the patient was treated conservatively, and even though he was able to return to competition, he was not able to exercise satisfactorily and retired.
Consent can be difficult to obtain, and depending on how the medical professional talks about it, it can take a turn that the patient does not want.
I want to be able to make the right decision.
