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Chen ZR, Liao SJ, Yang FC. Surgical treatment of an old avulsion fracture of the ischial tuberosity and ischial ramus: A case report. World J Orthop 2024; 15:94-100. [PMID: 38293263 PMCID: PMC10824063 DOI: 10.5312/wjo.v15.i1.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/21/2023] [Accepted: 12/21/2023] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND Avulsion fracture of the ischial tuberosity is a relatively clinically rare type of trauma that is mainly incurred by adolescents during competitive sports activities. According to previous literature, the most commonly involved sports are soccer, sprinting, and gymnastics, in descending order. Dance-induced avulsion fracture of the ischial tuberosity and ischial ramus is extremely clinically rare. CASE SUMMARY A case of a neglected avulsion fracture of the ischial tuberosity and ischial ramus was diagnosed in a young female dancer who complained of pain and restricted movement of her right hip. She stated that she had suffered the injury while performing a split leap during a dance performance 9 mo prior. Eventually, she underwent surgery and obtained satisfactory treatment results. CONCLUSION Early diagnosis of these fractures is important to ensuring early proper treatment towards a quicker recovery. For old fractures with nonunion and chronic buttock pain, surgery is a preferred therapeutic choice with good treatment outcomes.
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Affiliation(s)
- Zi-Ru Chen
- Department of Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Shi-Jie Liao
- Department of Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Fu-Chun Yang
- Department of Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
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Baal JD, Cecil KL, Patel R, O'Brien M, McGill K, Link TM. Imaging of Overuse Injuries of the Hip. Radiol Clin North Am 2023; 61:191-201. [PMID: 36739141 DOI: 10.1016/j.rcl.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Overuse injuries of the hip are common, and clinical diagnosis may be difficult because of overlapping and nonspecific clinical symptoms. Imaging can play an essential role in guiding diagnosis and management. Femoroacetabular joint structural abnormalities result in various conditions that can predispose patients to early development of osteoarthritis. Repetitive stress on the skeletally immature hip can result in apophyseal injuries. Notable nonosseous overuse hip pathologies include athletic pubalgia, trochanteric bursitis, and injuries involving the iliopsoas myotendinous unit. Timely diagnosis of overuse injuries of the hip can facilitate improved response to conservative measures and prevent irreversible damage.
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Affiliation(s)
- Joe D Baal
- Department of Radiology and Biomedical Imaging, University of California, 400 Parnassus Avenue, Box 0628, San Francisco, CA 94143, USA
| | - Katherine L Cecil
- Department of Radiology and Biomedical Imaging, University of California, 400 Parnassus Avenue, Box 0628, San Francisco, CA 94143, USA
| | - Rina Patel
- Department of Radiology and Biomedical Imaging, University of California, 400 Parnassus Avenue, Box 0628, San Francisco, CA 94143, USA
| | - Matthew O'Brien
- Diagnostic Radiology, Oregon Health & Science University, L340, 3181 SW Sam Jackson Park Road Portland, OR 97239, USA
| | - Kevin McGill
- Department of Radiology and Biomedical Imaging, University of California, 400 Parnassus Avenue, Box 0628, San Francisco, CA 94143, USA
| | - Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California, 400 Parnassus Avenue, Box 0628, San Francisco, CA 94143, USA.
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Schwarz-Bundy BD, Thater G, Appelhaus S, Schönberg SO, Weis M. [Sports injuries in children and adolescents]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:275-283. [PMID: 36811691 DOI: 10.1007/s00117-023-01123-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/19/2023] [Indexed: 02/24/2023]
Abstract
CLINICAL/METHODOLOGICAL ISSUE Due to active participation of children and adolescents in school sports as well as in club sports, sporting injuries in childhood are common. Because skeletal maturity is not yet complete, injury patterns in children differ from sporting injuries in adults. Knowledge of the pathophysiologic characteristics, as well as knowledge of typical injury sequelae, is of great relevance to radiologists. This review article therefore deals with common acute and chronic sporting injuries in children. STANDARD RADIOLOGICAL METHODS Basic diagnostic imaging comprises conventional X‑ray imaging in two planes. In addition, sonography, magnetic resonance imaging (MRI) and computed tomography (CT) are used. PRACTICAL RECOMMENDATIONS Close consultation with clinical colleagues and knowledge of childhood-specific injuries help identify sports-associated trauma sequelae.
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Affiliation(s)
- B D Schwarz-Bundy
- Klinik für Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Theodor Kutzer Ufer 1-3, 68167, Mannheim, Deutschland
| | - G Thater
- Klinik für Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Theodor Kutzer Ufer 1-3, 68167, Mannheim, Deutschland
| | - S Appelhaus
- Klinik für Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Theodor Kutzer Ufer 1-3, 68167, Mannheim, Deutschland
| | - S O Schönberg
- Klinik für Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Theodor Kutzer Ufer 1-3, 68167, Mannheim, Deutschland
| | - M Weis
- Klinik für Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Theodor Kutzer Ufer 1-3, 68167, Mannheim, Deutschland.
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Moore A, Sergent A. Chronic High Hamstring Tendinopathy and Sacroiliac Segmental Dysfunction in a Mature Tae Kwon Do Athlete: A Case Study. J Chiropr Med 2020; 18:317-320. [PMID: 32952477 DOI: 10.1016/j.jcm.2019.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 07/18/2019] [Accepted: 07/18/2019] [Indexed: 11/28/2022] Open
Abstract
Objective This case study describes conservative management of high hamstring tendinopathy in a master's-age tae kwon do athlete. Clinical Features A 53-year-old female tae kwon do athlete of 10 years presented after ceasing activities of performance for over a year owing to chronic pain of insidious onset in the left buttock with radiation to the left hip and posterior thigh. The patient's pain was preventing her from being able to perform regular activities of daily living such as brisk walking or sitting. The pain was registered as a 7/10 on the numeric pain scale. Radiographs of the lumbopelvic area were negative. Conservative treatment localized the pain to the left ischial tuberosity. Magnetic resonance imaging showed bilateral trochanteric bursitis and left hamstring tendinopathy. Intervention and Outcome Following conservative management with therapeutic ultrasound over the hamstring origin, manual sacroiliac manipulation, and rehabilitation, she had complete resolution of symptoms. Conclusion This patient had a combination of pain syndromes including chronic high hamstring tendinopathy and sacroiliac joint dysfunction. There are many other factors that must be taken into consideration, including repetitive trauma of tae kwon do, age, and sex, that play a role in tendon and ligament changes over time. This case demonstrates management of coconditions and comorbidities that can be used in not only the athletic population but many other populations.
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Affiliation(s)
| | - Adam Sergent
- Clinic Services, Palmer College of Chiropractic Florida, Port Orange, Florida
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Liu H, Zhang Y, Rang M, Li Q, Jiang Z, Xia J, Zhang M, Gu X, Zhao C. Avulsion Fractures of the Ischial Tuberosity: Progress of Injury, Mechanism, Clinical Manifestations, Imaging Examination, Diagnosis and Differential Diagnosis and Treatment. Med Sci Monit 2018; 24:9406-9412. [PMID: 30589058 PMCID: PMC6322373 DOI: 10.12659/msm.913799] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Avulsion fracture of the ischial tuberosity (AFIT) is a rare adolescent sports injury. At present, there is no consensus on its therapeutic paradigm, but conservative treatment appears to be the predominate choice. Furthermore, the degree of fracture displacement (DFD) remains as an important factor in determining whether AFIT needs internal fixation. The aim of the present study was to review and update the injury mechanism, clinical manifestations, imaging examination, diagnosis and differential diagnosis, and treatment of AFIT. A literature search was performed on a variety of databases using text words, and the results were limited to the English language. This review provides an important reference for the diagnosis and treatment of AFIT. AFIT can be easily misdiagnosed. Therefore, a detailed medical history and imaging examination are crucial for a correct diagnosis and differential diagnosis. For the choice of treatment of AFIT, it is necessary to consider not only the size of the fracture and DFD, but also the long-term functional needs of the patient.
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Affiliation(s)
- Heng Liu
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - Yiqun Zhang
- Department of Hand Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - Moujie Rang
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - Qiang Li
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - Zhaowei Jiang
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - Jidong Xia
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - Mingyi Zhang
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - Xuan Gu
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - Changfu Zhao
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China (mainland)
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Abstract
PURPOSE OF REVIEW Provide the reader with an evidence-based update on the importance of accurate diagnosis of commonly missed avulsion fractures of pelvis apophyses, the necessary imaging studies, the feared complications and the recent treatment recommendations. RECENT FINDINGS Accurate diagnosis of avulsion fractures of pelvis apophyses is high yield as misdiagnosis leads to improper treatment. They should be differentiated from muscle strain and apophysitis. These fractures are usually associated with good outcomes; however, missed diagnosis can lead to further displacement, nonunion, functional limitation, femoroacetabular impingement and infection. A/P and frog lateral pelvis radiograph show the fracture and its displacement in the majority of cases. Conservative treatment, consisting of a short period of rest and immobilization followed by passive stretching then progressive resisted activity before return to sports, is recommended in minimally displaced avulsions. Surgical treatment is favored in displaced fractures (>15 mm), as it is associated with quicker return to sports. SUMMARY Treating physicians should keep a high index of suspicion in pediatric and adolescent patients presenting with typical clinical exam findings. Pelvic Anteroposterior and frog leg radiographs are often diagnostic. Missed diagnosis can aggravate the prognosis of a usually benign condition. Adequate medical or surgical treatment should then be administered.
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Hegazi TM, Belair JA, McCarthy EJ, Roedl JB, Morrison WB. Sports Injuries about the Hip: What the Radiologist Should Know. Radiographics 2017; 36:1717-1745. [PMID: 27726744 DOI: 10.1148/rg.2016160012] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Injuries of the hip and surrounding structures represent a complex and commonly encountered scenario in athletes, with improper diagnosis serving as a cause of delayed return to play or progression to a more serious injury. As such, radiologists play an essential role in guiding management of athletic injuries. Familiarity with hip anatomy and the advantages and limitations of various imaging modalities is of paramount importance for accurate and timely diagnosis. Magnetic resonance (MR) imaging is often the modality of choice for evaluating many of the injuries discussed, although preliminary evaluation with conventional radiography and use of other imaging modalities such as ultrasonography (US), computed tomography, and bone scintigraphy may be supplementary or preferred in certain situations. Stress fractures, thigh splints, and posterior hip dislocations are important structural injuries to consider in the athlete, initially imaged with radiographs and often best diagnosed with MR imaging. Apophyseal injuries are particularly important to consider in young athletes and may be acute or related to chronic repetitive microtrauma. Femoroacetabular impingement has been implicated in development of labral tears and cartilage abnormalities. Tear of the ligamentum teres is now recognized as a potential cause of hip pain and instability, best evaluated with MR arthrography. Greater trochanteric pain syndrome encompasses a group of conditions leading to lateral hip pain, with US playing an increasingly important role for both evaluation and image-guided treatment. Muscle injuries and athletic pubalgia are common in athletes. Lastly, snapping hip syndrome and Morel-Lavallée lesions are two less common but nonetheless important considerations. ©RSNA, 2016.
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Affiliation(s)
- Tarek M Hegazi
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, 1079A Main Building, Philadelphia, PA 19107 (T.M.H., J.A.B., E.J.M., J.B.R., W.B.M.); and Department of Radiology, University of Dammam, Dammam, Saudi Arabia (T.M.H.)
| | - Jeffrey A Belair
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, 1079A Main Building, Philadelphia, PA 19107 (T.M.H., J.A.B., E.J.M., J.B.R., W.B.M.); and Department of Radiology, University of Dammam, Dammam, Saudi Arabia (T.M.H.)
| | - Eoghan J McCarthy
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, 1079A Main Building, Philadelphia, PA 19107 (T.M.H., J.A.B., E.J.M., J.B.R., W.B.M.); and Department of Radiology, University of Dammam, Dammam, Saudi Arabia (T.M.H.)
| | - Johannes B Roedl
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, 1079A Main Building, Philadelphia, PA 19107 (T.M.H., J.A.B., E.J.M., J.B.R., W.B.M.); and Department of Radiology, University of Dammam, Dammam, Saudi Arabia (T.M.H.)
| | - William B Morrison
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, 1079A Main Building, Philadelphia, PA 19107 (T.M.H., J.A.B., E.J.M., J.B.R., W.B.M.); and Department of Radiology, University of Dammam, Dammam, Saudi Arabia (T.M.H.)
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Abstract
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.
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Hamoud K, Abbas J. Fracture dislocation of the sacro-coccygeal joint in a 12-year-old boy. A case report and literature review. Orthop Traumatol Surg Res 2015; 101:871-3. [PMID: 26470803 DOI: 10.1016/j.otsr.2015.06.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 06/16/2015] [Accepted: 06/29/2015] [Indexed: 02/02/2023]
Abstract
A case report and literature review. To present a rare case of facture dislocation of the sacro-coccygeal joint in a 12-year-old boy who was treated conservatively. Fracture dislocations of the sacrum or the sacro-coccygeal joint are infrequent injuries and are rarely reported. The treatment for these disorders is usually conservative. Detailed description of the anterior dislocation (Salter-Harris type I) of the sacro-coccygeal joint in this child and its management are presented, with review of the relevant literature. A conservative treatment was performed, with excellent clinical and radiological result at three years after the injury. MR imaging obtained at two years showed very good healing and alignment. Fracture dislocation of the sacro-coccygeal joint in the pediatric population should be treated conservatively, as the potential of healing and remodeling is great. Closed reduction should not be attempted.
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Affiliation(s)
- K Hamoud
- Faculty of Medicine in the Galilee, Bar-Ilan University, Zefat, Israel; Department of Orthopaedic Surgery, The Baruch Padeh Poriya Medical Center, Lower Galilee, Tiberias, Israel; Department of Physiotherapy, Zefat Academic College, Zefat, Israel.
| | - J Abbas
- Department of Physiotherapy, Zefat Academic College, Zefat, Israel
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