Avulsion Fractures of the Pelvis

What are Avulsion fractures of the Pelvis?

Avulsion fractures of the pelvis is an injury that occurs when a tendon or ligament pulls off a piece of bone from the hip. This results in a part of the pelvic (hip) bone breaking away from the main part of the bone.

Avulsion fractures of the pelvis are seen more in people who:

• Play sports or practice too hard too often
• Use the wrong technique during training or sports
• Are adolescents whose bones are still growing 

Common Sites of Avulsion Fractures in the Pelvis 

The pelvis is a ring of several bones located at the lower end of the trunk, between the spine and the legs.

The three most common sites for avulsion fractures in the pelvis are:

• Anterior Superior Iliac Spine: The large broad bone (ilium) forming the top of the pelvis
• Anterior Inferior Iliac Spine: The bony wing of the ilium (upper lateral part of the pelvis)
• Ischial Tuberosity: The V-shaped bone at the bottom of the pelvis 

Although rare, avulsion fractures also occur at other parts of the hip such as:

• Lesser Trochanter: The bony projection from the lower or back part of the femur neck base

Causes of Avulsion Fractures in the Pelvis

Major causes of avulsion fractures can be:

• Sports or activities that involve speed and sudden stops
• Sudden and/or forceful contraction of the pelvic muscle
• A car accident or any accident that puts sudden stress on the hip

Signs and Symptoms of the Condition

The possible symptoms are any or all of the following depending on the severity:

• Swelling, redness and/or severe pain in your hip 
• Limited movement and pain when you try to move the pelvis
• Popping or sudden pain in your hip or groin during an activity
• Trouble moving the upper leg, both back and forth 

What if Avulsion Fractures of the Pelvis are Left Untreated?

If untreated, avulsion fractures of the pelvis could lead to:

• Instability of the pelvis
• Impaired mobility of the hip
• Loss of function in severe cases
• Sexual dysfunction due to nerve damage 

How is the Condition Diagnosed?

Your doctor is likely to begin the diagnosis with the evaluation of your medical history and a physical examination of the pelvis. This may be followed by a standard anteroposterior (AP) pelvis radiography.

An X-ray or a CT scan to check for broken bones and a bone scan to determine the site of the fracture may be taken to conclude the diagnosis.

Treatment of Avulsion Fractures of the Pelvis

The condition is treated both conservatively or surgically depending on the degree of the fracture. The conventional treatments of an avulsion fracture typically include but are not limited to:

• Resting and icing the pelvis
• Controlled exercises (physiotherapy)
• Use of crutches or walker 
• Prescription of medications

Most avulsion fractures are known to heal well without surgical intervention. However, you might require surgery if you are faced with situations such as:

• Unstable pelvic fractures 
• Bone fragment far away from the main bone 
• Dislocation greater than 2 cm
• Non-union of the bones 
• Painful exostosis (bone spur)
• Failure of conventional treatments

Your doctor will choose the best possible surgery and may include:

• External fixation
• Skeletal traction
• Open reduction and internal fixation (ORIF)  

The doctor will explain to you the details of each treatment depending on the requirement.

Prevention of Avulsion Fractures of the Pelvis

You can prevent avulsion fractures of the pelvis if you:

• Warm up and stretch before playing any sport 
• Do not push yourself too hard during any sport
• Avoid making sudden movements (twisting or direction change)
• Do exercises that strengthen and improve pelvic muscles