Asis Avulsion Fracture

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Asis Avulsion Fracture

Authors, Editors, Case Information Author: Zachary Noll, BS Affiliation: Rowan Virtua School of Osteopathic Medicine Co Author(s): Altamash Raja, DO, RMSK, CSCS Clinical Vignette: A 14-year-old female high school soccer player presented with 5 months of right anterior hip pain without any clear mechanism of injury. Pain was located over the anterior superior iliac spine and worsened with running, kicking, and jumping. Type of Probe Used: 15-4 MHz Linear Transducer Unlabeled Right ASIS Avulsion Fracture Short Axis An unlabeled short axis view of the right ASIS. Labeled Right ASIS Avulsion Fracture Short Axis A labeled short axis view of the right ASIS showing marked cortical irregularity. Pain with sonopalpation at this site. Normal appearing sartorius and tensor fascia latae tendons. Unlabeled Right ASIS Avulsion Fracture Long Axis An unlabeled long axis view of the right ASIS. Labeled Right ASIS Avulsion Fracture Long Axis A labeled long axis view of the right ASIS showing marked cortical irregularity. Pain with sonopalpation at this site. Normal appearing sartorius tendon. Unlabeled Right ASIS Avulsion Fracture in Long Axis with Doppler An unlabeled long axis view with Doppler of the right ASIS. Labeled Right ASIS Avulsion Fracture in Long Axis with Doppler A labeled long axis view with Doppler of the right ASIS showing no hyperemia. Unlabeled Left ASIS Long Axis An unlabeled long axis view of the left (unaffected) ASIS. Labeled Left ASIS Long Axis A labeled long axis view of the left (unaffected) ASIS. Unlabeled Left ASIS Short Axis An unlabeled short axis view of the left (unaffected) ASIS. Labeled Left ASIS Short Axis A labeled short axis view of the left (unaffected) ASIS. #11 - Image Unlabeled AP Pelvis XR correlate. #12 - Image Labeled AP Pelvis XR correlate. #13 - Image Unlabeled Frog Leg View XR correlate. #14 - Image Labeled Frog Leg View XR correlate. #15 - Image Unlabeled MRI Coronal STIR sequence correlate. #16 - Image Labeled MRI Coronal STIR sequence correlate. #17 - Image Unlabeled MRI Coronal T1 sequence correlate. #18 - Image Labeled MRI Coronal T1 sequence correlate. #19 - Video View Video A short axis view of the right ASIS sliding proximal to distal revealing normal sartorius and tensor fascia latae tendons and marked cortical irregularity with a probable step-off deformity. #20 - Video View Video A long axis view of the right ASIS sliding medial to lateral revealing normal sartorius tendon and marked cortical irregularity with a probable step-off deformity. Interpretation Image Interpretation: Marked cortical irregularity with a probable step-off deformity is noted at the anterior superior iliac spine with accompanying tenderness to sonopalpation. No hyperemia is noted. The Sartorius tendon is normal. The Tensor fascia latae is normal. The Gluteus Medius tendon origin is normal. These findings are suggestive of a chronic anterior superior iliac spine avulsion fracture. Teaching Pearl: Pelvic avulsion fractures are a rare subset of fractures occurring primarily in active adolescents due to forceful contractions of the attaching musculature in movements such as kicking, running, and sprinting. These fractures most commonly occur at the ASIS, AIIS, and ischial tuberosity. Although traditionally X-ray is used for diagnosis, point-of-care ultrasound allows for visualization of bony structures, dynamic assessment of surrounding musculature, and measurement of displacement of the fracture. Treatment of ASIS avulsions fractures is usually conservative with surgery only considered for those with displacement > 15-20mm. Sources: Chen L-W, Yeh W-C. Musculoskeletal sonography facilitates the diagnosis of adolescent anterior superior iliac spine avulsion fracture. J. Med. Ultrasound. 2010;18(4):158-160. https://doi.org/10.1016/j.jmu.2010.11.003. Mori T, Ihara T, Nomura O. Avulsion fracture of the anterior superior iliac spine in a young athlete detected by point-of-care ultrasound. POCUS J. 2022;7(1):140-143. https://doi.org/10.24908/pocus.v7i1.15096.
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Authors, Editors, Case Information

Unlabeled Right ASIS Avulsion Fracture Short Axis

Labeled Right ASIS Avulsion Fracture Short Axis

Unlabeled Right ASIS Avulsion Fracture Long Axis

Labeled Right ASIS Avulsion Fracture Long Axis

Unlabeled Right ASIS Avulsion Fracture in Long Axis with Doppler

Labeled Right ASIS Avulsion Fracture in Long Axis with Doppler

Unlabeled Left ASIS Long Axis

Labeled Left ASIS Long Axis

Unlabeled Left ASIS Short Axis

Labeled Left ASIS Short Axis

#11 - Image

#12 - Image

#13 - Image

#14 - Image

#15 - Image

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#18 - Image

#19 - Video

#20 - Video

Interpretation

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