Ischial Tuberosity Avulsion Fracture

Abstract

Ischial tuberosity avulsion fractures are uncommon injuries typically seen in adolescent athletes during activities of forced hip flexion with an extended knee position. The injury is often accompanied by the sudden onset of pain and a “popping” sensation in the proximal thigh or buttock region. Initial workup should include a thorough history and clinical exam with pelvic radiographs in the suspected patient. Conservative treatment with rest, restricted activity, and rehabilitation is typically reserved for fractures displaced less than 15 mm. Surgical management is recommended for fragments with displacement greater than 15 mm, those patients who fail conservative treatment, symptomatic nonunions, or for patients with sciatic nerve symptoms. A subgluteal approach is a safe approach that allows adequate reduction and fixation of the fragment. Advantages of this approach include the ability to obtain direct access of the fragment without exposing the sciatic nerve but, at the same time, providing the flexibility of extending the incision to expose the sciatic nerve when necessary. This approach also provides indirect reduction of the displaced ischial fragment with the patient positioned prone and the hip and knee slightly flexed. Symptomatic nonunion can be a complication in patients treated conservatively with severe, initial displacement >15 mm.