Operative treatment of pelvic apophyseal avulsions in adolescent and young adult athletes: a follow-up study.

Sinikumpu JJ1,2,3, Hetsroni I4, Schilders E5,6, Lempainen L7, Serlo W8,9, Orava S7.

Author information

1 Department of Pediatric Surgery and Orthopedics, Oulu University Hospital, POB 23, 90029 OYS, Oulu, Finland. juha-jaakko.sinikumpu@ppshp.fi.
2 Pedego Research Group, Medical Research Center Oulu, Oulu University, Oulu, Finland. juha-jaakko.sinikumpu@ppshp.fi.
3 Mehiläinen Sports Clinic, Oulu, Finland. juha-jaakko.sinikumpu@ppshp.fi.
4 Department of Orthopedic Surgery, Meir General Hospital, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
5 Fortius Clinic, FIFA Medical Centre of Excellence, London, UK.
6 Leeds Beckett University, Leeds, UK.
7 Sports Injury Research Center, Hospital NEO, Turku, Finland.
8 Department of Pediatric Surgery and Orthopedics, Oulu University Hospital, POB 23, 90029 OYS, Oulu, Finland.
9 Pedego Research Group, Medical Research Center Oulu, Oulu University, Oulu, Finland.

Abstract

INTRODUCTION:

Pelvic apophyseal avulsion can limit young athletes’ performance for months and may result in permanent disability. Nonoperative treatment is most commonly preferred, while surgical management with reduction and fixation is reserved for selected cases. Our aim was to evaluate outcomes of operative management of pelvic apophyseal avulsions in a series of adolescents and young adult athletes.

MATERIALS AND METHODS:

Operative room registries and medical records were reviewed to identify patients who received surgical treatment for pelvic apophyseal avulsions who were younger than 24 years and with a minimum of 12 month follow-up.

RESULTS:

Thirty-two patients (16.8 years ± 2.6) were identified. The most common avulsion sites were anterior inferior iliac spine (34.4%, N = 11) and ischial tuberosity (34.4%, N = 11). Other avulsions were five cases (15.6%) of the pubic apophysis, four cases (12.5%) of the anterior superior iliac spine apophysis and one case of the iliac crest apophysis. Seventeen cases (53.1%) underwent surgery early, i.e., during the first 3 months after the acute injury. Twenty-two cases (68.8%) involved reduction with internal fixation, and six cases (18.8%) involved resection of the fragment. Twenty-six athletes (81.3%, N = 26) reported good outcomes and were able to return to preinjury sports level. Six patients (18.8%) had moderate outcome and reported activity limitations during high-level sports. Large displacement (> 20 mm) or delayed (> 3 months) surgery was not associated with inferior outcomes (P = 0.690 and P = 0.392, respectively). Injury side (P = 0.61) or gender (P = 0.345) did not affect outcomes.

CONCLUSIONS:

Operative management of pelvic apophyseal avulsion results in return to the preinjury sports level in more than 80% of the cases. However, while both acute surgery for large displacement and delayed intervention for failed nonoperative treatment are generally successful in improving sports function in these cases, comparative studies are required to refine criteria for surgery.

LEVEL OF EVIDENCE:

Case series, IV.

KEYWORDS:

Adolescent; Apophysis; Fixation; Osteosynthesis; Outcomes; Pelvic avulsion; Reduction; Sports injury; Surgical treatmentPMID: 29159479 DOI: 10.1007/s00590-017-2074-x


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