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      A rare case of avulsion fracture of the iliac crest apophysis in a young female athlete

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          Abstract

          Avulsion fractures of the iliac crest in the adolescent are rare injuries poorly described in literature. The rarity of this injury along with the late ossification of the growth plate of the iliac crest can lead to misdiagnosis and improper treatment. In presence of high clinical suspicion and negative x-ray findings, second level imaging is advisable. Case reports and some case series report on successful outcome of both surgical and non-surgical treatment. We present the case of a fifteen year old female athlete who sustained an avulsion fracture of the iliac crest during a running race. The patient was treated conservatively and returned to previous sport activities after four months from injury. Mechanism of injury, diagnostic options and treatment opportunities are also described.

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          Acute avulsion fractures of the pelvis in adolescent competitive athletes: prevalence, location and sports distribution of 203 cases collected.

           F. Rossi,  S. Dragoni (2001)
          To describe the prevalence, location and sports distribution of pelvic avulsion fractures in adolescent competitive athletes. One thousand two hundred and thirty-eight radiographs of the pelvis taken for focal traumatic symptoms in athletes with an age range of 11-35 years over a period of 22 years were reviewed. One hundred and ninety-eight adolescent athletes were affected by 203 avulsion fractures of the pelvic apophyses (five cases presented multiple locations). The localisation was the ischial tuberosity (IT) in 109 cases, anterior inferior iliac spine (AIIS) in 45 cases, anterior superior iliac spine (ASIS) in 39 cases, superior corner of pubic symphysis (SCPS) in 7 cases and iliac crest (IC) in 3 cases. Soccer (74 cases) and gymnastics (55 cases) were the sports with the highest number of avulsion fractures documented. Apophyseal avulsion fractures of the pelvis in adolescent competitive athletes are most common in soccer and gymnastics. The lesions are usually the consequence of sudden and forceful muscle-tendon contractions during sport activities. Plain radiographs, are determinant for the diagnosis.
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            Avulsion fractures of the pelvis.

            Avulsion fractures of the pelvic apophyses are seen infrequently but they show a consistent pattern in mechanism, patient's age, symptoms, physical findings, and roentgenographic appearance. Some disagreement exists in the literature concerning the treatment of these fractures. This study indicates that early diagnosis and a carefully directed nonoperative treatment program will produce positive results for avulsion fractures of the pelvis. Twenty-seven cases of acute avulsion fracture of the pelvis were successfully treated in a directed nonoperative program.
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              Avulsion injuries of the pelvis and proximal femur.

              Twenty cases of avulsion fractures of the apophyses of the pelvis and proximal femur were reviewed. Most occurred in male adolescents engaged in active sports. Pain, often with little external evidence of trauma, was the most frequent presenting symptom. Conservative, nonsurgical treatment was successful in all the patients. The radiographic appearance of each type of apophyseal injury is demonstrated. Recognition of the initial deformity and of the patterns of repair is important to avoid unnecessary evaluation (tomography, radionuclide scans) and inappropriate therapy. While productive changes with healing are most likely to occur in the region of the ischium, any of the other sites may heal with abundant bone and may mimic neoplasm. In the proper clinical setting, bony changes at these sites should prompt the radiologist to consider a traumatic etiology.
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                Author and article information

                Contributors
                Journal
                Trauma Case Rep
                Trauma Case Rep
                Trauma Case Reports
                Elsevier
                2352-6440
                07 November 2019
                December 2019
                07 November 2019
                : 24
                Affiliations
                Department of Traumatology and General Orthopaedics, A.O.U. Careggi, Firenze, Italy
                Author notes
                []Corresponding author. Department of Traumatology and General Orthopaedics, A.O.U. Careggi, Italia, Largo P. Palagi 1, 50139, Firenze, Italy. michelelosco@ 123456gmail.com
                Article
                S2352-6440(19)30091-3 100257
                10.1016/j.tcr.2019.100257
                6849346
                © 2019 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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                Case Report

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