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An avulsion fracture occurs when a piece of bone tears away from the site where the muscle attaches to the bone. Muscle attaches to bone by a thick tissue called a tendon. When a muscle contracts quickly or forcefully, it can cause the tendon to pull off a part of the bone.
A pelvic avulsion fracture refers to a broken part of bone that occurs in the pelvis area, which includes the hips, buttocks, and upper thigh.
Several muscles in the pelvis area can cause avulsion fractures and pain at different areas along the pelvis, especially where there are open growth plates in children and teenagers. These types of fractures are caused by sudden, forceful contraction of the abdominal muscles, the hip and thigh muscles or the hamstring muscles. Irritation of the growth plate can also occur without an avulsion fracture, which is known as apophysitis.
Young athletes, especially adolescents at the age of puberty, are at higher risk for pelvic avulsion fractures. Pelvic avulsion fractures are frequently seen in sports that require sprinting, rapid changes in movement or jumping, such as track, tennis, soccer and hockey. Athletes who have tight muscles or who fail to properly warm up and stretch prior to exercise are at greater risk for this type of injury.
Pelvic avulsion fractures typically cause sudden, severe pain at the site of the bone injury. Other symptoms include swelling, bruising, limited motion, painful motion, inability to bear weight and limping. Some common sites of pelvic avulsion fractures include the iliac crest (top of the hip bone), the front of the pelvis and the ischial tuberosity (the buttock area or the “sit bones”).
Your child’s doctor at Children’s Hospital Colorado will examine the areas that are painful to him or her. Due to pain or muscle tearing, tests of muscle strength and range of motion may show weakness or inability to move.
The doctor may order an x-ray of the pelvic area to look for a piece of bone that has been pulled off.
Pelvic avulsion fractures require a long period of rest and changes in activity in order to heal. Typically, these injuries will get better with four to six weeks of rest. Your child’s doctor at the Hip Program at Children’s Hospital Colorado may recommend the use of crutches for the first one to two weeks.
When the injury first occurs, you should place ice on the injured area for 20 minutes every four to six hours for two to three days. Anti-inflammatory medications may be used to treat pain and swelling.
Before your child returns to sports, he or she should undergo physical therapy to strengthen and stretch the torn muscles. In very rare situations, such as if the torn bone piece is very large or it is torn away from its original location by a large distance, your child’s doctor may recommend surgery.
Your child can return to normal activities when he or she has full strength, normal range of motion and can perform all the skills required for their sport without pain.
Specialists from our Hip Program work closely with the Physical Therapy, Sports Medicine, Anesthesiology and Radiology Departments, among others, to provide access to a full spectrum of care. With a sole focus on hip disease in young patients, our Hip Program is nationally recognized for excellence in hip surgeries, and our doctors educate healthcare providers around the nation on hip disease and surgery.
Certified Pediatric Nurse Practitioner
Pain Management, Physical Medicine & Rehabilitation, Sports Medicine