Presentation
Insidious pain over the anterior innominate bilaterally, that is exacerbated after track and field events (hurdling).
Patient Data
There is avulsion of the anterior one-fourth of the iliac crest bilaterally. On the left, sclerosis can be seen inferior to the avulsed segment of bone, suggesting chronic mechanical stress that preceded the acute injury. There is no significant displacement of the avulsed segments. There are no additional sites of fracture.
Case Discussion
In this case, the avulsion is not a result of an acute injury, but rather chronic mechanical overuse that leads to the avulsion of the iliac crest.
Avulsion of the iliac crest is far less frequent than other apophyseal sites in the pelvis, and represents only 2% of pelvic avulsion fractures. It is due to complete hip extension combined with trunk rotation. The tensile force placed on the iliac crest causes avulsion of the apophysis due to intense abdominal wall contraction often seen in sports that require aggressive propulsion.
Case courtesy of Dr. David Herron.
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