Updated: 6/3/2017

Anterior Superior Iliac Spine (ASIS) Avulsion

Topic
Review Topic
0
0
Questions
7
0
0
Evidence
2
0
0
Videos
2
Cases
1
https://upload.orthobullets.com/topic/3091/images/ASIS2[1]_moved.jpg
https://upload.orthobullets.com/topic/3091/images/avulsionillustration_moved.jpg
Introduction
  • ASIS avulsions occur in young athletes through the physis
  • Mechanism
    • result from indirect trauma
    • caused by sudden and forceful contraction of sartorius and tensor fascia lata  
    • occurs during hip extension (sprinting or swinging a baseball bat)
Anatomy
  • Muscles that originate from ASIS 
    • sartorius (femoral n.) 
    • tensor fascia lata (superior gluteal n.) 
Presentation
  • History
    • athlete will often report a pop or snap at the time of injury
  • Symptoms
    • may complain of weakness
      • may be confused or misdiagnosed as an acute muscle strain
  • Physical exam
    • may see weakness to hip flexion and knee extension
    • severe injuries may result in a limp
Imaging
  • Radiographs
    • displaced fractures usually can be seen on radiographs
      • may be missed due to location and small size of bony fragment 
  • CT or MRI
    • can be obtained to confirm the diagnosis
Treatment
  • Nonoperative
    • rest, protected weight bearing with crutches, and early ROM and stretching    
      • indications
        • most cases
  • Operative
    • ORIF of avulsion fracture
      • indications
        • fractures with displacement of > 3 cm
        • painful nonunions
 

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Questions (7)
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(OBQ12.61) A 12-year-old male has immediate pain and echhymosis over his right groin after injuring himself during a hockey game. His radiograph is shown in figure A. Which of the following statements is true regarding the insertion of his injured muscle? Review Topic

QID: 4421
FIGURES:
1

Inserts on fibular head

2%

(86/4885)

2

Insertion on femur is anterior and distal to lateral collateral ligament of knee

7%

(331/4885)

3

Can be source of pes anserinus bursitis

65%

(3189/4885)

4

Tendon is a harvest option for autograft ACL reconstruction

10%

(475/4885)

5

Extends the hip and flexes the knee

16%

(786/4885)

ML 4

Select Answer to see Preferred Response

PREFERRED RESPONSE 3

(OBQ12.75) A 15-year-old male has the immediate onset of pain during a 100 meter sprint while coming out of the starting blocks and could not complete the race. A pelvis radiograph is shown in Figure A. What is the most appropriate next step in management? Review Topic

QID: 4435
FIGURES:
1

Skeletal survey, chest CT, and referral to an orthopaedic oncologist for biopsy

2%

(88/5782)

2

Open reduction and internal fixation

1%

(73/5782)

3

Hip abduction brace immobilization with the hip in 45 degrees of flexion and neutral rotation for 6 weeks

2%

(121/5782)

4

Protected weight bearing and activity as tolerated

92%

(5332/5782)

5

Immobilize in 120 degrees of knee flexion for 24 hours followed by physical therapy

2%

(120/5782)

ML 1

Select Answer to see Preferred Response

PREFERRED RESPONSE 4

(SAE07SM.42) A 12-year-old boy reports the acute onset of pain and a pop over the right side of his pelvis while swinging a baseball bat during a Little League game. Radiographs reveal an avulsion of the anterior superior iliac spine with 2 cm of displacement. Management should consist of Review Topic

QID: 8704
1

open reduction and internal fixation of the fragment along with the rectus femoris.

3%

(5/153)

2

open reduction and internal fixation of the fragment along with the sartorius.

21%

(32/153)

3

open reduction and internal fixation of the fragment along with the iliopsoas.

1%

(1/153)

4

rest and protected weight bearing with crutches.

75%

(115/153)

5

excision of the fragment.

0%

(0/153)

ML 2

Select Answer to see Preferred Response

PREFERRED RESPONSE 4

(SBQ07SM.42) A 14-year-old male sprinter felt a pop and began to experience immediate left hip pain while participating in the 400-meter dash. Upon evaluation, he has difficulty bearing weight due to left hip pain and has tenderness to palpation superior to his left hip joint. Imaging of the pelvis is included in Figure A. Treatment should should include: Review Topic

QID: 1427
FIGURES:
1

Fixation of the femoral neck stress fracture

0%

(7/3199)

2

Recession of the iliopsoas to releive internal snapping hip syndrome

0%

(11/3199)

3

Fixation of the sartorius origin

6%

(190/3199)

4

Fixation of the direct of head of rectus femoris origin

4%

(115/3199)

5

Progressive weightbearing with return to activities when pain free motion achieved

90%

(2866/3199)

ML 1

Select Answer to see Preferred Response

PREFERRED RESPONSE 5

(OBQ06.38) An avulsion fracture of the anterior superior iliac spine (ASIS) in a adolescent athlete often occurs from forceful eccentric contraction of which of the following muscles? Review Topic

QID: 149
1

External oblique

1%

(9/935)

2

Rectus femoris

12%

(109/935)

3

Iliopsoas

3%

(27/935)

4

Sartorius

84%

(788/935)

5

Gluteus medius

0%

(0/935)

ML 2

Select Answer to see Preferred Response

PREFERRED RESPONSE 4
ARTICLES (7)
VIDEOS (2)
CASES (1)
Topic COMMENTS (3)
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