summary An anterior superior iliac spine (ASIS) avulsion is a traumatic avulsion of the ASIS due to a sudden and forceful contraction of the sartorius and tensor fascia lata that occurs in young athletes. Diagnosis is made radiographically with displaced injuries but CT/MRI may be required to diagnosis nondisplaced fractures. Treatment is nonoperative for fractures < 3 cm displacement with rest and protected weight bearing. Surgical treatment is indicated for fractures > 3 cm displaced. Etiology 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
QUESTIONS 1 of 7 1 2 3 4 5 6 7 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (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? QID: 4435 FIGURES: A Type & Select Correct Answer 1 Skeletal survey, chest CT, and referral to an orthopaedic oncologist for biopsy 2% (109/7249) 2 Open reduction and internal fixation 1% (103/7249) 3 Hip abduction brace immobilization with the hip in 45 degrees of flexion and neutral rotation for 6 weeks 2% (164/7249) 4 Protected weight bearing and activity as tolerated 92% (6666/7249) 5 Immobilize in 120 degrees of knee flexion for 24 hours followed by physical therapy 2% (147/7249) L 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic (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? QID: 4421 FIGURES: A Type & Select Correct Answer 1 Inserts on fibular head 2% (107/5886) 2 Insertion on femur is anterior and distal to lateral collateral ligament of knee 7% (397/5886) 3 Can be source of pes anserinus bursitis 66% (3867/5886) 4 Tendon is a harvest option for autograft ACL reconstruction 11% (624/5886) 5 Extends the hip and flexes the knee 15% (868/5886) L 4 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic This is an AAOS Self Assessment Exam (SAE) question. Orthobullets was not involved in the editorial process and does not have the ability to alter the question. If you prefer to hide SAE questions, simply turn them off in your Learning Goals. (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 QID: 8704 Type & Select Correct Answer 1 open reduction and internal fixation of the fragment along with the rectus femoris. 2% (15/609) 2 open reduction and internal fixation of the fragment along with the sartorius. 22% (137/609) 3 open reduction and internal fixation of the fragment along with the iliopsoas. 2% (10/609) 4 rest and protected weight bearing with crutches. 73% (442/609) 5 excision of the fragment. 0% (0/609) L 2 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic (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: QID: 1427 FIGURES: A Type & Select Correct Answer 1 Fixation of the femoral neck stress fracture 0% (10/3927) 2 Recession of the iliopsoas to releive internal snapping hip syndrome 0% (18/3927) 3 Fixation of the sartorius origin 6% (247/3927) 4 Fixation of the direct of head of rectus femoris origin 4% (147/3927) 5 Progressive weightbearing with return to activities when pain free motion achieved 89% (3491/3927) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic (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? QID: 149 Type & Select Correct Answer 1 External oblique 1% (13/1544) 2 Rectus femoris 11% (177/1544) 3 Iliopsoas 3% (44/1544) 4 Sartorius 84% (1302/1544) 5 Gluteus medius 0% (4/1544) L 2 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic
All Videos (2) Podcasts (1) Login to View Community Videos Login to View Community Videos 2018 Baseball Sports Medicine: Game-Changing Concepts Case Presentations and Panel Discussion with Q&A SESSION V: HIP & FINGER TIP - Moderator T. Sean Lynch, MD (BSM 2018, #43) T. Sean Lynch Knee & Sports - Anterior Superior Iliac Spine (ASIS) Avulsion C 12/21/2018 115 views 3.0 (1) Login to View Community Videos Login to View Community Videos 2018 Baseball Sports Medicine: Game-Changing Concepts Baseball Hip Conditions Update - T. Sean Lynch, MD (BSM 2018, #40) T. Sean Lynch Knee & Sports - Anterior Superior Iliac Spine (ASIS) Avulsion B 12/21/2018 165 views 4.0 (1) Knee & SportsâȘAnterior Superior Iliac Spine (ASIS) Avulsion Orthobullets Team Knee & Sports - Anterior Superior Iliac Spine (ASIS) Avulsion Listen Now 11:42 min 2/24/2020 182 plays 5.0 (1)
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