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Updated: Apr 29 2023

Anterior Superior Iliac Spine (ASIS) Avulsion

  • 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
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