Review Question - QID 1427

The scenario presented is consistent with an avulsion of the anterior superior iliac spine (ASIS) which typically occur in patients approaching skeletal maturity participating in running activities. Figure A confirms the diagnosis by revealing a fracture of the anterior portion of the iliac apophysis.

White et al. described two different patterns of ASIS avulsion fractures based on the muscle that is attached to avulsed fragment, either the sartorius or the tensor fascia lata (TFL). The TFL associated avulsions were larger, laterally displaced and occurred during the beginning of a swing in baseball. Those associated with the sartorius were found to be smaller, displaced anteriorly and inferiorly, and more often associated with sprinting sports.

Incorrect Answers:
Answer 1 is incorrect because the x-rays reveal an ASIS avulsion fracture with no fracture of the femoral neck.
Answer 2 is incorrect because this patient's presentation and imaging are not consistent with internal snapping hip which would have negative x-rays and have recurring snapping with hip movement but the ability to bear weight.
Answer 3 involves the correct pathology but this injury is treated with conservative measures with equivalent outcomes to surgery.
Answer 4 would be a possible option for an avulsion fracture of the anterior inferior iliac spine.

Illustration A displays to commonly tested areas of avulsion fractures involving the pelvis and hip.