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Sartorius, 2 cm of displacement
3%
61/1912
Sartorius, 4 cm of displacement
56/1912
Indirect Head of Rectus Femoris, 4 cm of displacement
6%
109/1912
Direct Head of Rectus Femoris, 4 cm of displacement
43%
821/1912
Direct Head of Rectus Femoris, 2 cm of displacement
824/1912
Select Answer to see Preferred Response
The patient sustained an avulsion fracture of the anterior inferior iliac spine (AIIS). The structure causing fracture displacement is the direct head of the rectus femoris and the correct operative indication is 2 cm of displacement. This patient sustained an avulsion fracture of the AIIS which is caused by forceful hyperextension of the hip and flexion of the knee. The AIIS is the first pelvic ossification center to appear between the ages of 13-15. The direct head of the rectus femoris attaches here and causes the fracture to displace. Nonsurgical treatment is usually attempted first, but operative indications include failure of nonsurgical treatment, continued pain, impingement, and displacement of more than 2 centimeters. In most cases, full recovery can be expected within 3 months. Yildiz et al. wrote a case report of sequential bilateral avulsion fractures of the AIIS. In this case, a 17-year-old boy sustained a right AIIS avulsion fracture while long jumping. He was treated conservatively and returned to sport after 2 months. At that time, he sustained a fracture of the left AIIS. He was treated conservatively for that injury as well and made a full recovery. The authors recommend that with limited displacement, this injury may be treated non-operatively. Schiller et al. performed a review on lower extremity avulsion fractures in the pediatric and adolescent athlete. They report that these fractures are uncommon and may be misdiagnosed with proper imaging or clinical suspicion. When these injuries are identified, non-operative treatment is usually successful. If these injuries are misdiagnosed and treated with early range of motion, nonunion or further displacement may occur. Figure A is an AP pelvis demonstrating a fracture of the right AIIS. Illustration A is the same radiograph with an arrow indicating the fracture. Incorrect Answers: Answers 1 and 2: The sartorius originates on the anterior superior iliac spine (ASIS). Answers 3 & 4: The indirect head of the rectus femoris originates on a concavity above the acetabulum.
1.4
(15)
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