Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2017

Open Access 01-12-2017 | Research article

Operative versus conservative treatment of apophyseal avulsion fractures of the pelvis in the adolescents: a systematical review with meta-analysis of clinical outcome and return to sports

Authors: H. Eberbach, L. Hohloch, M.J. Feucht, L. Konstantinidis, N.P. Südkamp, J. Zwingmann

Published in: BMC Musculoskeletal Disorders | Issue 1/2017

Login to get access

Abstract

Background

Avulsion fractures of the pelvic apophyses typically occur in adolescent athletes due to a sudden strong muscle contraction while growth plates are still open. The main goals of this systematic review with meta-analysis were to summarize the evidence on clinical outcome and determine the rate of return to sports after conservative versus operative treatment of avulsion fractures of the pelvis.

Methods

A systematic search of the Ovid database was performed in December 2016 to identify all published articles reporting outcome and return to preinjury sport-level after conservative or operative treatment of avulsion fractures of the pelvis in adolescent patients. Included studies were abstracted regarding study characteristics, patient demographics and outcome measures. The methodological quality of the studies was assessed with the Coleman Methodology Score (CMS).

Results

Fourteen studies with a total of 596 patients met the inclusion criteria. The mean patient age was 14.3 ± 0.6 years and 75.5% of patients were male. Affected were the anterior inferior iliac spine (33.2%), ischial tuberosity (29.7%), anterior superior iliac spine (27.9%), iliac crest (6.7%) lesser trochanter (1.8%) and superior corner of the pubic symphysis (1.2%). Mean follow-up was 12.4 ± 11.7 months and most of the patients underwent a conservative treatment (89.6%). The overall success rate was higher in the patients receiving surgery (88%) compared to the patients receiving conservative treatment (79%) (p = 0,09). The rate of return to sports was 80% in conservative and 92% in operative treated patients (p = 0,03). Overall, the methodological quality of the included studies was low, with a mean CMS of 41.2.

Conclusion

On the basis of the present meta-analysis, the overall success and return to sports rate was higher in the patients receiving surgery. Especially in patients with fragment displacement greater 15 mm and high functional demands, surgical treatment should be considered.
Literature
1.
McKinney BI, Nelson C, Carrion W. Apophyseal avulsion fractures of the hip and pelvis. Orthopedics. 2009;32:42–8.CrossRefPubMed
2.
White KK, Williams SK, Mubarak SJ. Definition of two types of anterior superior iliac spine avulsion fractures. J Pediatr Orthop. 2002;22:578–82.PubMed
3.
4.
Kaneyama S, Yoshida K, Matsushima S. A surgical approach for an avulsion fracture of the ischial tuberosity - A case report. J Orthop Trauma. 2006;20:363–5.CrossRefPubMed
5.
Ferlic PW, Sadoghi P, Singer G, Kraus T, Eberl R. Treatment for ischial tuberosity avulsion fractures in adolescent athletes. Knee Surg Sports Traumatol Arthrosc. 2013;22:893–7.CrossRefPubMed
6.
Boyce SH, Quigley MA. Simultaneous bilateral avulsion fractures of the anterior superior iliac spines in an adolescent sprinter. BMJ Case Reports. 2009.
7.
Gidwani S, Bircher MD. Avulsion injuries of the hamstring origin – a series of 12 patients and management algorithm. Ann R Coll Surg Engl. 2007;89:394–9.CrossRefPubMedPubMedCentral
8.
Rossi F, Dragoni S. Acute avulsion fractures of the pelvis in adolescent competitive athletes: prevalence, location and sports distribution of 203 cases collected. Skeletal Radiol Springer-Verlag. 2001;30:127–31.CrossRef
9.
Gottsegen CJ, Eyer BA, White EA, Learch TJ, Forrester D. Avulsion fractures of the knee: imaging findings and clinical significance1. RadioGraphics. 2008;28:1755–70.CrossRefPubMed
10.
Schuett DJ, Bomar JD, Pennock AT. Pelvic apophyseal avulsion fractures: a retrospective review of 228 cases. J Pediatr Orthop. 2015;35:617–23.CrossRefPubMed
11.
Li X, Xu S, Lin X, Wang Q, Pan J. Results of operative treatment of avulsion fractures of the iliac crest apophysis in adolescents. Injury Elsevier Ltd. 2014;45:721–4.CrossRef
12.
Pogliacomi F, Calderazzi F, Paterlini M, Ceccarelli F. Surgical treatment of anterior iliac spines fractures: our experience. Acta Biomed. 2014;85:52–8.PubMed
13.
Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009. pp. 264–9.
14.
Zwingmann J, Welzel M, Dovi-Akue D, Schmal H, Südkamp NP, Strohm PC. Clinical results after different operative treatment methods of radial head and neck fractures: a systematic review and meta-analysis of clinical outcome. Injury. 2013;44:1540–50.CrossRefPubMed
15.
Zwingmann J, Hauschild O, Bode G, Südkamp NP, Schmal H. Malposition and revision rates of different imaging modalities for percutaneous iliosacral screw fixation following pelvic fractures: a systematic review and meta-analysis. Arch Orthop Trauma Surg. 2013;133:1257–65.CrossRefPubMed
16.
Zwingmann J, Mehlhorn AT, Hammer T, Bayer J, Südkamp NP, Strohm PC. Survival and neurologic outcome after traumatic out-of-hospital cardiopulmonary arrest in a pediatric and adult population: a systematic review. Crit Care BioMed Central. 2012;16:117.CrossRef
17.
Coleman BD, Khan KM, Maffulli N, Cook JL, Wark JD. Studies of surgical outcome after patellar tendinopathy: clinical significance of methodological deficiencies and guidelines for future studies. Victorian institute of sport tendon study group. Scand J Med Sci Sports. 2000;10:2–11.CrossRefPubMed
18.
Andrade R, Vasta S, Papalia R, Pereira H, Oliveira JM, Reis RL, et al. Prevalence of articular cartilage lesions and surgical clinical outcomes in football (soccer) players’ knees: a systematic review. Arthroscopy. 2016;32:1466–77.CrossRefPubMed
19.
Obremskey WT, Pappas N, Attallah-Wasif E, Tornetta P, Bhandari M. Level of evidence in orthopaedic journals. J Bone Joint Surg Am Orthopedic Assoc. 2005;87:2632–8.
20.
Higgins J, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ British Med J Publishing Group. 2003;327:557–60.CrossRef
21.
22.
Kautzner J, Trc T, Havlas V. Comparison of conservative against surgical treatment of anterior–superior iliac spine avulsion fractures in children and adolescents. Int Orthop. 2014;38:1495–8.CrossRefPubMedPubMedCentral
23.
Uzun M, Alpan B, Özger H. Avulsion fractures involving the straight and reflected heads of the rectus femoris. Hip Int. 2014;24:206–9.CrossRefPubMed
24.
Kosanović M, Brilej D, Komadina R, Buhanec B, Pilih IA, Vlaović M. Operative treatment of avulsion fractures of the anterior superior iliac spine according to the tension band principle. Arch Orthop Trauma Surg. 2002;122:421–3.PubMed
25.
Linni K, Mayr J, Höllwarth ME. Apophyseal fractures of the pelvis and trochanter minor in 20 adolescents and 2 young children. Unfallchirurg. 2000;103:961–4.CrossRefPubMed
26.
Sundar M, Carty H. Avulsion fractures of the pelvis in children: a report of 32 fractures and their outcome. Skeletal Radiol. 1994;23:85–90.CrossRefPubMed
27.
Fernbach SK, Wilkinson RH. Avulsion injuries of the pelvis and proximal femur. AJR Am J Roentgenol. 1981;137:581–4.CrossRefPubMed
28.
Biedert RM. Surgical management of traumatic avulsion of the ischial tuberosity in young athletes. Clin J Sport Med. 2015;25:67–72.CrossRefPubMed
29.
Kong C-G, In Y, Kim S-J, Sur Y-J. Avulsion fracture of the iliac crest apophysis treated with open reduction and internal fixation. J Orthop Trauma. 2011;25:E56–8.CrossRefPubMed
30.
Bolgla LA, Jones DL, Keskula DR, Duncan JB. Hip pain in a high school football player: a case report. J Athl Train National Athletic Trainers Assoc. 2001;36:81–4.
31.
Rajasekhar C, Kumar KS, Bhamra MS. Avulsion fractures of the anterior inferior iliac spine: the case for surgical intervention. Int Orthop. 2001;24:364–5.CrossRefPubMed
Metadata
Title
Operative versus conservative treatment of apophyseal avulsion fractures of the pelvis in the adolescents: a systematical review with meta-analysis of clinical outcome and return to sports
Authors
H. Eberbach
L. Hohloch
M.J. Feucht
L. Konstantinidis
N.P. Südkamp
J. Zwingmann
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2017
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-017-1527-z

Other articles of this Issue 1/2017

BMC Musculoskeletal Disorders 1/2017 Go to the issue

Research article

The pathway to consultation for rheumatoid arthritis: exploring anticipated actions between the onset of symptoms and face-to-face encounter with a healthcare professional

Research article

Arthroscopic findings of a diagnostic dilemma- hip pathology with normal imaging

Research article

Variations in sagittal locations of anterior cruciate ligament tibial footprints and their association with radiographic landmarks: a human cadaveric study

Research article

Hospital volume and the risk of revision in Oxford unicompartmental knee arthroplasty in the Nordic countries -an observational study of 14,496 cases

Research article

Postoperative alignment of TKA in patients with severe preoperative varus or valgus deformity: is there a difference between surgical techniques?

Research article

Correlation of blood bone turnover biomarkers and Wnt signaling antagonists with AS, DISH, OPLL, and OYL