Avulsion fractures in the hip

1. How do ischial tuberosity avulsion fractures usually occur? What is the presentation? How is it distinguished from ischial tuberosity bursitis?
2. How are ischial tuberosity avulsion fractures treated?
3. How are ASIS avulsion fractures caused? What is the presentation?
4. What is the treatment of ASIS avulsion fractures?
5. What is the cause of AIIS avulsion fractures? What is the presentation?
6. What is the treatment of AIIS avulsion fractures?

Answers:
1. They are caused by forceful hamstring contracture with knee in extension and hip in flexion. The presentation is of sudden pain and tenderness over the ischial tuberosity, whereas ischial is of insidious onset.
2. Rest, ice, weight bearing as tolerated. Resistance exercises can be started after achieving a full ROM.
3. ASIS avulsion is caused by forceful contraction with hip extended and knee flexed. The lateral femoral cutaneous nerve may be involved and there is acute pain and tenderness over the ASIS, with hip flexion pain.
4. Rest, ice, weight bearing as tol. May require knee splinting in flexion.
5. AIIS avulsion is caused by forceful kicking and quad contraction. Presentation is as pain over AIIS or acute groin pain.
6. Treatment is with rest and ice, weightbearing as tolerated.