Avulsion fractures, or, pull off fractures as they are more commonly known, around the hip are fairly common in children and they may occur in a number of locations, including the ischial tuberosity (hamstrings), the anterior superior iliac spine (Sartorius) as well as the anterior inferior iliac spine (rectus femoris) and the lesser trochanter of the femur (Iliopsoas).
Children (most often teenage boys) often present with local pain after athletic activities, some of them may have been complaining of intermittent pain around the area for some time prior to the avulsion episode and this is usually due to inflammation of the traction apophysis (apophysitis), where the muscle inserts. Apophysitis is a overuse injury and may be managed with oral non-steroidal anti-inflammatories and rest. Once a muscle avulsion has occurred, uncomplicated healing is the rule even in cases with significant displacement and open reduction and internal fixation of the avulsed fracture fragments is only rarely necessary.
An issue which sometimes arises with Avulsion fractures is that healing occurs with exuberant new bone formation and this may be mistaken for a tumour on x-ray, if the patient’s history is not considered.
Read more about hip problems in children here.
