Avulsion fractures occur more often than reported, and are commonly dismissed as sprains or strains. Avulsion fractures can be treated like sprains and strains. However, with no attention payed, nonunion or malunion may occur. Avulsion fracture sites are at the seven apophyseas. The apophyseas are the Iliac Crest, Anterior Superior Iliac Spine (ASIS), Anterior Inferior Iliac Spine (AIIS), Greater trochanter, Lesser trochanter, Ischial tuberosity and Symphysis pubis.
Symptoms may include medial groin pain, occasional radiating to the perineal region or along the adductor area of the thigh. Passive abduction or resisted abduction of the hip increase tenderness. Treatment includes activity restriction and crutch ambulation may be needed. Most avulsion fractures in adolescent athletes can be treated conservatively. The athlete should return to activity gradually and after they are pain free.
Some signs and symptoms at the Iliac crest are pain over the the injury site, and may have a gluteus medius lurch. At the ASIS, the most pain would be inferior to the anterior part of the iliac crest. AIIS pain would be maximal over the groin area. Greater trochanter symptoms would involve tenderness over the avulsion area. With involvement of the lesser trochanter, the athlete will not be able to flex the hip when seated. At the ischial tuberosity, symptoms would include low back pain. Symphysis pubis involvement would cause medial groin pain.