Chronic injury: Apophysitis, physeal stress fracture, osteochondrosis, various eponyms specific to site
Definitions
Apophysis: Nonarticular secondary center of ossification that serves as attachment site for muscle or tendon
Contributes to bony shape but not length
Considered epiphyseal equivalent
Acute injury: Avulsion fracture of osseous &/or cartilaginous apophysis through subjacent physis
Chronic injury: Repetitive submaximal tensile forces (avulsive microtrauma) exceed rate of repair, leading to local growth plate disturbance (± symptoms)
IMAGING
General Features
Radiographic Findings
CT Findings
MR Findings
Ultrasonographic Findings
Nuclear Medicine Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Image Interpretation Pearls
Selected References
Franz P et al: Tibial tubercle avulsion fractures in children. Curr Opin Pediatr. 32(1):86-92, 2020
Calderazzi F et al: Apophyseal avulsion fractures of the pelvis. A review. Acta Biomed. 89(4):470-6, 2018
Ghanem IB et al: Pediatric avulsion fractures of pelvis: current concepts. Curr Opin Pediatr. 30(1):78-83, 2018
Schiller J et al: Lower extremity avulsion fractures in the pediatric and adolescent athlete. J Am Acad Orthop Surg. 25(4):251-9, 2017
Schuett DJ et al: Pelvic apophyseal avulsion fractures: a retrospective review of 228 cases. J Pediatr Orthop. 35(6):617-23, 2015
Singer G et al: Diagnosis and treatment of apophyseal injuries of the pelvis in adolescents. Semin Musculoskelet Radiol. 18(5):498-504, 2014
Meyers AB et al: MRI of radiographically occult ischial apophyseal avulsions. Pediatr Radiol. 42(11):1357-63, 2012
McKinney BI et al: Apophyseal avulsion fractures of the hip and pelvis. Orthopedics. 32(1):42, 2009
Hébert KJ et al: MRI appearance of chronic stress injury of the iliac crest apophysis in adolescent athletes. AJR Am J Roentgenol. 190(6):1487-91, 2008
Sanders TG et al: Avulsion injuries of the pelvis. Semin Musculoskelet Radiol. 12(1):42-53, 2008
Raissaki M et al: Imaging of sports injuries in children and adolescents. Eur J Radiol. 62(1):86-96, 2007
Rossi F et al: Acute avulsion fractures of the pelvis in adolescent competitive athletes: prevalence, location and sports distribution of 203 cases collected. Skeletal Radiol. 30(3):127-31, 2001
Carey J et al: MRI of pediatric growth plate injury: correlation with plain film radiographs and clinical outcome. Skeletal Radiol. 27(5):250-5, 1998
Related Anatomy
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Clinical Issues
TERMINOLOGY
Synonyms
Acute injury: Avulsion fracture
Chronic injury: Apophysitis, physeal stress fracture, osteochondrosis, various eponyms specific to site
Definitions
Apophysis: Nonarticular secondary center of ossification that serves as attachment site for muscle or tendon
Contributes to bony shape but not length
Considered epiphyseal equivalent
Acute injury: Avulsion fracture of osseous &/or cartilaginous apophysis through subjacent physis
Chronic injury: Repetitive submaximal tensile forces (avulsive microtrauma) exceed rate of repair, leading to local growth plate disturbance (± symptoms)
IMAGING
General Features
Radiographic Findings
CT Findings
MR Findings
Ultrasonographic Findings
Nuclear Medicine Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Image Interpretation Pearls
Selected References
Franz P et al: Tibial tubercle avulsion fractures in children. Curr Opin Pediatr. 32(1):86-92, 2020
Calderazzi F et al: Apophyseal avulsion fractures of the pelvis. A review. Acta Biomed. 89(4):470-6, 2018
Ghanem IB et al: Pediatric avulsion fractures of pelvis: current concepts. Curr Opin Pediatr. 30(1):78-83, 2018
Schiller J et al: Lower extremity avulsion fractures in the pediatric and adolescent athlete. J Am Acad Orthop Surg. 25(4):251-9, 2017
Schuett DJ et al: Pelvic apophyseal avulsion fractures: a retrospective review of 228 cases. J Pediatr Orthop. 35(6):617-23, 2015
Singer G et al: Diagnosis and treatment of apophyseal injuries of the pelvis in adolescents. Semin Musculoskelet Radiol. 18(5):498-504, 2014
Meyers AB et al: MRI of radiographically occult ischial apophyseal avulsions. Pediatr Radiol. 42(11):1357-63, 2012
McKinney BI et al: Apophyseal avulsion fractures of the hip and pelvis. Orthopedics. 32(1):42, 2009
Hébert KJ et al: MRI appearance of chronic stress injury of the iliac crest apophysis in adolescent athletes. AJR Am J Roentgenol. 190(6):1487-91, 2008
Sanders TG et al: Avulsion injuries of the pelvis. Semin Musculoskelet Radiol. 12(1):42-53, 2008
Raissaki M et al: Imaging of sports injuries in children and adolescents. Eur J Radiol. 62(1):86-96, 2007
Rossi F et al: Acute avulsion fractures of the pelvis in adolescent competitive athletes: prevalence, location and sports distribution of 203 cases collected. Skeletal Radiol. 30(3):127-31, 2001
Carey J et al: MRI of pediatric growth plate injury: correlation with plain film radiographs and clinical outcome. Skeletal Radiol. 27(5):250-5, 1998
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