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Apophyseal Injuries
A. Carlson Merrow, Jr., MD, FAAP
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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 an 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

                                        1. Schuett DJ et al: Pelvic apophyseal avulsion fractures: a retrospective review of 228 cases. J Pediatr Orthop. 35(6):617-23, 2015
                                        2. Singer G et al: Diagnosis and treatment of apophyseal injuries of the pelvis in adolescents. Semin Musculoskelet Radiol. 18(5):498-504, 2014
                                        3. Meyers AB et al: MRI of radiographically occult ischial apophyseal avulsions. Pediatr Radiol. 42(11):1357-63, 2012
                                        4. McKinney BI et al: Apophyseal avulsion fractures of the hip and pelvis. Orthopedics. 32(1):42, 2009
                                        5. 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
                                        6. Sanders TG et al: Avulsion injuries of the pelvis. Semin Musculoskelet Radiol. 12(1):42-53, 2008
                                        7. Raissaki M et al: Imaging of sports injuries in children and adolescents. Eur J Radiol. 62(1):86-96, 2007
                                        8. 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
                                        9. 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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                                        Related Differential Diagnoses
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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 an 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

                                                                              1. Schuett DJ et al: Pelvic apophyseal avulsion fractures: a retrospective review of 228 cases. J Pediatr Orthop. 35(6):617-23, 2015
                                                                              2. Singer G et al: Diagnosis and treatment of apophyseal injuries of the pelvis in adolescents. Semin Musculoskelet Radiol. 18(5):498-504, 2014
                                                                              3. Meyers AB et al: MRI of radiographically occult ischial apophyseal avulsions. Pediatr Radiol. 42(11):1357-63, 2012
                                                                              4. McKinney BI et al: Apophyseal avulsion fractures of the hip and pelvis. Orthopedics. 32(1):42, 2009
                                                                              5. 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
                                                                              6. Sanders TG et al: Avulsion injuries of the pelvis. Semin Musculoskelet Radiol. 12(1):42-53, 2008
                                                                              7. Raissaki M et al: Imaging of sports injuries in children and adolescents. Eur J Radiol. 62(1):86-96, 2007
                                                                              8. 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
                                                                              9. 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