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Pelvic Avulsion Fracture/Apophysitis
Julia R. Crim, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Synonyms

              • Tug injury, tug lesion, pelvic avulsion
            • Definitions

              • Avulsion: Injury to tendon or bone at tendinous attachment due to single or repetitive trauma from myotendinous contraction
              • Apophysis: Accessory center of ossification
                • Does not contribute to length of bone
              • Apophysitis: "Inflammatory" changes at apophysis secondary to trauma
                • Injury occurs prior to ossification of apophysis

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • MR Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Gross Pathologic & Surgical Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          • Reporting Tips

                                            Selected References

                                            1. Singer G et al: Diagnosis and treatment of apophyseal injuries of the pelvis in adolescents. Semin Musculoskelet Radiol. 18(5):498-504, 2014
                                            2. Davis KW: Imaging pediatric sports injuries: lower extremity. Radiol Clin North Am. 48(6):1213-35, 2010
                                            3. McKinney BI et al: Apophyseal avulsion fractures of the hip and pelvis. Orthopedics. 32(1):42, 2009
                                            4. 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
                                            5. Sanders TG et al: Avulsion injuries of the pelvis. Semin Musculoskelet Radiol. 12(1):42-53, 2008
                                            6. Zajick DC et al: Spectrum of MRI findings in clinical athletic pubalgia. Semin Musculoskelet Radiol. 12(1):3-12, 2008
                                            7. Vandervliet EJ et al: Sports-related acute and chronic avulsion injuries in children and adolescents with special emphasis on tennis. Br J Sports Med. 41(11):827-31, 2007
                                            8. Ouellette H et al: MR imaging of rectus femoris origin injuries. Skeletal Radiol. 35(9):665-72, 2006
                                            9. Bui-Mansfield LT et al: Nontraumatic avulsions of the pelvis. AJR Am J Roentgenol. 178(2):423-7, 2002
                                            10. 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
                                            11. Stevens MA et al: Imaging features of avulsion injuries. Radiographics. 19(3):655-72, 1999
                                            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

                                                    • Diagnostic Checklist

                                                      TERMINOLOGY

                                                      • Synonyms

                                                        • Tug injury, tug lesion, pelvic avulsion
                                                      • Definitions

                                                        • Avulsion: Injury to tendon or bone at tendinous attachment due to single or repetitive trauma from myotendinous contraction
                                                        • Apophysis: Accessory center of ossification
                                                          • Does not contribute to length of bone
                                                        • Apophysitis: "Inflammatory" changes at apophysis secondary to trauma
                                                          • Injury occurs prior to ossification of apophysis

                                                      IMAGING

                                                      • General Features

                                                        • Radiographic Findings

                                                          • CT Findings

                                                            • MR Findings

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Gross Pathologic & Surgical Features

                                                                      • Microscopic Features

                                                                        CLINICAL ISSUES

                                                                        • Presentation

                                                                          • Demographics

                                                                            • Natural History & Prognosis

                                                                              • Treatment

                                                                                DIAGNOSTIC CHECKLIST

                                                                                • Consider

                                                                                  • Image Interpretation Pearls

                                                                                    • Reporting Tips

                                                                                      Selected References

                                                                                      1. Singer G et al: Diagnosis and treatment of apophyseal injuries of the pelvis in adolescents. Semin Musculoskelet Radiol. 18(5):498-504, 2014
                                                                                      2. Davis KW: Imaging pediatric sports injuries: lower extremity. Radiol Clin North Am. 48(6):1213-35, 2010
                                                                                      3. McKinney BI et al: Apophyseal avulsion fractures of the hip and pelvis. Orthopedics. 32(1):42, 2009
                                                                                      4. 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
                                                                                      5. Sanders TG et al: Avulsion injuries of the pelvis. Semin Musculoskelet Radiol. 12(1):42-53, 2008
                                                                                      6. Zajick DC et al: Spectrum of MRI findings in clinical athletic pubalgia. Semin Musculoskelet Radiol. 12(1):3-12, 2008
                                                                                      7. Vandervliet EJ et al: Sports-related acute and chronic avulsion injuries in children and adolescents with special emphasis on tennis. Br J Sports Med. 41(11):827-31, 2007
                                                                                      8. Ouellette H et al: MR imaging of rectus femoris origin injuries. Skeletal Radiol. 35(9):665-72, 2006
                                                                                      9. Bui-Mansfield LT et al: Nontraumatic avulsions of the pelvis. AJR Am J Roentgenol. 178(2):423-7, 2002
                                                                                      10. 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
                                                                                      11. Stevens MA et al: Imaging features of avulsion injuries. Radiographics. 19(3):655-72, 1999