Arthroscopic Treatment of a Displaced Nonunion of the Anterior Inferior Iliac Spine Causing Extra-articular Impingement

Abstract

This report describes a case of nonunion of an anterior inferior iliac spine (AIIS) apophyseal avulsion fracture with resultant subspine impingement combined with symptomatic femoroacetabular impingement (FAI). A 16-year-old male soccer player presented with a 6-month history of right groin pain exacerbated by kicking and running. The patient was diagnosed with a displaced nonunion of the AIIS apophysis avulsion fracture causing secondary extra-articular impingement beyond cam-type FAI by physical examination and radiological findings. The authors performed arthroscopic AIIS decompression, with concurrent FAI correction and labral repair and capsular closure. At 4 months after surgery, a radiograph and a computed tomography scan showed complete bony union of the AIIS apophyseal nonunion. Modified Harris Hip Sore and Nonarthritic Hip Score improved from 74.8 and 61, respectively, to 100 for both at final follow-up. The effectiveness of arthroscopic decompression of the AIIS as part of a comprehensive minimally invasive surgery including FAI correction and labral repair resulted in complete union of the AIIS and pain-free return to sport and bony union. [Orthopedics. 2017; 40(4):e725-e728.].

Management of proximal rectus femoris injuries – do we know what we’re doing?: A systematic review

“…Ninety-one athletes sustained a RF injury with an AIIS avulsion fracture in twenty three studies included in this systematic review [ 42 , 46 , 47 , 49 , 50 , 52 – 57 , 64 – 67 , 71 , 73 – 76 , 80 , 81 ].…”

“…Mechanism of injury: Over 90% of the avulsions (n = 83/91) were sustained during kicking [ 46 , 47 , 49 , 50 , 52 , 53 , 55 , 64 – 67 , 71 , 73 , 75 , 76 , 80 ] and the remainder occurred during sprinting [ 42 , 54 , 56 , 57 , 74 , 75 , 81 ]. The majority of these injuries (95%) occurred in adolescent males (n = 87).…”

“…The majority of these injuries (95%) occurred in adolescent males (n = 87). In 61% (n = 56/91) of the athletes the specific sport was not outlined, [ 71 ] and where reported most RF injuries were sustained during kicking in soccer players (29%, n = 26) [ 46 , 47 , 49 , 50 , 52 , 53 , 55 , 64 – 67 , 73 , 75 , 76 , 80 ].…”

“…Diagnostic modality: RF avulsion injuries in nine studies were diagnosed on plain X-rays only (n = 69) [ 49 , 55 – 57 , 65 , 71 , 73 , 74 , 76 , 80 , 81 ]. In three studies computed tomography (CT scan) was used for further evaluation (n = 7), [ 53 , 66 , 67 ] while MRI was the investigation modality of choice for athletes in the remaining studies (n = 15) [ 42 , 46 , 47 , 50 , 52 , 54 , 64 , 75 ].…”

Apophyseal ilium avulsion fractures in young athletes: a systematic review and return to sport analysis

“…1). Following application of the inclusion and exclusion criteria, a total of 70 studies [2,5,12–79] (all levels IV–V) comprising 279 athletes with 286 apophyseal injuries were included. The weighted mean age of included athletes was 14.5 + 1.3 years (range, 8–18 years).…”