Avulsion Fractures Involving the Straight and Reflected Heads of the Rectus Femoris

Uzun, Metin; Alpan, Buğra; Özger, Harzem

doi:10.5301/hipint.5000110

Cited by 17 publications

(18 citation statements)

References 12 publications

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“…Nonoperative treatment consisting of analgetics, limited activities, and partial weight bearing using crutches for at least 3–6 weeks has shown to be successful in many of these injuries [3, 21, 23, 25–27]. Metzmaker et al presented successful nonoperative treatment of 27 avulsion fractures using a 5-phase rehabilitation protocol with full return to sports not until 2 months after injury [3].…”

Section: Discussionmentioning

confidence: 99%

Operative versus conservative treatment of apophyseal avulsion fractures of the pelvis in the adolescents: a systematical review with meta-analysis of clinical outcome and return to sports

Eberbach

Hohloch

Feucht

et al. 2017

BMC Musculoskelet Disord

116

128

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BackgroundAvulsion fractures of the pelvic apophyses typically occur in adolescent athletes due to a sudden strong muscle contraction while growth plates are still open. The main goals of this systematic review with meta-analysis were to summarize the evidence on clinical outcome and determine the rate of return to sports after conservative versus operative treatment of avulsion fractures of the pelvis.MethodsA systematic search of the Ovid database was performed in December 2016 to identify all published articles reporting outcome and return to preinjury sport-level after conservative or operative treatment of avulsion fractures of the pelvis in adolescent patients. Included studies were abstracted regarding study characteristics, patient demographics and outcome measures. The methodological quality of the studies was assessed with the Coleman Methodology Score (CMS).ResultsFourteen studies with a total of 596 patients met the inclusion criteria. The mean patient age was 14.3 ± 0.6 years and 75.5% of patients were male. Affected were the anterior inferior iliac spine (33.2%), ischial tuberosity (29.7%), anterior superior iliac spine (27.9%), iliac crest (6.7%) lesser trochanter (1.8%) and superior corner of the pubic symphysis (1.2%). Mean follow-up was 12.4 ± 11.7 months and most of the patients underwent a conservative treatment (89.6%). The overall success rate was higher in the patients receiving surgery (88%) compared to the patients receiving conservative treatment (79%) (p = 0,09). The rate of return to sports was 80% in conservative and 92% in operative treated patients (p = 0,03). Overall, the methodological quality of the included studies was low, with a mean CMS of 41.2.ConclusionOn the basis of the present meta-analysis, the overall success and return to sports rate was higher in the patients receiving surgery. Especially in patients with fragment displacement greater 15 mm and high functional demands, surgical treatment should be considered.

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Section: Discussionmentioning

confidence: 99%

Operative versus conservative treatment of apophyseal avulsion fractures of the pelvis in the adolescents: a systematical review with meta-analysis of clinical outcome and return to sports

Eberbach

Hohloch

Feucht

et al. 2017

BMC Musculoskelet Disord

116

128

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“…Of the 83 avulsions, 63 (75.9%) occurred in male patients, 4(4.8%) in female patients and 16(19.2%) failed to specify gender. The mean age at the time of injury ranged from 14 19,20 e31.8 years, 22 with a mean age across all studies of 22.2 years. The sporting activities commonly practised were soccer and American football.…”

Section: Patient Characteristicsmentioning

confidence: 99%

“…The mean duration from onset of symptoms until diagnosis ranged from one day 7 to 90 days. 20 The most common reported symptom was pain during hip flexion.…”

Section: Preceding Historymentioning

confidence: 99%

Operative versus conservative treatment of proximal rectus femoris avulsions: A systematic review with meta-analysis of clinical outcomes, complications and return to sports

Dalal

Kotwal

Chandratreya

2021

Journal of Clinical Orthopaedics and Trauma

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Prospero registration number: CRD42020198333. Objective: To compare the surgical and conservative treatment of proximal rectus femoris avulsions regarding clinical outcomes, rate of return to sports and incidence of complications. Design: Systematic review and meta-analysis. Data sources: Cochrane, Medline, Scopus and SPORTDiscus. Eligibility criteria for selecting studies: Studies reporting on outcomes of PRFAs or return to sports were included.Results: Nine studies consisting of a total eighty-two patients met the inclusion criteria. The mean age was 22.2 years and 75.9% of patients were male. Mean follow-up was 28.9 months and 65% avulsions were managed surgically. The overall outcomes were similar in surgical and conservative treatment group (p ¼ 0.72) with similar incidence of complications (14%). The rate of return to sports was 95% in surgical and 92.7% in the conservative management groups (p ¼ 0.93). Overall, the quality of the methodology of included studies was low, with a mean CMS of 45.6. Conclusion: Both conservative and operative treatment provide excellent outcomes in proximal rectus femoris avulsions, with similar rates of return to sports and incidence of complications. More prospective and good quality studies are needed to compare surgical techniques and time to return to sports. Avulsions with retraction of more than 20 mm and high demand patients may benefit from surgical treatment. Patients should be counselled accordingly.

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“…Uzun et al reported nine patients with avulsion fractures of the AIIS who sought treatment at a mean of 3 months after the initial injury. 21 Radiographs, CT, and MRI were performed, and activity modification and physical therapy were initiated. Even in these nine patients conservative treatment led to an excellent outcome, and follow-up radiographs showed a significant decrease in the size of the ossified masses.…”

Section: Anterior Inferior Iliac Spinementioning

confidence: 99%

Diagnosis and Treatment of Apophyseal Injuries of the Pelvis in Adolescents

Singer

Eberl

Wegmann

et al. 2014

Semin Musculoskelet Radiol

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An avulsion fracture occurs when the growth plate of an apophysis is injured due to a sudden and forceful contraction of the attaching musculotendinous unit. Usually it is adolescents who sustain these injuries, and a significant male preponderance has been found. Even though apophyseal fractures have been described in a variety of locations, the apophyses of the pelvis and hip are more prone to these injuries. Due to their rarity, avulsion fractures of the pelvis are often misdiagnosed. Additionally, patients can present late, and other pathologies are suspected initially. In most acute cases conservative treatment is successful. However, some cases require operative intervention. To plan an optimal treatment regimen, it is important to be familiar with the typical pathomechanism, the typical clinical findings, and the most commonly applied imaging modalities of these injures. The present review analyzes the currently available literature on the most frequently encountered apophyseal injuries of the pelvis in adolescent patients. Some case examples are also presented.

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Avulsion Fractures Involving the Straight and Reflected Heads of the Rectus Femoris

Cited by 17 publications

References 12 publications

Operative versus conservative treatment of apophyseal avulsion fractures of the pelvis in the adolescents: a systematical review with meta-analysis of clinical outcome and return to sports

Operative versus conservative treatment of apophyseal avulsion fractures of the pelvis in the adolescents: a systematical review with meta-analysis of clinical outcome and return to sports

Operative versus conservative treatment of proximal rectus femoris avulsions: A systematic review with meta-analysis of clinical outcomes, complications and return to sports

Diagnosis and Treatment of Apophyseal Injuries of the Pelvis in Adolescents

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