Pelvic avulsion fracture

Background

• Isolated, closed avulsion fracture of pelvis or single-bone
• Trauma may be very minor (e.g. fall from seated) in elderly or those with weakened bones
• Sports-related avulsion fractures are most common pelvic injuries in children

Pelvic fracture types

The skeleton of the human pelvis: 1. Sacrum; 2. Ilium; 3. Ischium; 4. Pubic bone (4a. corpus, 4b. ramus superior, 4c. ramus inferior, 4d. tuberculum pubicum); 5. Pubic symphysis, 6. Acetabulum (of the hip joint), 7. Foramen obturatum, 8. Coccyx/tailbone; Dotted. Linea terminalis of the pelvic brim.

Pelvis anatomy, medial view.

Pelvis anatomy, lateral view.

• Acetabular pelvic fractures
• Open book pelvic fracture
• Straddle pelvic fracture
• Pelvic avulsion fracture

Clinical Features

• History of trauma
• Pain/point tenderness over iliac crests, pubic rami, sacrum, or coccyx

Differential Diagnosis

Abdominal Trauma

• Abdominal compartment syndrome
• Diaphragmatic trauma
• Duodenal hematoma
• Genitourinary trauma
• Liver trauma
• Pelvic fractures
  • Acetabular pelvic fractures
  • Open book pelvic fracture
  • Straddle pelvic fracture
  • Pelvic avulsion fracture
• Retroperitoneal hemorrhage
• Renal trauma
• Splenic trauma
• Trauma in pregnancy
• Ureter trauma

Hip pain

Acute Trauma

• Femur fracture
  • Proximal
    • Intracapsular
      • Femoral head fracture
      • Femoral neck fracture
    • Extracapsular
      • Intertrochanteric femur fracture
      • Trochanteric femur fracture
  • Shaft
    • Mid-shaft femur fracture (all subtrochanteric)
• Hip dislocation
• Pelvic fractures
  • Acetabular pelvic fractures
  • Open book pelvic fracture
  • Straddle pelvic fracture
  • Pelvic avulsion fracture

Chronic/Atraumatic

• Hip bursitis
• Psoas abscess
• Piriformis syndrome
• Meralgia paresthetica
• Septic arthritis
  • Septic arthritis of the hip (peds)
• Obturator nerve entrapment
• Avascular necrosis of hip

Evaluation

Avulsion fracture of: (1) Iliac wing (Duverney fracture) (2) Superior pubic ramus (3) Inferior pubic ramus (4) Transverse sacral (5) Coccyx fracture. (6) Anterior superior iliac spine (7) Anterior inferior iliac spine (8) Ischial tuberosity

• Pelvic X-ray, CT pelvis
• Assess for other injuries and more severe fracture

Management

• Do not disrupt pelvic ring, do not usually require surgery
• Analgesia
• Crutches, non-weight-bearing status
• Outpatient orthopedic follow-up

Disposition

• Discharge if pain controlled and able to safely manage at home with mobility limitations

See Also

• Pelvic fractures