Surgical Treatment of a Young Athlete with Displaced Avulsion Fracture of the Anterior Superior Iliac Spine (ASIS)

Abstract

Introduction: Avulsion fractures of the anterior superior iliac spine are uncommon without established treatment guidelines. Deciding between nonoperative versus surgical management depends on the grade of displacement, skeletal maturity, type of sport/activity, and competitive/ career requirements. Methods: We present a young athlete who sustained an ASIS avulsion fracture while playing baseball that was treated with open surgical reduction and fixation using absorbable sutures with an emphasis on mobilizing the TFL to reapproximate the avulsed segment without tension. Results: The patient was started on a progressive physical therapy protocol that did not involve any weight-bearing or range of motion restrictions. He was jogging in the third postoperative week and returned to full-play in the 6th week. As of 12 months postop, there were no complications and he is playing at his pre-injury level of performance without pain. Conclusion: Operative treatment of avulsion fracture of the ASIS without bone anchors or screws highlights the importance of soft tissue mobilization and reduction of tension. Additionally, the relatively rapid return to activities and lack of immobilization minimizes deconditioning, which might be an advantage over non-operative management. Athletes with ASIS avulsion fractures repaired with this technique can expect to return to play within 6 weeks.