Arthroscopic management of the nonunion avulsion fracture of ischial tuberosity for a teenager dancer: a case report

The avulsion fracture of the ischial tuberosity is uncommon and relatively specific in children or teenagers. Without proper imaging and/or clinical suspicion, this injury can be mismanaged and cause nonunion or displacement of the bony avulsion, which may require surgery. Although surgical intervention is rarely necessary, it has a high degree of success when it is used. Several minimally invasive interventions have been reported, but there are no arthroscopic techniques in the literature for reference. Here we report an unusual case of nonunion avulsion fractures of ischial tuberosity in a 19-year-old male dancer. The injury was missed initially and delayed for 5 years. Under hip arthroscopy, we removed the nonunion bone and repaired the insertion of the hamstring tendon. The patient was satisfied and returned to sports within 6 months. Although there is only one patient, this is the first time that the arthroscopic technique has been introduced to treat this unusual injury. All experiences based on this case, including positioning, approach, intraoperative targeting, manipulation and tendon fixation, and a brief review will be present.