Avulsion fracture of the ischial tuberosity: Is the current evidence sufficient to resolve the challenges of treatment selection?

Abstract

Avulsion fracture of the ischial tuberosity (AFIT) is a clinically rare injury that primarily occurs in adolescents participating in competitive sports. AFIT can be challenging to diagnose and manage due to its subtle presentation and the potential for misdiagnosis. Selecting an appropriate treatment method remains challenging due to the lack of universally accepted, evidence-based treatment guidelines for optimal management. A review of the relevant literature indicated that AFIT exhibits more complex healing patterns than other pelvic avulsion fractures with conservative management, and also that the outcomes of AFIT following the surgical treatment of chronic cases are often not as favorable as those of acute cases. Therefore, clinicians should increase their awareness of this type of fracture and consider aggressive surgical intervention in patients with displaced AFIT to ensure optimal outcomes and expedite their return to pre-injury athletic performance levels.

Keywords: Avulsion fracture of the ischial tuberosity; Treatment selection; Conservative management; Surgical intervention; Pelvic avulsion fracture

Core Tip: Avulsion fracture of the ischial tuberosity (AFIT) is a clinically rare injury mainly incurred by adolescents during competitive sports. AFIT is frequently misdiagnosed as a tendon tear or muscle strain and selecting an appropriate treatment method remains challenging due to the absence of evidence-based treatment guidelines. A literature review indicated that AFIT exhibits more complex healing patterns than other pelvic avulsion fractures under conservative management. Clinicians should increase their awareness of this type of injury. Aggressive surgical intervention is suggested for patients with displaced AFIT to ensure optimal outcomes and expedite their return to pre-injury athletic performance levels.