Treatment of pelvic avulsion fractures in children and adolescents

Introduction Paediatric avulsion fractures of the pelvis and hip joint are rare injuries most commonly associated with a rapid muscle contraction of the respected apophysis, which is the weakest component of the growing skeleton. The chosen therapy option can be either conservative or surgical. Methods We present a cohort of 69 patients treated for an apophyseal avulsion fracture of the anterior superior / inferior iliac spine, the lesser and greater trochanters iliac crest and the ischial tubercle. We compared the treatment outcomes, treatment time, need for immobilisation, and complications of conservative vs. surgical treatment. Results The mean time to mobilisation was 24.5 days in the conservative and 8.5 days in the surgical group of patients. In the group of surgically treated patients, healing signs were observed as early as in week 6. As of month 4, no difference was observed between the groups in terms of the clinical and radiological outcomes. Conclusions The treatment outcomes of both methods are comparable in the long term. Surgery is indicated in dislocations exceeding 1 cm. Faster recovery and return to sports activities is the main advantage of the surgical treatment method. Disadvantages include the necessity of general anaesthesia as well as the risk of infection and the need of the osteosynthetic material removal. The choice of the treatment method remains individual depending on the type of injury and habitual practice of the centre.Key words: avulsion fracture - child - pelvis - treatment - outcome.