Delayed Diagnosis of an Ischial Tuberosity Avulsion Fracture in a Young Gaelic Football Player

Abstract

Presentation
Ischial tuberosity avulsion fractures account for a minority of pelvic apophyseal injuries in adolescents but are frequently misdiagnosed as hamstring strains. We report one case of delayed diagnosis following a Gaelic Football Injury.

Diagnosis
A male teenaged footballer player developed persistent right buttock pain after kicking the ball at full sprint. Initial management was conservative for presumed hamstring strain. After two years of persistent pain and inability to sprint, he was referred for an Orthopaedic opinion. He had persistent focal bone tenderness over the ischium bone. Plain radiographs of the pelvis demonstrated an avulsion fracture of the ischial tuberosity, displaced over 2 cm.

Treatment
Open reduction and internal fixation with screw stabilisation and autologous bone grafting was performed. The patient returned to sport at three months. At follow up after one year he was asymptomatic, plain radiograph showed bone healing and he was discharged.

Discussion
Apophyseal avulsion fractures are uncommon. Failure to diagnose early may lead to a non union and failure to return to sport. Persistent buttock pain in adolescent athletes warrants early radiographic evaluation. Fractures displaced more than 2 cm may benefit from operative fixation to facilitate return to sport.