From the Guidelines
Iliac crest apophysitis with avulsion fracture should be treated with simple immobilization when fracture fragments are small, nonarticular, or minimally displaced. This approach is based on the principle of minimizing further injury and allowing the bone to heal naturally, as suggested by the American College of Foot and Ankle Surgeons 1. The diagnosis of iliac crest apophysitis with avulsion fracture is typically made based on a history of trauma and focal pain on palpation, confirmed with radiographic studies.
Key considerations in managing this condition include:
- Relative rest from aggravating activities to reduce stress on the affected area
- Pain control with NSAIDs, such as ibuprofen or naproxen, for 1-2 weeks
- Gradual rehabilitation with gentle stretching and strengthening exercises after acute pain subsides
- Progressive return to activities over 6-12 weeks, guided by pain levels
It's essential to note that surgery is usually reserved for cases where the fracture fragment is significantly displaced or symptoms persist despite conservative management, as indicated by the American Family Physician study 1. By prioritizing conservative treatment and immobilization when appropriate, patients can expect to recover fully within 3-6 months, with most making a full return to activities within this timeframe.
From the Research
Iliac Crest Apophysitis with Avulsion Fracture
- Iliac crest apophysitis with avulsion fracture is a rare condition that commonly occurs in adolescent athletes 2, 3, 4.
- The fracture can occur due to forceful contraction of attached muscles during high-level sporting activities 5.
- The diagnosis is typically made on the basis of radiographs of the pelvis, which show an avulsion fracture of the iliac crest 2, 3, 4.
Treatment Options
- Conservative treatment with nonsteroidal anti-inflammatory drugs and rest can produce excellent functional outcomes, but may require a long immobilization period 2, 6.
- Open reduction and internal fixation can be recommended for patients requiring rapid rehabilitation, with good results reported in several studies 3, 6.
- The use of cannulated screws for fixation of avulsion fractures of iliac crest apophysis has been shown to be effective, with patients returning to normal activity without pain or complications 6.
Patient Outcomes
- Patients with iliac crest apophysitis with avulsion fracture can expect to return to preinjury physical activity levels within 2-4 months after treatment, whether conservative or operative 2, 3, 6.
- The rehabilitation process can be lengthy, but with proper treatment, patients can resume their athletic activity without any complications 2, 3, 6.