From the Research
The treatment for an ischial tuberosity apophysitis avulsion fracture typically involves conservative management with rest, activity modification, and a gradual rehabilitation program, with surgical intervention considered for cases with significant displacement (>1.5cm) 1. The initial management should include the RICE protocol (rest, ice, compression, elevation) and NSAIDs like ibuprofen (400-600mg three times daily with food) for pain and inflammation.
- Complete rest from sports is necessary for 2-6 weeks, depending on fracture severity.
- Physical therapy should begin after acute pain subsides, focusing first on gentle stretching of hamstrings, then progressing to strengthening exercises and sport-specific training.
- Return to contact sports is generally permitted when the patient has full, pain-free range of motion, normal strength (compared to the unaffected side), and radiographic evidence of healing, which typically takes 3-4 months. The most recent and highest quality study 1 suggests that surgical refixation or restoration of apophyseal avulsion fractures of the ischial tuberosity results in good to excellent outcomes and return to sport rates, with prompt diagnosis and timely intervention being more promising than delayed interventions in chronic cases.
- The study recommends surgical intervention for cases with fragment displacement beyond 1.5 cm.
- The majority of adolescents (10/11) in the study were able to return to their pre-injury sports, whereas 63.6% achieved full or nearly full level, with a mean post-operative PHAT score of 86.9 (0-100, SD ± 11.9), indicating good to excellent functional outcomes.