Spring 1982 - Athletic Training History

Case Report:Avulsion Fractures of theAnterior Superior Iliac Spinein High School TrackMark Lee Miller, BS, RPTIntroductionIndividuals participating in athletic events andindividuals working with athletes know that the humanbody must be pushed to its limits in order to improveor excel. However, when doing this, athletes subject theirbodies to possible traumas, and increase their odds ofsustaining an injury as compared to less sedentary andnon-athletic individuals.Certain athletic injuries are common to all sports,whereas other injuries occur in much higher incidence inspecific sports. Age of individuals also has a bearing onthe type and frequency of injury. This case report onavulsion fractures of the anterior superior iliac spineinvolves both of these two common characteristics—aspecific sport and the age of the individuals. Avulsionfractures of the anterior superior iliac spine are of ahigher incidence in adolescent athletes and are morerelated to springing and/or kicking sports.It is the intent of this author to report on and to educatethose involved in athletic training to a not so commonathletic injury—one that can often be correctly assessedby the trainer prior to roentgenological and physiciandiagnosis.The avulsion usually occurs following an unusuallysudden forceful muscular contraction of the sartorius ortensor fascia lata in a running or jumping event. 3 It ispeculiar to those sports of the sprinting or hurdlingnature, soccer, football kicking or punting, andoccasionally high jumping and pole vaulting. In a study byOrva and Ala-Ketola 4 of thirty-four individuals withdiagnosis of avulsion fractures, nine of the injuries wereto the anterior superior iliac spine. Also noted as the factthat some of the fractures were not instantaneous, asathletes felt pain at the fracture site before theReview of LiteratureThe anterior superior iliac spine is the bony attachmentor origin for the tensor fascia lata and the sartoriusmuscle. The sartorius, the longest muscle of the body, is aflexor of the hip and knee and is a secondary externalrotator of the hip. It arises from the extreme portion ofthe anterior superior iliac spine, and inserts into theproximal part of the medial surface of the tibia. 1 Thetensor fascia lata causes flexion of the hip and someinternal rotation to occur upon contraction. Its origin is onthe outer border of the anterior superior iliac spine, withinsertion between the two layers of the iliotibial band ofthe fascia lata. 1Review of the literature reveals little information oninjury of this specific area. Rockwood and Green 6 statethat, until 1935, as few as 50 cases of avulsion fractures ofthe anterior superior iliac spine were reported. Most ofthe medical literature reports are of athletes in the mid tolate teen group, as this is the approximate age that theiliac crest unites with the ilium.Mr. Miller is Director of Physical Therapy at St. Mary'sHospital, Streator, Illinois 64364, and is currently a graduatestudent at Illinois State University, completing the curriculumfor an MS in Health, Physical Education, Recreation — AthleticTraining.Figure 1. The arrow in the center of the pictureillustrates the avulsion fragment of the anterior superioriliac spine of subject #1. All other bony structures arenormal.Athletic Training • Spring 1982 57