Spring 1982 - Athletic Training History

occurrence of the actual ruptures or avulsions.Following a fracture of this nature, an athlete willusually complain of extreme local pain and tenderness ofthe anterior superior iliac spine. Active hip flexion orpassive flexion of the knee with the hip extended willcause pain directly in the area with the intensitydependent upon individual pain tolerance and severity ofthe avulsion. These two characteristics usuallydifferentiate the fracture from a contusion. Palpation ofthe fragment may be possible, with the fragment as muchas one inch inferior to the attachment of the superior iliacspine. Passive flexion of both the hip and knee oftenrelieves the discomfort. It should be noted also that anavulsion of the tendon only may occur without the bonefragment. 3 Ambulation may be possible, but a definitedeviation will be noted, and more than likely the athletewill not want to walk after attempting a few steps.Treatment of the injury is varied. Conservativetreatment consists of bed rest with the hip and kneeflexed. The hip may also be abducted and/or externallyrotated. Individuals with this condition are allowed to sitwhen they wish, with the thighs being slightly abducted.Ambulation, when initiated, is usually with crutches, nonweight bearing on the involved side.Occasionally an individual is placed in a hip spica cast. Ifnecessary, surgical intervention may be used, internallyfixating the fragment and then applying a spica cast.Robertson 5 has reported such a technique. Recoveryusually takes longer because of the completeimmobilization.Case ReportThis report involves two such injuries, which ironically,occurred on successive nights. One involved a male in highschool track, the other a female also in high school track.Both athletes participated in the same type of event, the440-yard relay. The male was running the third leg of theevent, the female the second leg.Case one was a 16-year-old male, and the incidentoccurred on April 16, 1980 during competition. The injurywas witnessed, and a hamstring strain was suspected asthe athlete "pulled up" after a few running strides. Whenquestioned, the athlete reported that he had warmed up inhis usual manner. However, during his second or thirdstride after receiving the baton, he reported feeling avery sharp pain in the left anterior hip area during stancephase of the left lower extremity. Stance phase is definedas beginning when the heel strikes the ground and endswhen the toe rises at the end of the stride. During runningthis phase is much shorter and more stressful than duringwalking. Palpation of the area revealed point tendernessand pain over the anterior superior iliac spine. The athletewas able to walk with short strides only. He wasinstructed to discontinue competition, go home, and to liesupine with hip and knee flexed and to ice the area with anice bag. If pain persisted, he was told to report to thetrainer/therapist at the hospital the next morning, or, ifthe pain was intense, to contact his family physician. Atthis point in time, the avulsion fracture was not suspectedby the trainer. The pain persisted, and the next morningarrangements were made for x-ray diagnosis and anexamination by his physician. The x-ray (Figure 1)revealed an avulsion fracture of the left anterior superioriliac spine.The athlete was placed on non weight-bearingambulation, using crutches, with no physical therapytreatments ordered, and no external immobilizationutilized. He was able to attend school, but participated inno extra-curricular activities. He resumed normalactivities approximately 6-8 weeks post incident. He didnot participate in any sport other than track, and resumedrunning with no further complications.THE FUTURE ISWITH THE AMERICA'SNATIONAL SCHOOLOF SPORTASSISTANTSHIPS/SCHOLARSHIPSFORTHOSE PEOPLE LOOKINGFOR A CHALLENGINGAND INNOVATIVEMASTER'S PROGRAM IN:SPORT MEDICINEFITNESS MANAGEMENTWrite:Academics or JobsUNITED STATESSPORTS ACADEMYDept. DP. O. Box 8650Mobile, Alabama 36608EEO/AAE58 Athletic Training • Spring 1982Figure 2. The arrow on the right of picture illustrates theavulsion fragment of the anterior superior iliac spine ofsubject #2. The apparent increase in size of this fragmentmay be secondary to the angle of the x-ray.