Spring 1982 - Athletic Training History

Case two involved a 15-year-old female, and the injuryoccurred during track competition on April 17, 1980. Thetrack meet was held in another community, and followingher injury, the athlete was transported to a local hospitalby ambulance. The mechanism of her injury was similar tothat of the young man in the previous case (above) in thatit occurred as she was in the stance phase of the left lowerextremity. She too felt the sudden sharp pain in heranterior hip. However, this athlete was unable to walkand required hospitalization. Figure 2 is a view of her x-ray.Hospitalization continued for several days aftertransfer back to the facility near her home. Managementof the condition consisted of bed rest. When ambulationwas initiated, no weight was placed on the left lowerextremity and crutches were also used as the ambulationassistive device. After 6-8 weeks she, too, was allowed toresume activities, and five months later she wasperforming her activities as a cheerleader. Following thecheerleading season she did attempt to return to her trackactivities, but since has discontinued track participationbecause of a burning sensation in the area of the anteriorsuperior iliac spine.DiscussionAvulsion fractures of the anterior superior iliac spinemay occur in any athlete. However, because of its growthrelatedness, individuals involved with high schoolathletics should suspect this injury with any type oftrauma to this anatomical area. Proper treatment by thetrainer could alleviate discomfort of the athlete prior toexamination by the team and/or family physician. Atminimum, and dependent upon pain, the trainer shouldapply an ice pack to the area, and place the hip and knee inslight flexion. Transportation of choice is by stretcher. Ifthis is not available, non weight-bearing crutchambulation or assistance by two other athletes allowingnon weight-bearing on the involved extremity may beutilized. A hip spica using an ace bandage or bandagesmay be utilized for limiting mobility prior to seeing thephysician, especially if any length of time before physiciancare is anticipated. Any sensory loss should be welldocumented and the wrap should never impede circulationto the extremity.Caution should be taken with the extremelycompetitive athlete who might consider the injury amuscle pull that can be "walked off. The injury shouldnot be confused with a groin pull as the discomfort is toofar superior and lateral for a groin injury. A spica wrapmight be utilized for assistance once the athlete has beencleared by his/her physician, or when they are allowed tostart weight bearing activities. Dependent upon theathlete, follow-up treatment may be initiated using eitherwhirlpool or hydrocollator packs prior to range of motionexercises. Rehabilitation, utilizing progressive resistiveexercises, should also be considered at a later date. Ifsurgical intervention is necessary, a routine of isometricexercises would benefit and retard atrophy. Any form ofrehabilitation should be preceded by a physician's order.SummaryAvulsion fractures of the anterior superior iliac spineare not a common injury in sports. They do occur inathletes in the prepuberty stage more than in matureathletes, and occurrence can often be detected by theathletic trainer.These two case reports may provide moreunderstanding and insight into the injury that is usuallycaused by a sudden forceful contraction of the sartoriusmuscle. It is important that those coaches, teachers,school nurses, trainers, and family physicians dealingwith the young athlete recognize the severity of thisinjury and not classify it as simply another pulled musclewhich can be "walked off. +References1. Gray H: Anatomy of the Human Body. 28th edition.Philadelphia, Lea and Febigar, 1971, pp. 238, 495-496, 501-502.2. Krusen FA: Handbook of Physical Medicine andRehabilitation. Philadelphia, WB Saunders Co., 1971, pp. 92.3. O'Donoghue DH: Treatment of Injuries to Athletes. 2ndedition. Philadelphia Saunders, 1970, pp. 446-447.4. Orva S, Ala-Ketola L: Avulsion Fractures in Athletes,British Journal of Sports Medicine, 11: 65-71,1977.5. Robertson RC: Fractures of the Anterior Superior Spine ofthe Ilium, Journal of Bone and Joint Surgery, 17(4): 1045-1048,1935.6. Rockwood CA, Green DP: Fractures. Philadelphia, J.B.Lippincott, 1975, pp. 926-927.Athletic Training • Spring 1982 59