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Classifying Ischial Tuberosity Avulsion Fractures by Ossification Stage and Tendon Attachment.

Brendon C Mitchell1, James D Bomar2, Dennis R Wenger2

  • 1Department of Orthopaedic Surgery, University of California San Diego , San Diego , California.

The Journal of Bone and Joint Surgery. American Volume
|March 16, 2021
PubMed
Summary

A new classification system for adolescent ischial tuberosity fractures, based on apophysis ossification, helps predict nonunion risk. This system considers skeletal maturity, fracture characteristics, and involved tendons for better patient outcomes.

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Area of Science:

  • Orthopedic Surgery
  • Pediatric Orthopedics
  • Radiology

Background:

  • Ischial tuberosity avulsion fractures commonly occur in adolescents.
  • Existing classification systems may not fully capture fracture characteristics or predict outcomes.
  • A novel approach is needed to classify these injuries based on developmental patterns.

Purpose of the Study:

  • To propose and validate a new classification system for ischial tuberosity fractures in adolescents.
  • To correlate fracture patterns with skeletal maturity, displacement, size, and tendon involvement.
  • To assess the system's ability to predict nonunion rates.

Main Methods:

  • Retrospective review of 45 adolescent ischial tuberosity avulsion fractures (2008-2018).
  • Classification based on fracture location (Type 1: lateral, Type 2: complete) and pelvic CT-assessed ossification stages.
  • Radiographic and advanced imaging (CT/MRI) analysis of fracture characteristics and tendinous insertions.

Main Results:

  • Type 1 fractures were associated with younger age, lower skeletal maturity scores, less displacement, and smaller size compared to Type 2.
  • Nonunion occurred in 56% of fractures, associated with greater displacement and size.
  • Type 2 fractures showed a higher nonunion rate (78%) than Type 1 (33%), though not statistically significant.

Conclusions:

  • A new classification system based on ischial tuberosity apophysis ossification patterns is proposed.
  • This system correlates with skeletal maturity, fracture characteristics, and involved tendons (semimembranosus, conjoined, adductor magnus).
  • The proposed classification may predict nonunion probability in adolescent ischial tuberosity fractures.