An Iliac Crest Avulsion with Meralgia Paresthetica in a Child: A Case Report

This case report details an unusual presentation of an iliac crest (IC) avulsion fracture in a 15-year-old male, complicated by meralgia paresthetica (MP), despite no involvement of the anterior superior iliac spine (ASIS). IC avulsion fractures are rare, occurring in only 6.7% of pelvic avulsion fractures (PAF). They are rarely associated with MP, which typically correlates with ASIS injuries due to the proximity of the lateral femoral cutaneous nerve (LFCN).

This case suggests a potential anatomical variation where the LFCN may traverse posteriorly to the IC, explaining the MP without ASIS involvement. The patient fully recovered with conservative treatment within 1 month, indicating that the MP symptoms likely resulted from localized inflammation rather than direct nerve injury.

This case highlights the need for awareness of rare anatomical variations and their impact on clinical presentation, reinforcing the importance of a thorough physical examination. Prompt diagnosis is crucial, and while conservative management is effective for minimally displaced fractures, ongoing debates exist regarding surgical intervention criteria. Future research should focus on refining treatment guidelines for pediatric PAF and exploring anatomical variations to understand better and manage atypical symptoms.