Endoscopic Repair of Ischial Tuberosity Avulsion Fracture

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Pediatric Orthopedics

Background:

• Ischial tuberosity apophysis is a hamstring attachment site in pediatric pelvis.
• Ossification around 13-15 years makes the physis the weakest point, leading to fractures in adolescents.
• These fractures are equivalent to adult 3-tendon proximal hamstring injuries and have high non-union rates.

Purpose of the Study:

• To describe an endoscopic surgical technique for treating ischial tuberosity avulsion fractures in adolescents.
• To highlight the advantages of minimally invasive surgery over traditional open procedures.

Main Methods:

• Patient positioned prone under fluoroscopic guidance with two endoscopic portals.
• Sciatic nerve visualized, neurolysed, and protected.
• Avulsed apophysis and hamstring tendon identified, bony surfaces prepared, and fragment reduced.
• Percutaneous fixation using three partially threaded cannulated screws.
• Interval between semimembranosus and conjoined tendons closed with suture.

Main Results:

• No specific outcome results published for this endoscopic technique.
• Cohort studies indicate significant displacement increases non-union risk.
• Displaced fractures may risk sciatic nerve irritation and decreased hamstring strength.

Conclusions:

• Endoscopic surgery enables minimally invasive treatment of ischial tuberosity avulsion fractures.
• The technique achieves robust fixation and anatomical repair of hamstring origin.
• This approach avoids large incisions and extensive soft tissue dissection, offering potential advantages over open procedures.