Iliac Epiphyseal Avulsion Repair Using a Suture Bridge and Lag Screw Construct

Apophyseal avulsion fractures in adolescents are not uncommon, particularly among young athletes participating in explosive sports. Typically, avulsion fractures around the pelvis occur associated with a forceful eccentric contraction, in which a tendon avulses its osseous origin from the underlying apophysis. An atypical or less commonly encountered avulsion fracture pattern involves the apophysis from the iliac wing extending distally to include the anterior superior iliac spine. This fracture pattern is subject to deforming forces from varying directions, which must be considered during fixation, as these are the attachment sites for both abdominal muscles and the origin of the sartorius. This Technical Note details a reduction and fixation technique for the treatment of an iliac apophyseal avulsion fracture. This approach leverages double-loaded anchors in the ilium in a suture-bridge construct, combined with lag screw boney compression and fixation. This hybrid approach addresses deforming forces from the abdominal musculature and sartorius while respecting soft tissue attachments and anatomic fracture fixation principles.