Avulsion injuries of the pelvis and proximal femur

Twenty cases of avulsion fractures of the apophyses of the pelvis and proximal femur were reviewed. Most occurred in male adolescents engaged in active sports. Pain, often with little external evidence of trauma, was the most frequent presenting symptom. Conservative, nonsurgical treatment was successful in all the patients. The radiographic appearance of each type of apophyseal injury is demonstrated. Recognition of the initial deformity and of the patterns of repair is important to avoid unnecessary evaluation (tomography, radionuclide scans) and inappropriate therapy. While productive changes with healing are most likely to occur in the region of the ischium, any of the other sites may heal with abundant bone and may mimic neoplasm. In the proper clinical setting, bony changes at these sites should prompt the radiologist to consider a traumatic etiology.