info on An avulsion fracture

fatpup,

There are several places about the pelvis in which avulsion fractures may occur. Most often it is located at the ischium, the anterior iliac spines, off the anterior acetabular rim, or the trochanters. This is commonly seen in adolescents who still have open apophyses. It is caused by an explosive contracture of the muscle attaching at that point, so this is often seen in sprinters, jumpers, or kickers and also in a slip or fall as the person tries to catch him or herself.

These are treated nonoperatively if the fragment is not too far displaced. If the distance is too great for the body to heal the fragment back to the donor site, then surgery is done to reattach the fragment (if large enough) or to resect the fragment and attach the tendon to the bone. It is preferable to get bone to bone healing if possible.

The fragment is kept alive by blood from the soft tissue attachment. Usually, the fragment heals back to the bone from which it was avulsed. In rare cases, the fragment reattaches, but never fully ossifies the connection. Thus, there is a fibrous union. If the patient is not having any problems, then it is left alone.

However, if the patient is having pain from the fibrous union or there is a tardy nerve palsy, then after weighing the risks and benefits, surgery may be done to, usually, resect the fragment. If the fragment is large enough that the fibrous tissue can be taken down and the fragment reattached, then that may be done.


So, since it has been 20 years since the injury, the present status of the fragment is what you'll most likely also have in the next 20 years. If it is not bothering you, leave it alone. Otherwise, talk to your orthopedic surgeon about your options.

Good luck.