Avulsion Fracture of Ischial Tuberosity

The ischium is the sturdiest bone of the pelvis, extending to the buttock where you can feel the bone like a bump. This section of the ischium is known as the ischial tuberosity, to which the hamstring muscles connect.

Symptoms

Sharp pain in the groin or buttock areas which can be chronic. This can feel debilitating, with sitting down becoming impossible without great pain and walking also being impaired. Joggers or runners may find that they cannot run. A lot of this is a result of the fracture weakening the hamstring muscles. The area around the fracture can become inflamed and will feel tender when touched. Moving the legs under weight or other pressure can be significantly difficult. The symptoms will be worse the longer the injury has gone undiagnosed (or in some cases been misdiagnosed).

Causes

These kinds of fractures are provoked due to abrupt hamstring movements that excessively stretch or contract the muscle and thus place inordinate strain on the ischial tuberosity. A common motion resulting in such a fracture is to flex the hip too far (such as by twisting the upper body) while the leg is fully straightened. This frequently occurs in gymnastics and in football where simultaneous hip and leg movements are crucial. Track athletes such as hurdlers, jumpers and runners can also sustain the injury.

Age

An important factor is the age of the sportsperson. The apophysis is part of the ischial tuberosity and the part which generally allows the avulsion fracture to take place. When the relatively weak apophysis eventually becomes harder bone, the incidence of these fractures is greatly reduced. It is usually strengthened in this way at the end of adolescence, and so it is people aged 15 to 18 who are most affected by these fractures. However a significant number of fractures still occur in people up to the age of 25. Beyond this age, symptoms similar to an ischial tuberosity fracture are more likely to point to a hamstring soft tissue injury.

Medical Treatment

Consult a doctor who will take an x-ray and other relevant tests such as a CT scan. Depending on the severity of the fracture the doctor will recommend non-surgical or surgical treatment. Surgery is particularly probable if the injury has affected the sciatic nerve.

Non-surgical treatment will involve a period of rest, being careful not to perform any activities that could further worsen the injury. You should ice the area a few times per day in order to relieve pain and swelling symptoms, and anti-inflammatory pain medication can also be helpful. When the pain has diminished a program of physical therapy will seek to gradually restore full movement and strength to the hips and legs.

However, sometimes this treatment fails to fix the bone. This can result in ongoing pain and problems for athletes due to a lack of restored motion. In this case surgery is the best option, and generally athletes are advised to undergo surgery if other treatment fails for longer than a month.