Abstract
We report a case of a 21-year-old male with massive hypertrophic ischial tuberosity non-union. Among multiple other lesions, the patient suffered an open avulsion of the ischial tuberosity in a severe traffic accident in adolescence. A conservative treatment was decided for the avulsion. Because of sciatic pain and difficulties while sitting since the age of 19, X-rays were realised and showed a massive hypertrophic non-union of the ischial tuberosity. To preserve hamstring origin with bone attachment, the non-union was mobilised, reduced by osteotomy and fixed by plate and screws. At the follow up of one year, the patient sits without pain and can work without interruption. Avulsion of the ischial tuberosity is infrequent and the diagnosis is often missed (Gidwani et al., BMJ 329:99–100, 2004; Hamada, Clin Orthop 31:117–130, 1963). This lesion is more often seen in adolescence as the consequence of a sport injury (Gidwani et al., BMJ 329:99–100, 2004). Treatment is generally conservative and outcome good. Surgical therapy is only needed in cases with severe displacement. Long-term problems are seldom and surgical therapy to solve these problems is the exception.
References
Gidwani S, Jagiello J, Bircher M (2004) Avulsion fracture of the ischial tuberosity in adolescents: an easily missed diagnosis. BMJ 329:99–100
Hamada G, Rida A (1963) Ischial apophysiolysis (IAL): report of a case and a review of the literature. Clin Orthop 31:117–130
Martin TA, Pipkin G (1957) Treatment of avulsion of the ischial tuberosity. Clin Orthop 10:108–118
Wootton JR, Cross MJ, Holt KWG (1990) Avulsion of the ischial apophysis. The case for open reduction and internal fixation. J Bone Joint Surg Br 72:625–627
Akova B, Okay E (2002) Avulsion of the ischial tuberosity in a young soccer player: six years follow-up. J Sports Sci Med 1:27–30
Miller A, Stedman GH, Beisaw NE et al (1987) Sciatica caused by an avulsion fracture of the ischial tuberosity. J Bone Joint Surg 69(1):143–145
Spinner RJ, Atkinson JL, Wenger DE et al (1998) Tardy sciatic nerve palsy following apophyseal avulsion fracture of the ischial tuberosity: case report. J Neurosurg 89:819–821
Dosani A, Giannoudis PV, Waseem M et al (2004) Unusual presentation of sciatica in a 14-year-old girl. Injury 35:1071–1072
Kaneyama S, Yoshida K, Matsushima S, Wakami T, Tsunoda M, Doita M (2006) A surgical approach for an avulsion fracture of the ischial tuberosity: a case report. J Orthop Trauma 20(5):363–365
Barnes ST, Hinds RB (1972) Pseudotumor of the ischium. A late manifestation of avulsion of the ischial epiphysis. J BoneJoint Surg (Am) 54:645–647
Milch H (1935) Partial resection of the ischium. J Bone Joint Surg 17:166
Schlonsky J, Olix ML (1972) Functional disability following avulsion fracture of the ischial epiphysis: a report of two cases. J Bone Joint Surg Am 7:615–624
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Putman, S., Rommens, P.M. A case of hypertrophic ischial tuberosity non-union treated by closed wedge osteotomy and plate and screws fixation. Arch Orthop Trauma Surg 133, 513–516 (2013). https://doi.org/10.1007/s00402-013-1695-8
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-013-1695-8