Pediatric Radiology

, Volume 42, Issue 11, pp 1357–1363 | Cite as

MRI of radiographically occult ischial apophyseal avulsions

  • Arthur B. Meyers
  • Tal Laor
  • Andrew M. Zbojniewicz
  • Christopher G. Anton
Original Article

Abstract

Background

Acute avulsions of unossified ischial apophyses in children may go undetected on radiography. Therapy includes rest and rehabilitation; however, substantial displacement may require surgery.

Objective

Our purpose is to illustrate the utility of MRI in the detection of these radiographically occult injuries in skeletally immature children.

Materials and methods

This retrospective study of more than 5 years included children with ischial avulsions who were evaluated with both radiography and MRI within 3 weeks of acute injury. Initially, radiographs were reviewed to identify those children with unossified ischial apophyses. Subsequently, their MRI examinations were assessed for physeal disruption, bone/soft tissue edema, periosteal/perichondrial elevation and disruption. Initial and follow-up radiographs (if available) were reviewed. Patient age, symptoms and offending activity were determined from clinical records.

Results

Five children met inclusion criteria. All initial radiographs were normal. MRI showed: edema (n = 5), periosteal elevation (n = 4), periosteal/perichondrial disruption (n = 4), >5.5 mm displacement (n = 0). Follow-up radiographs in two children (2 and 2.5 months from MRI) showed osseous ischial irregularity. The apophyses remained unossified.

Conclusions

Acute unossified ischial apophyseal avulsions in children may be radiographically undetected. In the setting of correlative clinical symptoms, MRI can be used to identify these injuries and to help direct appropriate therapy.

Keywords

Ischium Avulsion Pelvis Trauma Children 

Notes

Conflict of interest

The authors declare no conflict of interest.

References

  1. 1.
    Robinson RJ, Robinson P (2011) Pelvis and groin. In: Baert AL (ed) Sports injuries in children and adolescents. Springer, Berlin Heidelberg, pp 145–162Google Scholar
  2. 2.
    Petersilge CA (2008) Hip. In: Pedowitz RA, Chung CB, Resnick D (eds) Magnetic resonance imaging in orthopedic sports medicine. Springer, New York, pp 273–312CrossRefGoogle Scholar
  3. 3.
    Gidwani S, Bircher MD (2007) Avulsion injuries of the hamstring origin—a series of 12 patients and management algorithm. Ann R Coll Surg Engl 89:394–399PubMedCrossRefGoogle Scholar
  4. 4.
    Davis KW (2008) Imaging of the hamstrings. Semin Musculoskelet Radiol 12:28–41PubMedCrossRefGoogle Scholar
  5. 5.
    Martinoli C, Valle M, Malattia C et al (2011) Paediatric musculoskeletal US beyond the hip joint. Pediatr Radiol 41(Suppl 1):S113–S124PubMedCrossRefGoogle Scholar
  6. 6.
    Koulouris G, Connell D (2003) Evaluation of the hamstring muscle complex following acute injury. Skeletal Radiol 32:582–589PubMedCrossRefGoogle Scholar
  7. 7.
    Davis KW (2010) Imaging pediatric sports injuries: lower extremity. Radiol Clin North Am 48:1213–1235PubMedCrossRefGoogle Scholar
  8. 8.
    Zieger M, Dörr U, Schulz RD (1987) Sonography of slipped humeral epiphysis due to birth injury. Pediatr Radiol 17:425–426PubMedCrossRefGoogle Scholar
  9. 9.
    Jaramillo D, Connolly SA, Mulkern RV et al (1998) Developing epiphysis: MR imaging characteristics and histologic correlation in the newborn lamb. Radiology 207:637–645PubMedGoogle Scholar
  10. 10.
    Paluska S (2005) An overview of hip injuries in running. Sports Med 35:991–1014PubMedCrossRefGoogle Scholar
  11. 11.
    Gidwani S, Jaqiello J, Bircher M (2004) Avulsion fracture of the ischial tuberosity in adolescents—an easily missed diagnosis. BMJ 329:99–100PubMedCrossRefGoogle Scholar
  12. 12.
    Kocher MS, Tucker R (2006) Pediatric athlete hip disorders. Clin Sports Med 25:241–253PubMedCrossRefGoogle Scholar
  13. 13.
    Yamamoto T, Akisue T, Nakatani T et al (2004) Apophysitis of the ischial tuberosity mimicking a neoplasm on magnetic resonance imaging. Skeletal Radiol 33:737–740PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Arthur B. Meyers
    • 1
    • 2
  • Tal Laor
    • 1
  • Andrew M. Zbojniewicz
    • 1
  • Christopher G. Anton
    • 1
  1. 1.Department of Radiology, MLC 5031Cincinnati Children’s Hospital Medical CenterCincinnatiUSA
  2. 2.Children’s Hospital of WisconsinMilwaukeeUSA

Personalised recommendations