Proximal hamstring tendon ruptures are rare in children and adolescents. The typical pediatric hamstring injury pattern involves an apophyseal avulsion fracture. We present the case of a 14-year-old male with a widely displaced ischial avulsion fracture and a bony fragment that was too small to allow for bony fixation. The patient presented with left-buttock pain and ecchymosis, as well as tenderness at the ischial tuberosity, following an injury sustained while running 2 weeks prior. Imaging demonstrated an avulsion of the proximal hamstrings with a 4-mm bony fragment, too small to allow for repair. The patient underwent primary repair using two 3-mm suture anchors. The bony fragment was not excised but incorporated into the repair. Although most proximal hamstring injuries in children and adolescents are treated non-operatively, operative treatment may confer a small but clinically important difference in rates of healing and return to play in adolescent athletes. This case demonstrates successful treatment of a proximal hamstring rupture with suture anchor fixation, which may be considered for pediatric and adolescent displaced avulsion fractures when the bony fragment is too small to allow for bony fixation.
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Conflict of Interest
Patrick S. Buckley, MD, declares that he has no conflicts of interest. Christopher C. Dodson, MD, reports being a paid consultant to Arthrex, Inc., during the conduct of the study.
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2013.
Informed consent was obtained from all patients for being included in this case study.
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Work performed at Rothman Institute at Thomas Jefferson University Hospital
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Buckley, P.S., Dodson, C.C. Repair of a Proximal Hamstring Rupture in a 14-Year-Old Patient: A Case Report. HSS Jrnl 14, 302–306 (2018). https://doi.org/10.1007/s11420-018-9620-x
- proximal hamstring
- ischial avulsion fracture
- suture anchor repair