Pelvis avulsion fractures

Pelvis avulsion fractures

Mitsutoshi Hayashi

Mitsutoshi Hayashi

Doctor of Medicine, specialist in the Japanese Society of Rehabilitation Medicine, specialist in the Japanese Society of Orthopaedic Surgery, specialist in the Japanese Society of Rheumatology, staff to strengthen JOC, and sports physician certified by the Japan Sports Association

Doctor’s Edition

Pelvis avulsion fracture is a sports disorder that tends to develop during growing season

Disease Overview


Pelvis avulsion fracture is a sports disorder that tends to develop during growth periods of weak bones, but they are not common. Tensor fasciae latae and sartorius muscle are attached to the anterior superior iliac spine of the ilium in the pelvis, and quadriceps muscle (rectus) is attached to the anterior inferior iliac spine (Figure.). Some of these muscles can tear (fracture) part of the pelvis because sports-induced muscle movements, such as kicking, can rapidly pull on the pelvis attachments.

Pelvis row abscission fracture 1

Photo: X-ray; pelvis avulsion fracture seen in lateral view, inferior anterior iliac spine


Pelvis row abscission fracture 3

Graphic Anatomy

Cause and mechanism of onset

Injury mechanism

When rapid flexion movements (such as kicking) are added to the hip joint extension position, particularly during growth period, the epiphyses of the pelvis are more likely to be torn apart because the bones are fragile. Dashes often produce anterior superior iliac spine, and rarely, the ischial tubercle is ruptured by sudden contractions of the hamstrings.



Sudden appearance of hip joint pain, difficulty of walking, and tenderness around the hip joint.


The x-ray or CT shows an avulsed fragment of fracture in the iliac region.

Common sports

It is common for soccer, sprint, high-hurdle race, jumping and judo.

Age predilection

It occurs most commonly among middle-and high-school students aged 12 to 18 (especially on 14 to 15).

Treatment and rehabilitation


For conservative treatment, the first step is to maintain rest and ice (about 1 week). Walking is allowed if the pain is relieved and the pain disappears during walking (2 to 3 weeks after the injury, but not allowed to do sports). Running is allowed (2 to 3 months) if bone union is confirmed on the x-ray. In case of surgery, a piece of bone are combined with screws, which is conducted when the patient has large separation of bone fracture or needs to return to competition and so on. Conservative treatment is sufficient because bone healing is active during growth period.


Even if some bone deformity persists, the prognosis is relatively good, as long as the union of the bone is complete and sufficient time passes.

Yasuhiro Nakajima

Yasuhiro Nakajima

Head coach of Shonan Bellmares Sports Club Triathlon Team, Head coach of Triathlon Team of Nippon Sport Science University, and Chairman of the Japan Triathlon Union Multi-sports Committee

Trainer’s Edition


Be careful not to leave the press tile because it often demonstrates strong ability and may lead to injury.
Environmental factors, lack of physical strength, lack of warm-up, and accumulation of fatigue lead to this injury. Growing children tend to have less muscle flexibility. However, accumulating fatigue or forcing a person with reduced flexibility can cause extra forces to become more powerful.

Please consider stretching, warm-up, and cool-down are important to prevent injuries and to improve athletic skills

Pelvis avulsion fracture 2

On-site evaluation and first aid

During sports activities, the person suddenly feels an awkward sound and feels pain in the area. We recommend that you take first aid such as icing immediately and seeking medical attention. Especially with an avulsion fracture of the ischial tuberosity, the pain is often mild, and the person may be able to walk. People often misunderstand as separation of hamstrings and leave them without treatment.


It may take months to return to a competition. Bed rest and icing are needed for 1 to 2 weeks after the injury, and crutches are used to prevent weight gain during walking. Walking is usually possible for about the third week. Then stretching to increase flexibility and isometric exercises without joint movement are started. Exercise, aerobics, and light jogging are started in 4 to 6 weeks. Water exercises relieve weight gain by buoyancy. Aerobics is also a recommended exercise because it does not require direct weight bearing. And you are allowed to do light sports like jogging. After that, you may return to sports, but please perform them gradually in terms of level of hardness. To prevent recurrence, please seek medical attention before returning to sports.

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