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Re: Case 2
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Re: Case 2 - January 27, 2006 3:40:00 PM
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connie.pt
Posts: 76
Joined: March 28, 2005
From: Michigan
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Could be a trans. femoral head fx. Is that a pubic fx?
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Re: Case 2 - January 28, 2006 11:28:00 AM
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Dr.Wagner
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Joined: January 24, 2003
From: Indianapolis
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No and no. You are looking at a shadow from the acetabulum and the pubis is fine.
This is a classic presentation of a ASIS avulsion fracture seen on the third xray.
This young guy was a fantastic example. On the third film (I tried to highlight it by essentially using a film of ONLY the ASIS and two normal hip xrays). Great example of the patient attempting to PREVENT the throw by quickly and strongly (eccentric) against another violent and powerful force (the thrower).
The result is an avulsion fracture from the strong quadriceps.
Here is a bit from "The Physician and Sports Medicine"
Avulsion fractures about the hip. Avulsion fractures occur more commonly in skeletally immature athletes than in adults because young patients' tendons are stronger than their cartilaginous growth centers. The same stress that causes a muscle strain in an adult can cause an avulsion fracture in an adolescent. These fractures occur at the secondary growth centers, or apophyses, which become separated from the underlying bone. The fractures do not become widely displaced because of the surrounding thick periosteum (2,3).
The mechanism of injury is a sudden, violent muscle contraction or excessive repetitive action across the apophysis. Hip avulsion fractures are common in young sprinters, soccer players, and jumpers. Patients typically describe local pain and swelling after an extreme effort and report no external trauma .
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Dr. Wagner DO
Moderator of Medical Complexity Forum
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Re: Case 2 - January 28, 2006 12:32:00 PM
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jma
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Joined: August 24, 2000
From: NY
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Found an image that is a bit more clear to me. I can barely see the avulsed bone on the third image except for the vertical white line by the ASIS. Thanks for the clarification Dr. Wagner. The shadows definitely mislead me.
[IMG]http://www.glaciermedicaled.com/bone/11_06.jpg[/IMG]
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Re: Case 2 - January 28, 2006 2:33:00 PM
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Dr.Wagner
Posts: 1239
Joined: January 24, 2003
From: Indianapolis
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Yep, it was difficult to find a picture without the "arrow sign"...but I think if you look closely at it, it screams pathology. Wish I had the original pelvic film, it was very clear.
Good luck guys.
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Dr. Wagner DO
Moderator of Medical Complexity Forum
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Re: Case 2 - January 29, 2006 5:33:00 AM
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FLAOrthoPT
Posts: 1011
Joined: May 8, 2004
From: West Palm Beach
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Still think it would be apropo to point and laugh.
Ben
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Re: Case 2 - January 29, 2006 8:59:00 AM
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Dr.Wagner
Posts: 1239
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From: Indianapolis
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Oh I did that too.
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Dr. Wagner DO
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Re: Case 2 - February 6, 2006 6:39:00 AM
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Alex Brenner PT MPT OCS
Posts: 1057
Joined: February 29, 2004
From: Kentucky
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Good case. I may have a good film of this to post.
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Alex Brenner, PT, MPT, OCS
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