16-Year-Old With Hip Pain

Differential Diagnosis

• Avulsion fracture of the left iliac crest apophysis
• Sacroiliitis
• Labral tear

Diagnosis

This is a classic case of an avulsion fracture of the left iliac crest apophysis, as the x-ray shows a widening of the left iliac crest apophysis. Apophyseal cartilage is a weak point, and avulsion fractures at this site are caused by forceful contraction of the abdominal wall muscles usually while sprinting or jumping. The most common avulsion sites are the anterior superior iliac spine and the anterior inferior iliac spine.

What to Look For

• While an uncommon injury, most often occurs in young adolescent athletes
• Acute pain and tenderness will likely be present over the iliac crest
• Some with this injury may be unable to bear weight
• X-ray can help with the diagnosis, but in younger patients, the apophysis may still be radiolucent, making diagnosis more difficult

Pearls for Urgent Care Management

• Limit weight bearing if painful
• Limit flexion and rotational movement of the trunk
• Pain management includes ice and over-the-counter pain medications
• If significant displacement occurs, surgical intervention may be required

Download the Article PDF: 16-Year-Old With Hip Pain