An 11-Year-Old Boy with Groin Pain After Playing Soccer

Differential Diagnosis

• Avulsion fracture of the ischial tuberosity
• Hamstring syndrome
• Proximal hamstring tendinopathy
• Pubic apophysitis

 

Diagnosis

This patient has an avulsion fracture of the ischial tuberosity, seen as displacement of the apophysis.

 

Learnings/What to Look for

• This injury is seen most commonly seen in young athletes, especially soccer players. It results from sudden, forceful contraction of the hamstrings
• Patients in puberty and late adolescence are at greatest risk, as this is a time when the secondary ossification centre or apophysis is weakest in the chain of muscle–tendon–bone

 

Pearls for Urgent Care Management and Considerations for Transfer

• Radiograph of the pelvis should be performed in adolescent patients with a history of proximal hamstring injury and current ischial tenderness
• Displaced avulsion fragments or chronic nonunion fragments may require surgical repair.

Acknowledgment: Image courtesy of Teleradiology Specialists.