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TitleFizikalna i Rehabilitacijska Medicina - God 2011 Br 1 - 2
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Page 33

Fiz. rehabil. med. 2011; 23 (1-2): 27-34
27

Prikaz slučaja
Case report

ISSN 1846-1867

Guven Hospital Physical Therapy and Rehabilitation Department, Ankara/TURKEY

Primljeno / Received : 2010-02-18; Prihvaćeno / Accepted: 2010-10-20

Correspondence to:
Nural Albayrak Aydin,MD
Guven Hospital Physical Therapy and Rehabilitation Department
Dikmen Cad. No 479/11 Albayrak Apt. Keklikpinari-Ankara/TURKEY
Phone: 00 90 312 457 24 35
E-mail: [email protected]



Apophyseal injuries of the anterior superior iliac spine and pubic bone are common,
whereas injuries to the anterior inferior iliac spine are only rarely encountered.
When it occurs in children, it may be difficult to diagnose and is easily mistaken for
slipped capital femoral epiphysis. To make timely and correct diagnosis, the physi-
cian must have thorough understanding of the basic anatomical relationships and
awareness of the existence of this injury. In this case report treatment and follow-
up period in a 12-year-old patient with apophyseal avulsion of anterior inferior iliac
spine is described and the differential diagnosis is discussed..

: avulsion, pelvic, diagnosis, treatment, rehabilitation

Apofizealne ozljede prednje gornje šiljaste izbočine bočne kosti i stidne kosti su
česte, dok su ozljede prednje donje šiljaste izbočine bočne kosti rijetke. Kada se
dogodi u djece ponekad je teško postaviti dijagnozu i lako se zamijeni s poskliznućem
epifize glave femura. Da bi se postavila točna i pravovremena dijagnoza liječnik

Page 34

Fiz. rehabil. med. 2011; 23 (1-2): 27-34
28

ALBAYRAK AYDIN N. et al: Apophyseal injury of the anterior inferior iliac spine

mora temeljito razumijeti osnovne anatomske odnose i biti svjestan mogućnosti
pojave ove ozljede. U ovom prikazu slučaja iznosi se liječenje i praćenje tijekom
dvije godine 12-godišnjeg bolesnika s apofizealnom avulzijom prednje donje šiljaste
izbočine bočne kosti, a raspravljeno je o diferencijalnoj dijagnozi.

avulzija, zdjelični, dijagnoza, liječenje, rehabilitacija

Apophysis is a secondary ossification center characteristically located at a bony

prominence, which acts as the insertion site for a tendon. Unlike epiphysis,

apophysis does not participate in longitudinal growth and does not form an

articular surface. The hip and pelvis have several apophyses, which enable

circumferential growth. In growing children, stresses during sportive activities,

trauma and/or repetitive activity can make apophysis susceptible to acute or

chronic avulsion injury as a result of tension forces from attached musculature.

Acute apophyseal avulsion fractures are most common during the second

decade, just prior to physeal fusion. The apophyses are particularly vulnerable

in this group of children because they represent a relatively weak link in the

immature skeleton. Common sites include the anterior superior iliac spine,

ischial tuberosity, iliac crest and medial epicondyle of distal humerus. Search of

the literature on apophyseal avulsion of anterior inferior iliac spine (AAAIIS) and

surfing through PubMed database yielded a limited number of cases reported

(1,2). In this paper, we present clinical and radiological features in a patient

diagnosed with AAAIIS and complete regression upon appropriate conservative

treatment.




A 12-year-old male presented to our hospital with a 1-day history of severe

right hip pain and refusal to bear weight. Prior to evaluation in our hospital, he

was treated with ice, rest and partial weight bearing. He could not ambulate

because of complaints of the right anterolateral groin pain after the trauma.

However, he felt less pain while lying in bed. He stated that he had slipped and

fallen on his hip during a football match.

He had no previous neurologic or extremity problems. There were no associated

abdominal or urinary symptoms. There was no relevant past medical history

of any note. Physical examination revealed an obese, healthy appearing 12-

year-old boy in mild acute distress. He was afebrile and his vital signs were

stable. His right hip was moderately limited in forward flexion (0-60°), external

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