Clinical Analysis Of 12 Cases Of Avulsion Fracture Of Ischial Tuberosity In Adolescents

Purpose:Avulsion fracture of the ischial tuberosity(AFIT)is a rare athletic injury that usually occurs in young athletes.In recent years,with the improvement of people's living standards,the family has strengthened the cultivation of adolescents' quality,and the number of adolescents who are engaged in art and sports specialty learning has increased significantly.Therefore,the incidence of AFIT has also increased.Since the epiphysis of ischial tuberosity has not been closed in adolescents,it can also be called avulsion fracture of the epiphysis of the ischial tuberosity.In 1912,Berry reported the first AFIT,and subsequent reports have appeared in the form of case reports.Due to its low incidence,no one in the world has done systematic research in this field.Therefore,there is no consensus on the diagnosis and treatment of AFIT.For the treatment of AFIT,it is now common to choose a treatment mode based on the size and degree of displacement(DFD)of the avulsed fracture block.However,some scholars believe that this is unscientific,and the choice of treatment methods needs to take into account the patient's requirements for functional recovery,and requires individualized treatment options.In this paper,we retrospectively analyzed the medical records of patients with AFIT treated by the China-Japan Union Hospital of Jilin University,and discussed the injury mechanism,imaging examination,diagnosis and treatment of the AFIT,in order to provide an important reference for the diagnosis and treatment of this rare case.Materials and Methods:This article discussed the mechanism,diagnosis management,treatment and prognosis of AFIT in adolescents by retrospective analysis of twelve patients with AFIT from October 2014 to October 2017 at the China-Japan Union Hospital of Jilin University.In twelve patients,eight males and four females,aged 12-20 years,mean 15.92 ± 2.61 years old.All patients were unilateral ill,with five cases on the left(41.67%)and seven on the right(58.33%).Three patients with a fracture shift of >20mm underwent surgery.Of the two patients with a fracture displacement of 15-20 mm,one patient chose surgery and the other patient chose conservative treatment.Seven patients with a fracture shift <15 mm underwent a conservative treatment regimen.Result:Of the twelve patients,four patients who underwent surgery were admitted to the hospital immediately after the injury and were diagnosed,and surgery was performed early.All patients achieved a high hip score(Harris score of 100).Eight patients had conservative treatment,and five patients who were admitted to the hospital immediately after the injury had excellent results(Harris score of 96-100).Two patients who had come to our hospital more than 2 weeks after the injury had a good outcome(Harris scores of85 and 88),but the patients developed pain during exercise;In another patient,the fracture was displaced between 15-20 mm,and the patient's admission time was 2 weeks after the injury,and the patient refused our recommendation for surgery.The patient's conservative treatment results were only moderate(Harris score of 78),with long-term pain,cannot sit for a long time.Conclusion:Due to the low incidence of AFIT,there is currently no consensus on the treatment and a large number of clinical studies are needed to propose standard treatment options.The DFD of the avulsed fracture block is an important reference factor for the choice of treatment for patients with AFIT.For patients with a fracture shift <15 mm,conservative treatment is preferred,and for patients with a fracture shift >20 mm,early surgery should be considered.However,the choice of treatment scheme should not only be based on the size of the fracture block and the DFD,but also fully consider the level of patients' functional requirements for recovery and whether they have the willingness to choose surgical treatment.Because different therapeutic regimens will affect the functional recovery of patients after recovery,individualized therapeutic regimens should be selected for different patients.In addition,no matter conservative treatment or surgical treatment is chosen,systematic and scientific rehabilitation exercise is very important for the recovery of patients' functions after recovery.