About Avulsion Fractures
An avulsion fracture is an injury that occurs when a ligament or tendon tears a tiny piece of bone away from the main bone. These injuries primarily happen to active individuals as they move, play, and exercise. Young athletes are particularly susceptible as their bones, ligaments, and tendons are still developing and more prone to damage. Avulsion fractures are most common in female athletes who are 13-14 years old and male athletes between the ages of 15 and 17.
In less common cases, an avulsion fracture may result from a surgical procedure, a genetic condition, an infection, or other medical issue.
Anatomy of an Avulsion Fracture
As children run, play, jump, and swim, their ligaments and tendons exert and receive force. When this force is too great, it can cause the bone and its attachment to move in different directions, resulting in an avulsion fracture. Because ligaments and tendons are so strong, they tend to damage the bone rather than causing a simple sprain or tear.
Avulsion fractures occur in areas where soft tissue attaches to the bone, most commonly in joints such as the hip, ankle, knee, heel, elbow, or pelvis. These joint areas contain dense amounts of ligaments and tendons, which make them susceptible to the stressors that cause these injuries. While they can happen in any sport, avulsion fractures are most common in activities that require explosive jumping and cutting, such as basketball, football, soccer, and tennis.
Causes
Young athletes are constantly in motion as they sprint, jump, kick, stop, and start quickly. These powerful motions can cause avulsion fractures if the force is great enough to damage the impacted joint. This damage can result from a direct force—such as a collision in football—or indirect—such as making a sudden turn to shoot a goal. In other cases, a hard fall or car crash can cause avulsion fractures. If you suspect an injury has occurred, your child should be checked out immediately by their pediatrician or sports medicine professional.
Due to the repetitive nature of sports, young athletes may begin to wear down a ligament or tendon over time through heavy use. Baseball pitchers, in particular, can damage their elbows by throwing too much over a short period. Other factors, such as a growth spurt, can cause the ligaments to become weaker too. Overuse and repetitive motions are primary causes of avulsion fractures and must be monitored carefully. If your child is a young athlete, it’s important to work with their pediatrician, coaches, and trainers to ensure they are not overexerting themselves and sticking to a prescribed plan for training and rest.
Symptoms
In most cases, an avulsion fracture is accompanied by a “pop” or “crack” and an immediate feeling of pain at the injury site. Swelling may occur and the pain can persist as the child moves their affected limb. Other symptoms include bruising, bleeding, numbness, tingling, and an inability to bear weight or use the injured limb.
Diagnosis
The first step in diagnosing an avulsion fracture is a physical examination. Your child’s pediatrician will begin by asking questions regarding how the injury occurred, their current symptoms, and their past health history. They will then proceed to check the injury site for signs of damage.
If an avulsion fracture is suspected, the doctor will likely order additional tests to confirm the diagnosis. X-rays are commonly used to verify the fracture, while other imaging tests, such as a CT scan or MRI, can determine the extent of the injury and any associated complications.
Treatment Options
For many avulsion fractures, the RICE (rest, ice, compression, elevation) method is enough to treat the injury. Your child’s pediatrician may also prescribe medications to help alleviate inflammation, pain, and swelling. Depending on the location of the injury, a brace, splint, or crutch may be necessary to help with mobility and healing.
If the fracture is substantial, surgery may be required to treat the injured area. This is typically prescribed if the fractured bone is either too large or far away from the main bone to heal on its own. When this occurs, there are two options that the surgeon will consider:
- Open reduction: This procedure involves repositioning the bone fragment to correctly align with the rest of the bone.
- Internal fixation: This procedure uses screws, pins, plates, or rods to reposition and permanently align the bone fragment with the main bone.
If the tendon or ligament is badly damaged in an avulsion fracture, then surgery may also be used to repair these connections.
Recovery and Rehabilitation
Depending on the severity of the avulsion fracture, the timeline for recovery is typically between six weeks to six months. During this time, rest is essential, and overt stress on the injured area should be avoided at all costs. As your child recovers, their pediatrician will prescribe a routine to help facilitate the process, which may include physical therapy to rehabilitate the area and improve mobility. Your pediatrician will work with you to determine the best treatment plan based on your child’s injury, age, activity level, and other factors.
For young athletes, our Rady Children’s Sports Medicine Program provides comprehensive, state-of-the-art services designed to return them to the field. This care is provided by a multidisciplinary team of health professionals including orthopedic surgeons, sports medicine specialists, concussion specialists, physical therapists, nutritionists, and certified athletic trainers.
- Orthopedic assessments and treatment
- Sports physical therapy
- Sports Injury Prevention Program
- Nutrition counseling
Prevention
Prevention is a major component of reducing injury risk. This is especially important for young athletes active in one or many sports. Examples of preventative efforts include:
- Warming up with efforts specific to the physical activity, including stretching before and after exercise
- Wearing well-fitting and supportive shoes
- Following conditioning exercises to train muscles and balance
- Monitoring the child’s activity levels and practice time
- Employing taping, icing, and other methods at the direction of your pediatrician or sports medicine professional
To avoid damage from repetition or overuse, closely watch your child’s physical activity and limit the amount of sports played during a season. When in doubt, consult your child’s pediatrician, team trainer, or other medical professional to best prevent and treat any issues that may arise.
Contact Us
Avulsion fractures are common injuries for young athletes. They take time and rest to heal and can be scary for a young person, some of whom may be experiencing a real injury for the first time. It’s important to answer any questions they may have about the injury, make sure they’re following their rehabilitation routine, and let them know that this is just a minor setback in their athletic and personal journey.
At Rady Children’s, we know how important physical activity is to a child’s development and well-being. We want to make sure your child has the tools necessary to recover from their injury and continue to thrive in sports and life. If you suspect an injury has occurred, don’t hesitate to contact your pediatrician and set up a consultation visit. The earlier an avulsion fracture is identified and treated, the better.