Poster 212: Ischial Tuberosity Avulsion Fractures: Treatment and Return to Sport in Athletes with Displaced Fragments

Objectives: Ischial tuberosity avulsion fractures are relatively rare injuries that typically occur in young athletes during activity. Some of these patients may experience significant morbidity, often through chronic pain and changes in sports participation. The influence of fragment displacement on optimal treatment and proper return to sport protocol has not been well investigated. This study sought to evaluate the relationship between displacement and both choice of treatment and time to return to sport. Methods: Retrospective analysis of ischial tuberosity avulsion fractures in pediatric patients between 2010-2021 at Boston Children’s Hospital was completed. Information regarding demographics, treatment, and recovery were extracted from individual patient charts. Plain radiographs and magnetic resonance imaging (MRI) were analyzed in order to measure fragment displacement at the ischial apophysis. Treatment protocol, return to sport (RTS) time, and complications were analyzed. Results: Eighty-eight patients with a diagnosis of an ischial tuberosity avulsion fracture were identified. Of these, 64 (73%) were treated non-operatively, 8 (9%) were treated acute operatively (within 6 weeks), and 16 (18%) were treated chronic operatively (>6 weeks). Imaging for measurement of fragment displacement was available for 86 (98%) of patients. The median displacement was 0.2cm for the non-operative group, 2.2cm for the acute operative group, and 1.5 for the chronic operative group. Of the 86 patients with available imaging, 67 (78%) had a RTS time. The median RTS was 3.6 months in the non-operative group, 5.5 months in the acute operative group, and 13.3 months in the chronic operative group. Conclusions: In this retrospective cohort study, nearly all fractures with displacement >= 1.0cm were surgically treated, either acutely or at a delayed time point. All patients that underwent acute operation had displacement > 1.0cm, while 87% of those undergoing delayed operation had displacements > 1.0cm. Those treated non-operatively returned to sport about 1 month earlier than those undergoing acute operation, and several months prior to those who underwent delayed surgical intervention. This data suggests that patients with displacement less than 1.0cm may be successfully treated through non-operative treatment and those with displacement greater than this should undergo operative treatment in the acute period to optimize outcome and return to sport.