ANTERIOR ILIAC SPINES FRACTURES IN THE ADOLESCENT ATHLETES: SURGICAL OR CONSERVATIVE TREATMENT?

Aim. Iliac spines fractures affect more frequently adolescent. These structures might be involved in avulsion injuries in many sport activities usually due to a sudden and forceful contraction of the muscles where they take origin. The treatment can be conservative or surgical according to the size and dislocation of the fragment. The aim of this study is to define the correct approach to these lesions in adolescent athletes by evaluating the outcomes in 2 groups of patients which were treated differently. Methods. Between 2002 and 2012, 24 adolescent athletes, affected by anterior iliac spines fractures, were treated. All cases had similar characteristics. Twelve patients were treated surgically (group 1) and 12 conservatively (group 2). All patients were evaluated clinically with the non-arthritic hip score (NAHS) and radiographically. Return to sport activity (RSA) was also recorded. Results. Mean NAHS was similar in groups 1 and 2. A significant faster RSA was noticed in patients treated surgically. In 6 cases (1 in group 1 and 5 in group 2) radiographs showed heterotopic bone formation. Two patients of group 1 developed a postoperative lateral femoral cutaneous nerve impairment which resolved spontaneously after a mean period of 6 months. Conclusion. The incidence of these fractures is increasing in young population due to the earlier and more intensive sports activity. Their treatment is mainly conservative. When fragment in its major axis and the amount of dislocation is ≥2 cm, surgical treatment is indicated in adolescent athletes, thus allowing a faster RSA. Fixation with screws guarantees a more stable ostheosynthesis.