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SAEM Clinical Image Series: Hip Pain

Posted by Louis Yu, MD MA on

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Chief complaint: Left hip pain

History of Present Illness: A healthy right leg-dominant 13-year-old male athlete presents with left hip pain after kicking a soccer ball.

He states that he kicked the ball awkwardly and experienced hip pain immediately afterwards. He did not feel a pop or cracking sensation but could not stand after the kick and fell to the ground. He can ambulate but only with significant pain.

He now has 8/10 sharp, non-radiating left hip pain that is worse with movement, weight-bearing and palpation.

Physical Exam

Vitals: Unremarkable

Abdominal: No wall defect on palpation, no scrotal mass and no tenderness

Musculoskeletal: Full range of motion at the hip and the knee. No ecchymosis, deformity, or edema. Tenderness to palpation at the anterior inferior iliac spine (AIIS).

Laboratory Data

None acquired

Case Question: What is the diagnosis?

Anterior inferior iliac spine (AIIS) avulsion fracture

Classically, specific pelvic avulsion fractures are associated with certain activities and age groups based on anatomy and the timing of closure or various ossification centers.

These fractures are seen most commonly in adolescent athletes. The AIIS is the origin of the powerful rectus femoris, and injuries are seen most frequently in soccer and sprinting. Pain, point tenderness, and swelling are common findings. Radiographs are the first choice for imaging, however, bedside ultrasound can demonstrate local hematoma and cortical irregularity keying in the diagnosis.

Case Question: What is abnormal in the ultrasound and X-ray images?

Case Discussion

Take Home Points

  • Consider pelvic avulsion fractures in young athletes with point tenderness at the ASIS, AIIS, or ischial tuberosity.
  • Bedside ultrasound can quickly identify hematoma, and in this case, cortical bone irregularity.
  • X-ray is the first choice for imaging.

Copyright

Images and cases from the Society of Academic Emergency Medicine (SAEM) Clinical Images Exhibit at the 2019 SAEM Annual Meeting | Copyrighted by SAEM 2019 – all rights reserved. View other other cases from this series on ALiEM.

Author information

Louis Yu, MD MA

Director of EM, Arc Health/Pinnacle EMG

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