Differential Diagnosis

  • Avulsion fracture of the ischial tuberosity
  • Hamstring syndrome
  • Proximal hamstring tendinopathy
  • Pubic apophysitis



This patient has an avulsion fracture of the ischial tuberosity, seen as displacement of the apophysis.


Learnings/What to Look for

  • This injury is seen most commonly seen in young athletes, especially soccer players. It results from sudden, forceful contraction of the hamstrings
  • Patients in puberty and late adolescence are at greatest risk, as this is a time when the secondary ossification centre or apophysis is weakest in the chain of muscle–tendon–bone


Pearls for Urgent Care Management and Considerations for Transfer

  • Radiograph of the pelvis should be performed in adolescent patients with a history of proximal hamstring injury and current ischial tenderness
  • Displaced avulsion fragments or chronic nonunion fragments may require surgical repair.

Acknowledgment: Image courtesy of Teleradiology Specialists.

An 11-Year-Old Boy with Groin Pain After Playing Soccer
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