In the present patient, the apophysis appeared hyperechoic with an acoustic shadow on the anterolateral side of the ASIS with an anterior and lateral displacement of 3.6 mm and 3.8 mm, respectively, suggesting an ASIS avulsion fracture (Figure 3). POCUS normally allows visualization of the ASIS and its apophysis as hyperechoic structures with an acoustic shadow, with the apophysis overlying the ASIS (Figure 2). The patient was placed in a supine position, and a transducer was placed transversely and longitudinally from the iliac crest to the ischium (Figure 1). His right leg was slightly flexed, and the range of motion of his right pelvic joint was limited because of the pain.Īn attending pediatric emergency physician with five years’ experience using pediatric POCUS performed a scan using LOGIQ TM e (GE Healthcare, Japan) with a high-frequency linear transducer (8-13 MHz). ![]() Physical examination revealed tenderness in the ASIS area but denied tenderness in the iliac crest or femoral head. His vital signs were appropriate for his age. He denied paresthesia or testicular pain. We herein reported a pediatric case of ASIS avulsion fracture detected by pediatric emergency physicians using POCUS.Ī previously healthy, 14-year-old male patient visited our emergency department for right groin pain which occurred when he suddenly changed course while running during a game of baseball. Point-of-care ultrasound (POCUS) is an alternative modality for diagnosing long bone fractures or ruptured tendons, 4, 5 but the reports of its use for this purpose in the pediatric emergency care setting are scarce. Computed tomography (CT) or magnetic resonance imaging (MRI) may also be used but they are expensive to perform. X-ray is normally used to diagnose PAFs, but the condition can be misdiagnosed if the fragments of the fractured bones are small 3. Owing to their stage of musculoskeletal development, forceful contractions of muscles or tendons during sports activities frequently cause a PAF to occur in any of four anatomical sites, including the iliac crest, anterior superior iliac spine (ASIS), anterior inferior iliac spine (AIIS), and ischial tuberosity 1, 2. ![]() Pelvic avulsion fractures (PAFs) are rare and specific to adolescents and young athletes 1, 2.
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