Date: Tue, 6 Mar 2001 17:28:37 +0200

Subject: Ischial Tuberosity Fx

From: Dr Savvides

It happened to a fifteen year old boy who was doing the "Long Jump" during his school athletic meeting. The separation as it measures on the CT scan (not shown here) is 1.9 cm.

I would be grateful for your views as regards:

• 1. Operative or conservative treatment?
• 2. If Operative method of approach, fixation, postoperative management.
• 3. How much will this affect his athletic performance.

Giorgos Savvides

Date: Tue, 06 Mar 2001 15:27:49 -0500

From: Charles Mehlman

This is an impressively displaced ischial avulsion fracture!!! My brief perusal of MEDLINE revealed several reports of "late sciatic nerve complications" following these fractures. There is however, a rather strong precedent for non-operative care.

I would say that if your patient has any signs of nerve irritation at this time - operative treatment could be justified. I would consider an ischial approach similar to what is described for a Triple Innominate Osteotomy (Steel type) and probably "fix the fracture" with strong absorbable suture and make the patient wear at least a one leg spica cast with the hip in full extension.

Charles T Mehlman, DO, MPH
Assistant Professor Pediatric Orthopaedic Surgery
Division of Pediatric Orthopaedic Surgery
Children's Hospital Medical Center Cincinnati
Cincinnati, Ohio

Date: Tue, 6 Mar 2001 15:57:31 -0500

From: bruce meinhard

Most of the literature supports nonoperative treatment. Those who were most dissatisfied were the world class sprinters who responded to operative treatment.The other complication which can occur late besides sciatic nerve problems is that of exuberant bone which interferes with sitting.

BPM