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Avulsion Fracture of the Iliac Crest Apophysis in a Collegiate Wrestler

INTRODUCTION Fractures of the pelvic girdle along the iliac crest, although rare, have been documented since the mid-1700s. The pelvic girdle is made up of two coxal bones that are joined anteriorly at the symphysis pubis and posteriorly to the sacrum; the two coxal bones join with the sacrum and coccyx to form the pelvis. The pelvis provides protection for internal organs, attachments for muscles, and stable support of the lower extremities to enable locomotion. Although fractures of the iliac crest are rare, they typically occur in individuals aged 11–25 years because of incomplete ossification of the apophyses in the pelvis, with males having an incidence rate 13 times that of females. The mechanism of injury is commonly a rapid, forceful eccentric lateral flexion and/or rotation of the torso causing excessive strain of the abdominal musculature. The tensile force exceeds the strength of the apophysis of the iliac crest, resulting in an avulsion. Fortunately, because of the numerous muscle attachments of the pelvis, bone displacement is minimal, and surgical intervention is often unnecessary. Avulsion fractures of the iliac crest are rare, making up roughly 2% of all pelvic fractures. To our knowledge, no case has been reported regarding an avulsion fracture from wrestling, making our patient’s case unique.