Sports Medicine
Schan Lartigue, MD
Resident, PGY-2
Yale New Haven Hospital
New Haven, Connecticut, United States
Sera Yoo, MD
Resident, PGY-2
Yale New Haven Hospital
New Haven, Connecticut, United States
Avish S. Persaud, MD
Resident doctor
Yale New Haven Health
Rochester Hills, Michigan, United States
Eric K. Holder, MD, MD
Associate Professor of Orthopaedics and Rehabilitation
Yale University School of Medicine
New Haven, Connecticut, United States
Schan M. Lartigue, MD
Yale New Haven Hospital
New Haven, Connecticut, United States
Right ischial tuberosity (IT) avulsion fracture with fibrous nonunion
Case Description:
A 16-year-old male experienced acute right buttock and proximal thigh pain with an audible pop while playing soccer. At initial evaluation at our academic center, he described pain limiting exercise. Imaging confirmed a minimally displaced right IT avulsion fracture.
Despite relative rest, nonsteroidal anti-inflammatory use, and extensive physical therapy he continued to experience persistent pain with attempts to return to sport. Repeat imaging demonstrated fibrous nonunion. Thereafter, the patient was referred to our physiatric clinic and underwent 8 weeks of daily bone stimulator use and subsequent ultrasound-guided platelet-rich plasma (PRP) injection to the IT avulsion defect/IT-hamstring tendon origin complex, followed by a home-exercise program with continued bone stimulator use to complete a 3-month regimen. At follow-up, radiographs demonstrated progressive fracture healing and the patient described complete symptom resolution with full return to high-level soccer.
Discussions:
IT avulsion fractures are most common in adolescent athletes. 68% of cases require surgical intervention with athletes returning to play in 6-12 months. PRP and adjunctive bone stimulator therapy represent a minimally invasive alternative that may expedite return to play. PRP delivers growth factors that promote bone healing, while bone stimulators use electromagnetic or ultrasound signals to enhance osteogenesis, both with evidence supporting benefits in bone defect repair. To our knowledge, this is the second reported case of IT avulsion fracture nonunion successfully treated with combined PRP and bone stimulator therapy. Both cases demonstrated progressive radiographic healing and return to full athletic participation within 4 months of treatment initiation.
Conclusions:
This case highlights the potential role of PRP with adjunct bone stimulator therapy as a novel, minimally invasive treatment for IT avulsion fractures with fibrous nonunion. While evidence remains limited, favorable clinical and radiographic outcomes suggest this may be a viable alternative to surgical fixation in select cases.
