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Home > What is an Avulsion Fracture and How is it Treated?

What is an Avulsion Fracture and How is it Treated?

Dr. Jeffrey Carlson

Jeffrey R. Carlson, MD, CPE

As an Orthopaedic physician, I’ve seen my share of broken bones in my years of practice.  Surprisingly, there are quite a few ways that a bone can break.  One of the less familiar to you may be an avulsion fracture, which I am going to discuss in this article.  I’ll describe this type of bone break, how it is typically caused, diagnosed and how it is most effectively treated.

Our bones are connected at the ends to tendons or ligaments, which then connect either to other bones or muscle and help us move.  When enough impact is applied in just the right manner, sometimes these tissues can pull from the bone with such force that they pull a chunk of bone with them at their attachment point, called an avulsion or avulsion fracture. 

This type of injury is typically seen in young athletes where sudden directional changes or quick movements are made, but that isn’t always the case. Contact sports, including gymnastics, are also a common cause of this injury.  These sports push the young athlete’s muscles and bones to their limits and sometimes beyond.  However, a person of any age can have an avulsion fracture.  Certain bones; elbows, ankles, knees, pelvis, and the spinal bones are the areas of the body that are more prone to avulsion fractures due to the number of ligaments that are needed to keep these joints stable.

Symptoms of avulsion fractures are similar to sprains and smaller fractures, and typically include swelling, bruising, pain, difficulty moving the affected limb, and difficulty weight-bearing if a foot, ankle, knee, or pelvis is involved. Some avulsion fractures are less urgent, and some will require early surgery, which is why it is always important to get checked out by a physician or at an emergency room as soon as possible.

Avulsion fractures are diagnosed by x-ray or CT scan, after a physical examination by a physician.  Most avulsion fractures do not require surgery and can heal by being immobilized in a splint or Air cast for 6-12 weeks.  We treat the swelling, bruising and pain with rest, elevation, and intermittent icing for the first 24-48 hours and can give the patient an anti-inflammatory medication as well for the pain and swelling.  Physical Therapy will help the patient to regain their range of motion and strength in the affected limb or body part and most patients recover with no complications.

For those patients who have a displaced avulsion fracture where the piece has separated away from the main bone significantly (this depends on the body part), we usually take those patients to surgery. I can reduce (realign and stabilize) the fracture by performing an open reduction with or without an internal fixation device. This requires an incision in the skin to replace the broken piece of bone to its original position then using a screw, pin or plate to keep it in position while the bone heals.

The recovery after surgery follows pretty much the same track as the non-surgical treatment, except we have the increased recovery burden surgery places on the body and the added concern of post-surgical incision care.  That may preclude immediate post-surgical splinting or require extra padding/cushioning over the incision as it heals for the first few weeks after surgery.  It will be important to provide the immobilization that the splint or cast will provide as the bone fuses together and heals.  I will help the patient find the best option after surgery, depending on their activity level, lifestyle, and work.

As avulsion fractures tend to happen in young athletes, a return to sports is usually top of mind and recovery can sometimes be rushed.  It is important to let the fracture heal completely and to rehab thoroughly, as avulsion fractures can recur.

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