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What to Know About Avulsion Fractures

Medically Reviewed by Dan Brennan, MD on June 08, 2021

An avulsion fracture happens when a ligament or tendon pulls part of your bone off. This usually happens as the result of a traumatic injury. Avulsion fractures commonly occur in the hip, elbow, and ankle in young people who play sports. However, they can happen anywhere in your body that soft tissue attaches to the bone. 

Types of Avulsion Fractures

While avulsion fractures can happen in many different bones, the most common types are: 

Pelvic avulsion fracture. Any broken part of a bone that happens in the hips, buttocks, or upper thigh is called a pelvic avulsion fracture. These bone fractures often happen in areas where children and teenagers have open growth plates. Sudden, forceful contractions of the abdominal muscles, hip muscles, thigh muscles, or hamstring muscles can cause a pelvic avulsion fracture.

Sports that involve jumping, sprinting, or rapid changes in movement can often cause pelvic avulsion fractures. These can include: 

  • Track
  • Tennis
  • Soccer
  • Hockey

Fibular avulsion fracture. Your fibula is the outer bone in your lower leg. A fibular avulsion fracture is usually caused by a sudden inward rolling of your foot. This puts too much stress on your ligament and causes it to pull off a small piece of bone. This causes swelling and pain that makes walking difficult or impossible.

A fibular avulsion fracture is similar to a moderate or severe ankle sprain. A sprain, however, happens when a ligament — the tough band of tissue that connects two bones in your joints — stretches or tears.

Fibular avulsion fractures are common in elderly women because they often have weak bones due to osteoporosis. They are also common in young adult males because they have very strong ligaments.

Medial epicondyle avulsion fracture. This is a type of elbow injury that happens most often in baseball players between the ages of 9 and 14 and can be caused by hard pitching. It affects the bony part that sticks out on the inside of your elbow. It's the most common elbow injury in teenagers.

Finger avulsion fracture.Mallet finger, or baseball finger, happens when something such as a baseball hits the tip of your finger or thumb. This force causes the tendon at the back of your finger to tear and rip off part of the bone with it. This is the tendon that straightens the finger. With this injury, the tip of your finger or thumb droops down because it can't straighten.

Another type of common finger avulsion injury is called jersey finger. This affects the tendon that bends your finger down. When you have this type of finger avulsion fracture, you can't bend your finger at the first joint. This injury gets its name because it often happens when a player grabs another player's jersey. As the player tries to get away, the finger is straightened forcefully while it's still trying to flex.

As a result, the tendon is pulled in two directions at once. You may feel a popping sensation when the injury happens. This injury happens most often to the ringer finger, but it can happen to any finger. 

What Are the Symptoms of an Avulsion Fracture?

Your symptoms may be different depending on where your avulsion fracture is located, but they may include: 

  • Swelling
  • Bruising
  • Bleeding
  • Numbness
  • Tingling
  • Difficulty moving your injured limb

How Are Avulsion Fractures Diagnosed?

Your doctor will talk to you about your symptoms and how your injury happened. They will also do a physical exam. An exam may be enough to diagnose you with an avulsion fracture. Your doctor may order an X-ray to rule out other types of injuries.

How Are Avulsion Fractures Treated?

Many avulsion fractures can be treated by resting or icing the injured limb. You will probably also need to do exercises to restore full movement, improve your muscle strength, and help your bone heal.

Generally, nonsurgical recovery for people involved in sports happens in five phases:

  • Phase one. Rest, ice, and protect the injury. 
  • Phase two. Start exercise to gradually increase the range of motion of the injured area.
  • Phase three. Progressive resistance is introduced to help the injury.
  • Phase four. Use the injured area with all of the surrounding muscles.
  • Phase five. Prepare for a complete return to the sport. 

Most avulsion fractures will heal without surgery, but if the chunk of bone is too far away from the main bone, you may need surgery. If your child has an avulsion fracture that involves a growth plate, they may need surgery as well.

How Can You Prevent Avulsion Fractures?

You are likely to reinjure yourself if you try to return to full activity too soon. To prevent avulsion fractures, it's important to focus on warming up before sports. You should also do a pre-season strengthening exercise program if your sport is seasonal.

Chronic overuse can cause inflammation and trauma to your bones and make you more likely to get acute avulsion fractures. Don't play through the pain. If you have pain while doing sports or another repetitive activity, rest and ice the area. You may need to use a brace to immobilize it to prevent a worse injury.

WebMD Medical Reference

Sources

SOURCES:

Ann & Robert H. Lurie Children's Hospital of Chicago: "Medial Epicondyle Avulsion Fracture." 

Children's Hospital Colorado: "Pelvic Avulsion Fracture (Fractured Pelvis)."

FootEducation: "Fibular Avulsion Fracture."

Handcare: The Upper Extremity Expert: "Jersey Finger," "Mallet Finger."

Mayo Clinic: "Avulsion fracture: How is it treated?: What is the best way to treat an avulsion fracture in a young athlete?", "Sprains."

McCoy, J.; Nelson, R. StatPearls [Internet]: Avulsion Fractures. Stat Pearls Publishing, 2021.

Intermountain Healthcare: "Avulsion Fracture."

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