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This is Pediatrics week five case three and

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the diagnosis under consideration is pelvic apophil

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avulsion injury. This is

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a diagnosis very specific to children and

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teenagers. It's often the result of sports or athletic

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injuries. And there are many different places where a

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Volcan can occur. The pelvis is full of a

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bunch of growing bones. And remember apophies are

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a little different than epiphys the

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epiphysis of course is the growing end

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of a long bone that is extending the length of

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that bone.

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An apophysis is a growth plate that

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is not extending the length of the bone. So for example on this frontal

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pelvic radiograph, there are several apophys that

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are these iliac crest apotheses aren't really visible anymore,

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but we can see greater trochanterica apophysis. We

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can see lesser trochanteric apophysis. There

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are synchondroses and

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You know various different areas where bone is

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fusing or growing or developing or even elongating and

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in children. We are most likely

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to see avulsion because of strain on

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the muscle that attaches. So in this case what we're

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particularly interested in is the asymmetry that

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we see between the lesser trochanter on

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the right and on the left. So if you look at this image, you

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can see right away that you've got.

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A lesser trochanter here on the left that's subtle

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and really not doing very much. We've got

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the same lesser trochanter here.

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Similarly subtle, but then on top

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of that we've got this little bone fragment right here, and that

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is the a vulst.

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Lesser trochanteric apophysis now, why would

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that be evolved? Well, it turns out that this is the insertion

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point of the iliosoas muscles and there are

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two different muscles fusing to form the one iliopos. You

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can kind of imagine the iliacus muscle fibers coming down here and

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then you've got the soas muscle coming down

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here and joining it and they

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all insert right there. So any kind of abrupt tearing

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or jerking injury?

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Sports Injury is going to pull and instead

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of tearing the tendon of the muscle or the muscle belly

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itself. The apophysis of the bone is

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ripped off that won't happen in adults. Once that apophysis

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is fused if you're going to have an injury there. It's going

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to be an injury of the muscle or the tendon.

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But in this very unique age group you get apophil avulsion.

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So it's important for the Radiologists to be

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aware of where those apophysical centers are in the pelvis a

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lot of growth plates a lot of moving Parts in the pelvis.

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And to be on the lookout when the complaint is

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of hip pain or pelvic pain or difficulty bearing

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weight Sports Injury. These are key

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areas to be on the lookout. That's the end

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of the case.