Adolescent athletes are no strangers to sports-related injuries, but some injuries, like avulsion fracture of the ischial tuberosity (AFIT), are particularly rare and challenging to treat. These fractures, which occur at the hamstring’s attachment to the pelvis (in the buttock), are caused by high-intensity activities like sprinting and kicking. While some cases may respond to non-surgical care, others will require advanced surgical intervention to restore mobility and prevent complications like chronic pain and nerve damage.
At Children’s Hospital of Philadelphia (CHOP), a multidisciplinary team of researchers and surgeons conducted a pioneering study on AFIT surgical management, focusing on the outcomes of a variety of fixation techniques that have been utilized. Their findings offer critical insights regarding the postoperative outcomes and complications observed for clinicians navigating this complex injury.
Groundbreaking research on fixation strategies
The study, led by Brendan A. Williams, MD, with collaborating surgeons J. Todd Lawrence, MD, PhD, Lawrence Wells, MD, and Kathleen J. Maguire, MD, reviewed 16 cases of surgically treated AFIT in adolescents. Researchers compared outcomes of three fixation techniques screws, suture anchors, and cortical buttons — and evaluated their effectiveness in restoring mobility and returning patients to sports, in addition to the rates of operative complications.
Key findings:
- Patient demographics: Most cases involved male athletes (88%), with soccer being the most common sport associated with this injury.
- Surgical techniques: Cortical buttons emerged as a promising option with no cases of fixation failure or re-fracture in the study cohort.
- Complication rates: While a substantial proportion of patients experienced postoperative complications, most were minor (e.g., temporary numbness or mild pain) and did not delay recovery timelines.
- Return to sport: All patients successfully returned to sports within six months on average, underscoring the effectiveness of surgical intervention.
A novel approach: Cortical button fixation
This study is one of the first to report outcomes using cortical buttons for AFIT repair. This technique involves anchoring a metallic button on the bone’s surface to stabilize the fracture while minimizing disruption to surrounding tissue. Cortical buttons, commonly used in ligament repairs, demonstrated high pull-out strength and appeared to be associated with fewer complications in this study.
“The introduction of cortical buttons in treating ischial tuberosity fractures offers durable and reliable options for treatment of this injury,” Dr. Lawrence noted.
Shaping future care for adolescent athletes
The findings from CHOP’s study contribute to the limited but growing body of literature on AFIT management. By evaluating various surgical approaches and their safety, this research supports more informed decision-making and improved patient and family counseling.
“This work enhances our ability to guide families through treatment options,” said Dr. Williams. “While complications are not uncommon, most are minor and don’t interfere with recovery. Our goal is to provide evidence-based care that gets these young athletes back to their activities safely and confidently.”
For more information about this study and other innovative research, visit CHOP’s Orthopedic Center and Sports Medicine and Performance Center. Together, we’re redefining care for young athletes and active children.
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Adolescent athletes are no strangers to sports-related injuries, but some injuries, like avulsion fracture of the ischial tuberosity (AFIT), are particularly rare and challenging to treat. These fractures, which occur at the hamstring’s attachment to the pelvis (in the buttock), are caused by high-intensity activities like sprinting and kicking. While some cases may respond to non-surgical care, others will require advanced surgical intervention to restore mobility and prevent complications like chronic pain and nerve damage.
At Children’s Hospital of Philadelphia (CHOP), a multidisciplinary team of researchers and surgeons conducted a pioneering study on AFIT surgical management, focusing on the outcomes of a variety of fixation techniques that have been utilized. Their findings offer critical insights regarding the postoperative outcomes and complications observed for clinicians navigating this complex injury.
Groundbreaking research on fixation strategies
The study, led by Brendan A. Williams, MD, with collaborating surgeons J. Todd Lawrence, MD, PhD, Lawrence Wells, MD, and Kathleen J. Maguire, MD, reviewed 16 cases of surgically treated AFIT in adolescents. Researchers compared outcomes of three fixation techniques screws, suture anchors, and cortical buttons — and evaluated their effectiveness in restoring mobility and returning patients to sports, in addition to the rates of operative complications.
Key findings:
- Patient demographics: Most cases involved male athletes (88%), with soccer being the most common sport associated with this injury.
- Surgical techniques: Cortical buttons emerged as a promising option with no cases of fixation failure or re-fracture in the study cohort.
- Complication rates: While a substantial proportion of patients experienced postoperative complications, most were minor (e.g., temporary numbness or mild pain) and did not delay recovery timelines.
- Return to sport: All patients successfully returned to sports within six months on average, underscoring the effectiveness of surgical intervention.
A novel approach: Cortical button fixation
This study is one of the first to report outcomes using cortical buttons for AFIT repair. This technique involves anchoring a metallic button on the bone’s surface to stabilize the fracture while minimizing disruption to surrounding tissue. Cortical buttons, commonly used in ligament repairs, demonstrated high pull-out strength and appeared to be associated with fewer complications in this study.
“The introduction of cortical buttons in treating ischial tuberosity fractures offers durable and reliable options for treatment of this injury,” Dr. Lawrence noted.
Shaping future care for adolescent athletes
The findings from CHOP’s study contribute to the limited but growing body of literature on AFIT management. By evaluating various surgical approaches and their safety, this research supports more informed decision-making and improved patient and family counseling.
“This work enhances our ability to guide families through treatment options,” said Dr. Williams. “While complications are not uncommon, most are minor and don’t interfere with recovery. Our goal is to provide evidence-based care that gets these young athletes back to their activities safely and confidently.”
For more information about this study and other innovative research, visit CHOP’s Orthopedic Center and Sports Medicine and Performance Center. Together, we’re redefining care for young athletes and active children.
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