What are avulsion fractures?

Avulsion fractures occur when a sudden change in motion or direction causes a small piece of bone to break off while remaining attached to the tendons surrounding the bone. While some bones are at a higher chance of fracture, avulsion fractures can occur on any bone which connects to tendons or ligaments. The bone fracture most often occurs in the knees, ankles, elbows, hands, spine, and pelvis. Most avulsion fractures can heal successfully over time and are usually not cause for great concern. 

Avulsion fractures are a common injury for children in sports like soccer and football that involve running, cutting, or kicking motions. For most, treatment involves stabilizing the fracture with the use of a boot or a cast and limiting motion. For children, treatment needs to take into consideration whether the fracture occurred near a growth plate. Most avulsion fractures heal successfully with careful attention and do not lead to complications.

What causes avulsion fractures?

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There are many causes of avulsion fractures that can result in damage to the bone and potentially the surrounding tissue. Those who play sports can cause an avulsion fracture when engaging in actions like kicking, leaping, or sprinting which make the limbs move suddenly and in different directions. Other sports activities can lead to avulsion fractures like colliding, falling, and sliding that put stress on the bones and can result in fractures.  

Tendons, muscles, and bones all work together to move the body and operate the limbs. However, muscles can put pressure on bones that bones cannot sustain, creating the potential for an avulsion fracture with the right movement. As younger children begin to grow rapidly during adolescence, their tendons and muscles tend to be stiffer, increasing the tension between the muscles, tendons, and bones. For adults, avulsion fractures can occur outside the context of sports with sudden actions that involve physical force like falling down or jumping. 

What are symptoms of avulsion fractures?

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The symptoms of avulsion fractures vary person to person, but there are some common symptoms that occur with an avulsion fracture. When the avulsion fracture occurs, you will likely experience a sharp and intense pain that will fade after the injury. The fracture can often cause a popping feeling and sound, which could be caused by the bone fragment breaking off. 

Other common symptoms of avulsion fractures include:

  • Radiating pain from the site of the supposed fracture
  • Swelling 
  • Bruising
  • Sharp pain when moving the joint
  • Limited range of motion in affected joint 
  • Surrounding pain in the muscles 
  • Difficulty walking or walking with a limp

The symptoms of avulsion fractures resemble those of many other common injuries, so only a proper diagnosis from a medical professional can help confirm that an avulsion fracture is the source of the symptoms. Be sure to keep a good record of the symptoms you experience and when you notice the injury to communicate with your doctor. 

Are there any risk factors or groups for avulsion fractures?

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Even though avulsion fractures can happen at any age to any type of person, some factors put certain groups at a higher risk of this type of fracture than others. This injury is most common in athletes, children, and dancers.

Athletes: Athletes who participate in high-impact and fast-paced sports, such as basketball, gymnastics, skiing, football, and soccer, are at a higher risk of avulsion fractures than non-athletes or people who participate in low-impact sports. These sports require quick movements and rapid change in direction, putting strain on the joints and ligaments. Female athletes more often get avulsion fractures between the ages of 13 and 14 while male athletes get fractures more often between the ages of 15 and 17. 

Children: As children grow and their bones and muscles develop, they can be more vulnerable to avulsion fractures. Especially if children are active and participate in sports, they can easily get a fracture if their muscles put too much pressure on the bones during activities. 

Dancers: Dancers are in a more specific group of athletes who have a higher chance of avulsion fractures given the increased pressure on the feet and ankles for extended periods of time. Dancers engage in similar directional movements which can strain the joints and make them vulnerable to fractures. 

No matter your risk for avulsion factors, you can take preventative measures to lower your risk of a fracture. For example, you can stretch and warm up before exercising or sports to ease into activity. In addition, strengthening your muscles and improving your range of motion can help you move more confidently.

How are avulsion fractures diagnosed?

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Because the symptoms of avulsion fractures are difficult to distinguish from the symptoms of other fractures or bone injuries, a proper diagnosis is essential to the right treatment plan. If the injury is very sudden and painful, you might first visit an emergency room to receive immediate care to tend to the injury. The emergency room medical providers can provide a preliminary diagnosis before you have the chance to see your primary care doctor or a specialist. They will likely review the incident that brought you to the emergency room, ask about your symptoms, test your joint mobility, and conduct imaging tests to detect the fracture. 

The two main imaging tests are the following:

  • Computed tomography (CT) scans: CT scans create an image of the muscles and tissue surrounding the bone to detect bone damage. 
  • X-rays: X-rays take an image of the bones, which will show the avulsion fracture in most cases. 
  • Magnetic resonance imaging (MRI): An MRI may be needed if an X-ray or a CT scan are not clear enough to diagnose the avulsion fracture. 

It is important to have a clear diagnosis. The wrong treatment can make an injury worse and can cause nerve damage, more pain, and trouble using the joints. If there is doubt about your diagnosis, you can seek a second opinion from a specialist who can take clear images and diagnose your injury after a thorough examination.

How are avulsion fractures treated?

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The goal of treating avulsion fractures is to stabilize the damaged bone and create the right environment and conditions for the bone to regenerate and repair as strong as possible. Bones naturally begin to heal right after an injury, so treatments like casts or splints help the bone restore in the right direction. In most cases, surgery is not needed to treat an avulsion fracture. Surgery might be needed if a growth plate is impacted in children or if the bone is severely unstable.  

The exact treatment will depend on the bone that fractures. In general, your doctor will treat an avulsion fracture by using a cast, splint, boot, or other stabilizing external device to allow for little movement to keep the bone steady. Along with stabilizing the fracture, your doctor will likely have you keep to a regiment of resting and icing the fracture area to encourage healing and prevent future injury. Treatment tends to span from a few weeks to months, depending on the severity and location of the injury. 

Once the pain subsides and your bone has healed, your doctor may have you do some physical therapy to strengthen the muscles and ligaments before you return to your normal activities. It is important to attend all follow up appointments to ensure the treatment plan is effective at healing the fracture.

Should you see a doctor for avulsion fractures?

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Prompt medical attention is important for avulsion fractures, so you should see a doctor if you suspect you have a bone fracture. The symptoms of an avulsion fracture happen very suddenly after the injury that causes the fracture, so you should be able to tell when the injury occurs. If the pain is severe, you may visit an emergency room before your primary care physician because immediate treatment will help ensure the bone heals properly. 

After you receive a diagnosis of an avulsion fracture, you should keep in good contact with your doctor about your symptoms and how the treatment plan is going. Your doctor may recommend physical therapy or adjustments to your current treatment as you get better. While the treatment for avulsion fractures is relatively simple, you must be consistent with the plan your doctor prescribes to ensure proper healing. 

What is the outlook for people living with avulsion fractures?

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The outlook for someone with an avulsion fracture is positive because there are minimal complications from avulsion fractures, and the fracture heals completely in most cases. Fractures that occur at a younger age should not cause problems later on so long as the fracture heals. To prevent future avulsion fractures, athletes should warm up before playing sports and should stretch to prepare the body for physical activity. 

Sticking to physical therapy and regular physical exercise helps strengthen and protect your body from future fractures or other injuries. In addition, supportive shoes and adequate caution in playing sports can help offer additional safety.