[Avulsion injuries of the anterior inferior iliac spine among soccer players--a differential diagnosis to neoplasm decades following the trauma].

Pelvic apophyseal injuries typically involve adolescents, ranging gradually from apophysitis as a chronic traction injury to avulsion fractures after a sudden contraction of a muscle to the immature musculo-skeleton adolescent. While avulsion fractures to the anterior superior iliac spine, the iliac crest and the pubic bone are common, injuries to the anterior inferior iliac spine (AIIS) are only rarely encountered. We report on two 42 and 43-year old male soccer players complaining of groin pain. Both had AIIS avulsion fractures diagnosed by conventional plain x-ray of the pelvis, ultrasound and magnetic resonance imaging. One patient had an acute adductor longus muscle injury with concomitant asymptomatic AIIS avulsion fracture. Conservative treatment of the muscle injury with initial RICE therapy followed by pain-restricted jogging brought him back to sport within four weeks. The other patient had local tenderness and exercise pain at AIIS with a large exostosis on imaging studies mimicking a pseudotumor. Surgical resection was applied and the rectus femoris muscle was reattached. After three months of intensive physical therapy he could be return to sport. Avulsion fractures of the AIIS may cause persistent pain syndrome and mimic a pseudotumor decades after the initial trauma, which can be treated by surgical resection and reattachment of the rectus femoris muscle with good results. Conservative treatment for minor dislocated AIIS avulsion fractures can be effective in sportsmen. Differential diagnosis often involves bony tumors, so patient's soccer history gives important information regarding past avulsion fractures of the pelvis, which often occur during kicking in the adolescence.