title: Ischiofemoral impingement and hamstring dysfunction as a potential pain generator after ischial tuberosity apophyseal fracture non-union/malunion.
abstract: OBJECTIVE
  The purpose of this study was to describe the occurrence of ischiofemoral impingement (IFI) and hamstring dysfunction following malunion or non-union of ischial tuberosity apophyseal avulsion fractures and report the short-term outcomes of surgical treatment with regard to alleviating symptomatic extra-articular impingement.
  
  
  METHODS
  All patients who underwent surgery for recalcitrant hip and buttock pain in the setting of prior ischial tuberosity avulsion fracture at three tertiary-level hip preservation centres were included for this review. A total of ten patients met our inclusion criteria and underwent sciatic neurolysis, resection of the ischial tuberosity fragment and hamstring reattachment. Clinical outcomes scores were collected post-operatively including the Modified Harris Hip Score (mHHS) and the Hip Outcomes Score (HOS).
  
  
  RESULTS
  Ten patients with a mean age of 18 years (range 14-28) underwent surgery for symptomatic ischiofemoral impingement after ischial tuberosity avulsion fracture. At a mean of 2.2-year follow-up (range 1.7-3.5), the median post-operative mHHS was 89.7 (65.7-96.8) and HOS ADL and Sport subscales were 90 % or greater in all cases. Five patients (50 %) rated their hip as normal, and five patients (50 %) rated their hip as near normal.
  
  
  CONCLUSIONS
  Malunion or non-union following ischial tuberosity apophyseal fracture can lead to IFI and hamstring dysfunction. Clinically, the resultant pain and dysfunction is often chronic, and can be debilitating. In select cases, a reliable surgical technique is presented to improve hamstring function and correct ischiofemoral impingement in this setting with good-to-excellent outcomes in the majority of cases at short-term follow-up.
  
  
  METHODS
  IV.
authors.affiliation: Mayo Clinic, 200 1st St SW, Rochester, MN, 55901, USA.
authors.forename: Luke
authors.initials: L
authors.lastname: Spencer-Gardner
authors.affiliation: Medsport Clinic University of Michigan, 24 Frank Lloyd Wright Dr Ste 1000, Ann Arbor, MI, 48105, USA.
authors.forename: Asheesh
authors.initials: A
authors.lastname: Bedi
authors.affiliation: Mayo Clinic, 200 1st St SW, Rochester, MN, 55901, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Stuart
authors.affiliation: Twin Cities Orthopedics, 4010 West 65th Street, Edina, MN, 55435, USA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Larson
authors.affiliation: Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
authors.forename: Bryan T
authors.initials: BT
authors.lastname: Kelly
authors.affiliation: Mayo Clinic, 200 1st St SW, Rochester, MN, 55901, USA. krych.aaron@mayo.edu.
authors.forename: Aaron J
authors.initials: AJ
authors.lastname: Krych
mesh_terms: D000293:Adolescent; D000328:Adult; D001265:Athletic Injuries / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D057925:Femoracetabular Impingement / Q000000981:diagnostic imaging / Q000601:surgery*; D000071562:Fractures, Avulsion / Q000000981:diagnostic imaging / Q000601:surgery*; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D000070633:Hamstring Muscles / Q000293:injuries*; D006801:Humans; D007512:Ischium / Q000000981:diagnostic imaging*; D008297:Male; D010149:Postoperative Pain; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Avulsion fracture; Hamstring injury; Impingement; Ischial tuberosity; Ischiofemoral