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Chronic (Ten Years) Ischial Tuberosity Avulsion Fracture Nonunion Treated with Fragment Excision and Simultaneous Primary Repair of the Hamstring TendonA Case Report
Steven K. Dailey, MD1; Barton Branam, MD1; Michael T. Archdeacon, MD, MSE1
1 Department of Orthopaedic Surgery, University of Cincinnati, PO Box 670212, Cincinnati, OH 45267-0212. E-mail address for S. Dailey: steven.dailey@uc.edu. E-mail address for B. Branam: branambr@ucmail.uc.edu. E-mail address for M.T. Archdeacon: michael.archdeacon@uc.edu
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Investigation performed at the Department of Orthopaedic Surgery, University of Cincinnati, Cincinnati, Ohio

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
JBJS Case Connector, 2013 Dec 24;3(4):e137 1-5. doi: 10.2106/JBJS.CC.M.00176
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Ischial tuberosity avulsion fractures are infrequent injuries that primarily affect adolescent athletes1-8. Ischial avulsions can be easily mistaken for hamstring injuries and therefore missed on initial presentation1,6. Whereas some of these fractures heal spontaneously, they often can progress to painful nonunion1,2,9,10. Painful nonunion of an ischial avulsion fracture is generally treated operatively with open reduction and internal fixation. To our knowledge, three years is the longest time span reported in the literature between ischial tuberosity avulsion fracture injury and nonunion repair1,2,8,9,11,12. We present a case of a chronic ischial tuberosity avulsion fracture nonunion with a ten-year delay between the initial injury and definitive surgical management via fragment excision and primary hamstring repair. This case report presents a viable option for repair of chronic, painful ischial tuberosity avulsion nonunion. Furthermore, it demonstrates that patients can benefit from this procedure, even after an extensive interval from the index injury.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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