Avulsion Fractures

What is an avulsion fracture?

An avulsion fracture is a type of fracture that happens when a sudden, forceful movement causes a tendon or ligament to pull a piece of bone away from the rest of the bone. 

Tendons connect your bones and muscles and ligaments keep your joints in place. When a ligament or tendon moves one way and your bone moves the other way, you could get an avulsion fracture. They can be large or small.

Avulsion fractures are common in children, athletes and people who are physically active. They can happen in lots of different bones throughout your body and often occur in the ankle, foot, knee, hip, pelvis, spine, elbow, finger or wrist. They are painful but they usually heal with treatment and rest.

Avulsion fracture causes and risk factors   

Avulsion fractures typically happen during rapid or intense movements such as:

• Sports where you’re likely to make sudden changes in direction, quick movements or jump or collide with another player or object (such as soccer, basketball, football, ballet, skiing or snowboarding, track, tennis, hockey, lacrosse, boxing or gymnastics)
• Sliding, hitting, throwing, falling or sprinting 
• Accidental falls
• Trauma such as car accidents 
• Heavy, repetitive use of a joint

Anyone can develop an avulsion fracture. People in these groups are at higher risk:

• Athletes who participate in sports that involve running, jumping or quick changes in direction.   
• Children and teens, because their bones are still developing. The growth plates in their bones are still open, and those sites are weaker than fully fused bone. Therefore, the ligaments or tendons can place enough force on the growth plate to cause an avulsion fracture. 
  • Growth spurts can make avulsion fractures even more likely. They are most common in male athletes ages 15 to 17 and female athletes ages 13 to 14. Boys are more likely to develop them than girls.
• Older people who have weaker bones from osteoporosis.

In rare cases, you could get an avulsion fracture from infection, cancer, surgery complications or genetic conditions.

Avulsion fracture symptoms 

With an avulsion fracture, you may notice symptoms similar to other types of fractures or sprains, such as:

• Pain that’s worse when you move the joint and possibly spreads to nearby areas
• Swelling
• Bruising or discoloration
• Numbness or tingling
• Weakness, less range of motion or trouble moving the injured area
• A popping sensation at the time of the injury

If you have symptoms of an avulsion fracture, you should see a health care provider for diagnosis and treatment right away.

Diagnosing avulsion fractures

You’ll want to get an exam quickly, since fractures can be serious. You may need to go to an urgent care center or emergency room. Your provider will likely:

• Ask you what happened when the injury occurred and what symptoms you have.
• Perform a physical exam and check for pain, swelling and range of motion.
• Recommend X-rays to confirm the diagnosis. They may suggest MRI, CT scans or ultrasound if your fracture seems more complicated.

Avulsion fracture treatment

Treatment depends on how severe the fracture is and where it’s located. You may want to see a sports medicine or orthopedic specialist for treatment. Most avulsion fractures can be treated with:

• Rest, ice, compression and elevation (RICE) to reduce pain and swelling
• Anti-inflammatory medication
• Restricting your activities
• Splints, casts, walking boots or braces to protect and immobilize the joint while it heals (you may also need to use crutches)
• Rest, if the fracture is in a place like your pelvis where you can’t use a cast to immobilize it
• Physical therapy for strengthening, mobility and recovery

Physical therapy also helps prepare you to return to sports and reduces the risk of future injuries.

While your bone is immobilized, your body creates a type of blood clot around the fracture to protect the bone. Then, bone cells grow from the main bone and the bone chip and gradually connect to each other. Avulsion fractures usually heal in six to 12 weeks but sometimes take longer.

You may need surgery if the bone fragment has moved too far away (an inch or more) from the main bone to heal on its own.  During the procedure, a surgeon may either realign your bones so they can heal or reattach the bone fragment and stabilize it with screws or pins to fix it in place, or possibly perform a reconstruction of the ligament/tendon.

Your health care provider will talk to you about how and when you can return to your activities. You could reinjure the bone if you start too soon or ramp up too quickly.

Preventing avulsion fractures

To prevent avulsion fractures, your health care team will talk to you about what caused the fracture, so you can take steps to prevent another one from occurring. 

It can help to:

• Strengthen the muscles so they support your joints
• Maintain or improve your flexibility
• Warm up with dynamic exercises 
• Use the right techniques, form and body mechanics when you are taking part in sports and physical activity
• Wear protective gear when you are playing high-impact sports
• Be careful not to overtrain, which can stress your bones

Complications and when to seek treatment   

It's important to treat avulsion fractures. Otherwise, you risk complications such as:

• Chronic pain or stiffness
• Limited mobility in the area
• A bone that doesn't heal or align properly

Contact your health care provider if you notice:

• Pain or swelling in spite of resting the joint
• Signs of infection, such as redness or warmth 

Getting care

Avulsion fractures may occur when a tendon or ligament pulls a piece of bone fragment away from the main bone. They are most common in athletes, especially younger athletes, who can stress the growth plates where their bones are weaker.

If you think you may have an avulsion fracture, don’t wait to get the care you need. At Banner Health, our team has extensive expertise in diagnosing and treating bone injuries. We use state-of-the-art diagnostic and treatment techniques to create a care and recovery plan designed around you and your needs. We’ll help you get back to doing what you love.