Upon examination two days later, he had profound weakness and pain with right hip flexion. The patient is a 16-year-old, Risser stage 2, high-level high school baseball player who felt a pop and sudden, sharp pain at the right ASIS while simultaneously running the base path and shifting his hips to his right to avoid a tag. We present the case of a young athlete who sustained an ASIS avulsion fractures while playing baseball that was treated with open surgical reduction and fixation using absorbable sutures with an emphasis on mobilizing the tensor fascia latae to reapproximate the avulsed segment without tension. Prior to the ossification, the epiphyseal plate is weaker than the myotendonous junction or pelvic bone, making avulsions more likely in younger athletes. Apophysis ossification of the ASIS usually occurs between the age of 21 and 25. A sudden forceful strain on the sartorius or the tensor fasciae latae during the starting phase of running or jumping is the most common mechanism of accident. Avulsion injuries of the ASIS constitute 1.4% of injuries of the hip and pelvis and 19% of avulsion injuries of the pelvis. The Anterior Superior Iliac Spine (ASIS) serves as the origin of the sartorius muscle and of parts of the Tensor Fasciae Latae (TFL). The decision between nonoperative versus surgical management depends on the grade of displacement, skeletal maturity, type of sport/activity, and competitive/career requirements. Tensor fascia latae (TFL), Anterior superior iliac spine (ASIS), Avulsion fracture, Core muscle injuryДЄSIS: Anterior Superior Iliac Spine TFL: Tensor Fasciae Latae MRI: Magnetic Resonance ImagingДЄvulsion fractures of the anterior superior iliac spine are uncommon and there are no established treatment guidelines. Athletes with ASIS avulsion fractures repaired with this technique can expect to return to play within 6 weeks. Additionally, the relatively rapid return to activities and lack of immobilization minimizes deconditioning, which might be an advantage over non-operative management. Operative treatment of avulsion fracture of the ASIS without bone anchors or screws highlights the importance of soft tissue mobilization and reduction of tension. As of 12 months postop, there were no complications and he is playing at his pre-injury level of performance without pain. He was jogging in the third postoperative week and returned to full-play in the 6 th week. The patient was started on a progressive physical therapy protocol that did not involve any weight-bearing or range of motion restrictions. We present a young athlete who sustained an ASIS avulsion fracture while playing baseball that was treated with open surgical reduction and fixation using absorbable sutures with an emphasis on mobilizing the TFL to reapproximate the avulsed segment without tension. Deciding between nonoperative versus surgical management depends on the grade of displacement, skeletal maturity, type of sport/activity, and competitive/career requirements.

Avulsion fractures of the anterior superior iliac spine are uncommon without established treatment guidelines.