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Imaging Features of Avulsion Injuries¹

¹ From the Department of Radiology, Musculoskeletal Division, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA 52242. Recipient of a Certificate of Merit award for a scientific exhibit at the 1997 RSNA scientific assembly. Received April 13, 1998; revision requested June 1 and final revision received October 5; accepted October 6. Address reprint requests to G.Y.E.

Avulsion injuries are common among participants in organized sports, especially among adolescent participants. Imaging features of both acute and chronic avulsion injuries of the pelvis, knee, ankle and foot, shoulder, and elbow were evaluated to help distinguish these injuries from more serious disease processes such as neoplasm and infection. At radiography, acute injuries (ie, those resulting from extreme, unbalanced, often eccentric muscular contractions) may be associated with avulsed bone fragments, whereas subacute injuries have an aggressive appearance that may include areas of mixed lysis and sclerosis. Chronic injuries (ie, those resulting from repetitive microtrauma or overuse) or old inactive injuries may be associated with a protuberant mass of bone and may bear a striking resemblance to a neoplastic or infectious process. Although not usually required, computed tomography is helpful in the diagnosis if radiographic findings are equivocal or if the injury is not in the acute phase. MR imaging is best suited for the evaluation of injuries to muscles, tendons, and ligaments. Recognition of characteristic imaging features and familiarity with musculotendinous anatomy will aid in accurate diagnosis of avulsion injuries.

Index Terms: Ankle, fractures, 46.4191 • Elbow, fractures, 42.4191 • Extremities, CT, 40.1211 • Extremities, MR, 40.1214 • Foot, fractures, 46.4191 • Fractures, stress • Knee, fractures, 45.4191 • Pelvis, fractures, 44.4191 • Shoulder, injuries, 41.4191

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