Ligaments and tendons are made up of fibrous connective tissue. Ligaments appear as crisscross bands that attach bone to bone and help stabilize joints. For instance, the anterior cruciate ligament (ACL) attaches the thighbone to the shinbone, stabilizing the knee joint. Tendons, located at each end of a muscle, attach muscle to bone.
Tendons are located throughout the body, from the head and neck all the way down to the feet. Additionally, the Achilles tendon is the largest tendon in the body. It attaches the calf muscle to the heel bone. The rotator cuff tendons help your shoulder rotate forwards and backwards.
An avulsion fracture is where a tendon or ligament pulls off a piece of the bone. This trauma is due to muscular contractions and can happen on any part of the body, but usually occurs around joints. The most common examples of avulsion fractures are fractures or bone chips such as an ankle avulsion, foot avulsion, finger avulsion, hip avulsion, and knee avulsion.
Causes & Symptoms of an Avulsion Fracture
As mentioned, an avulsion fracture occurs when a ligament or tendon suddenly pulls part of your bone off. This happens as the result of a traumatic injury. Avulsion fractures commonly occur in the hip, elbow, and ankle in younger people who participate in high contact sports. However, avulsion fractures can also happen anywhere in your body that soft tissues attach to the bone. Therefore, while these fractures can occur in many different bones, the most common types include:
Fibular avulsion fracture
Your fibula is the outer bone located in your lower leg. A fibular avulsion fracture is usually caused by a sudden inward rolling of your foot. This puts too much stress on your ligament and causes it to pull off a small piece of bone. This causes swelling and pain that makes walking much more difficult or near impossible. In addition, a fibular avulsion fracture is similar to a moderate or severe ankle sprain. A sprain originally happens when a ligament stretches or tears. Fibular avulsion fractures are more susceptible in elderly women because they often have weaker bones due to general wear and tear (osteoporosis).
Pelvic avulsion fracture
A broken part of a bone that happens in the hips, upper thigh, or buttocks is known as a ‘pelvic avulsion fracture’. These bone fractures often occur in areas where children and teenagers have open growth plates. Some signs of a pelvic avulsion fracture include forceful contractions of the abdominal muscles, hip muscles, thigh muscles, or hamstring muscles. In addition, sports that involve jumping or rapid changes of movements may cause this condition.
Medial epicondyle avulsion fracture
A medial epicondyle avulsion fracture is a type of elbow injury that happens in athletes who perform baseball activities between the ages of 9-14 and can be caused by hard pitching. It primarily affects the bony part that sticks out on the inside of your elbow.
Finger avulsion fracture (mallet finger, or baseball finger)
This happens when something such as a baseball hits the tip of your finger or thumb. This type of force causes the tendon at the back of your finger to tear and rip off part of the bone with it. With this injury, the tip of your finger or thumb droops down because it cannot straighten. Another type of finger avulsion is a jersey finger. When you experience this type of finger fracture, you cannot bend your finger at the first joint.
After experiencing an avulsion fracture of any part of your body, the most common symptoms include:
- Muscle pain.
- Bruising and swelling.
- A clicking or popping sensation.
- Pain that may spread to nearby parts of your body.
- Having trouble moving your limb.
- Limping or an inability to walk if the broken bone is near your leg.
Who gets an Avulsion Fracture?
Avulsion fractures are a problem that can be caused anywhere in the body, therefore, each risk factor may depend on where the fracture has taken place. Here are some factors that play a role in avulsion fractures:
- Age – Patients who are older than 50 are more susceptible to experiencing avulsion fractures due to wear and tear (osteoporosis).
- Gender – Women are more prone than men to experience a fibular avulsion fracture because of having weaker bones when growing older.
- Sports – Participating in high contact sports, such as basketball, ice hockey, baseball, soccer, football, and skiing, can all increase your chance of an avulsion fracture.
- Certain medications – Medications that are used to treat type 2 diabetes may increase your risk of experiencing avulsion fractures due to the side effects of this type of prescription.
- Malnutrition – Lack of vitamins and nutrition can put you at a great amount of risk of fracturing a bone.
- Vehicle accidents – Going through a vehicle accident will most likely damage any part of your bone, whether it is the result of an avulsion fracture or something much more serious, such as a broken bone, which may require surgical treatment.
How Does it Affect You? How Serious is it?
Fractures in general can lead to a rupture if you re-injure the same area. While most avulsion fractures do not require surgery, if the injury is to a bone attached to the tendon or ligament more than 2 centimeters away from the main bone, a surgeon may have to perform one of the two main procedures described below:
- Open reduction – Your surgeon makes an incision in your body and then realigns your bones.
- Internal fixation – Your surgeon uses metal hardware to align your bones permanently. Some examples of hardware include plates, pins, and screws.
Even though there is a chance to successfully achieve surgery for a severe avulsion fracture, unfortunately, there is a chance of complications; some of these include:
- Persistent pain – Some patients continue to have persistent pain after surgery. When this happens, your doctor will work with you to create a treatment plan, which may include additional physiotherapy, behavioral therapy, or medicines to help you recover regularly.
- Nerve or blood vessel damage – During surgery, there is a slight chance that the nerves, veins, or tissue around your affected area can be damaged. Damaged nerves or blood vessels can cause numbness, pain, or lower blood flow around where the fracture occurred.
- Blood clots – Because surgery for your avulsion fracture affects the way blood flows around the damaged area, it can increase your risk of developing blood clots.
Recommended Treatment & Rehabilitation for an Avulsion Fracture
In order to diagnose an avulsion fracture, a healthcare provider will begin by examining the injury. You will likely have one or more imaging tests to rule out other conditions associated with your fracture. Therefore, these tests may include:
- X-rays – This particular tool produces a two-dimensional picture of the break. This is often the first imaging test to be done in any diagnostic process.
- Bone scan – Your healthcare provider will use a bone scan to locate small fractures that do not appear on an X-ray. This scan usually takes longer, but it can help find some fractures.
- Computed Tomography (CT) scan – A CT scan uses computers and X-rays to create detailed slices or cross-sections of the bone.
- Magnetic Resonance Imaging (MRI) – A MRI creates detailed images using strong magnetic fields. MRI is also commonly used to diagnose stress fractures.
After a diagnosis for your avulsion fracture has been done, visiting a physiotherapist can help ensure your bone is healing properly, and on the right track to functioning normally in the long term. For many avulsion fractures (or fractures in general), a physiotherapist can reset the alignment of the affected bone through a process called reduction. This is to make sure the bone is in the right place and does not heal in an improper position.
Improper healing could lead to worse complications in the future. In more serious cases, a surgeon may have to surgically cut through the skin and muscle tissue to ensure the alignment is correct. In this case, screws and brackets may be installed to make sure the bone pieces can properly fuse together.
While the fracture begins to subside, you’ll often be instructed to avoid any movement in the affected area. Therefore, your physiotherapist may help you return to your regular daily activities. Depending on what bone was affected, you may be given certain assistive devices such as a sling, braces, or a pair of crutches.
Meanwhile, during your physiotherapy session, your therapist will assess the progress of your recovery, and gauge how you have progressed in terms of motion, strength, overall pain in the area, and more. By evaluating where you are in the recovery process, your physiotherapist may recommend appropriate exercises, pain management techniques, or proper rest, to make sure the bone recovers correctly.
The following exercises are performed to relieve most parts of your body where avulsion fractures are commonly caused (such as your ankle, finger, hip, and pelvic). Some of these include:
DIP Flexion (for finger fractures)
With your good hand, grasp your affected finger. Your thumb will be on the top side of your finger just below the joint that is closest to your fingernail. Next, slowly bend your affected finger only at the joint closest to your fingernail. Hold for 6 seconds, then repeat 8-12 times a day.
Heel raises (for ankle fractures)
Stand with your feet 8-10 centimeters apart, with your hands lightly resting on a counter or chair in front of you. Next, slowly raise your heels off the floor while keeping your knees straight. Hold for about 6 seconds, then slowly lower your heels to the floor. Repeat this method 8-12 times a day.
Hip abduction (for hip / pelvic fractures)
Slide your leg out to the side keeping your knee straight. Then return your leg back to the middle. Repeat this exercise 10 times a day.
Alternative & Homeopathic Treatment for an Avulsion Fracture
Avulsion fractures usually take a few homeopathic treatment plans to help you recover sooner. Here are some home remedies to relieve the pain and discomfort that can be associated with an avulsion fracture to combine with other treatments:
If you sustained an avulsion fracture anywhere in your body, the first thing that is recommended to do is to immobilize the affected limb, and from there, rest it as much as possible over the coming 6-8 weeks.
One of the best treatments you can do at home for fractures is to massage the area around the injury. Massage can help to promote the flow of blood to the area that is still being healed, and it can also help to relieve a lot of the muscle tension and discomfort that’s associated with an avulsion fracture.
Mobility tape is available over-the-counter and is known to be a well-known product for the recovery of a fracture. However, this type of tape is strong enough to support a healing fracture, but not so tight that it can impair blood flow.
Ice and compression together are one of the most recommended combinations that can be done for a recent injury. In most cases, it can even reduce the risk of added bruising and can help relieve swelling and inflammation.