CHAPTER 57 • PELVIS, HIP, AND THIGH 339primary and secondary osteitis is usually made on
physical examination. Initial treatment consists of
rest, range of motion(ROM) exercises, oral nons-
teroidal anti-inflammatory drugs (NSAIDs), and
sometimes corticosteroid injection. Secondary osteitis
will respond to treatment of the underlying condition.
Surgical intervention can be required in recalcitrant
cases, but has unpredictable results (Busconi, Wixted,
and Owens, 2003).FRACTURE AND DISLOCATION
- Pelvic and femoral diaphyseal fractures are rare in
sports but can have devastating consequences. These
injuries require great amounts of energy imparted in
order to occur, although lower energy mechanisms
can be seen in pathologic bone. The majority of pelvic
fractures are stable injuries of the pelvic ring and
requires symptomatic treatment with an initial course
of protected weight bearing. The determination of
pelvic ring stability should be confirmed by inlet/outlet
radiographs, in addition to computed tomography. The
standard of care for diaphyseal femur fractures is
reduction followed by intramedullarynailing. - Hip dislocation and fracture-dislocations can be seen
more commonly, but are still rare injuries. Intertro-
chanteric hip fractures require surgical reduction and
internal fixation. Femoral neck fractures in athletes
are a true orthopedic emergency. Anatomic reduction
and internal fixation are required in a timely fashion,
as avascular necrosis (AVN) is associated with
delays in treatment. Another injury that has the dev-
astating risk of AVN is hip dislocation, which may
also have associated femoral head or acetabular frac-
tures. These require emergent closed (or open if nec-
essary) reduction followed by computed tomography
(CT) to assess a fracture if present or to rule out an
osseous loose body. Even in the absence of fracture,
the presence of chondral loose bodies and labral
pathology can cause persistent symptoms. Hip
arthroscopy has been useful in this scenario (Owens
and Busconi, 2003).
SOFT TISSUE INJURIES
MUSCLE STRAINS
- Soft tissue injuries to the periarticular structures sur-
rounding the hip and pelvis are the most common
injuries seen in athletes. In general, the great majority
of soft tissue injuries about the hip and pelvis are mus-
culotendinous strains. The type of injury sustained is
highly dependent on ( 1 ) skeletal age of the athlete, ( 2 )
physical condition, and ( 3 ) biomechanical forces
involved in both the sport and nature of the trauma.
The degree of injury can range from repetitive
microinjury associated with each performance to a
more significant single macroinjury caused by an
abnormal biomechanical force. A certain degree of
microtrauma occurs with every major exertional per-
formance immediately manifested by swelling, sensi-
tivity, and a recovery interval. If additional moderate
or severe micro- or macroinjury occurs, there may not
be a normal healing response that may lead to more
significant changes in tissue structure and a negative
effect on future athletic performance (Busconi,
Wixted, and Owens, 2003).
•A strain is an injury to a musculotendinous structure
caused by an indirectly applied force. The most
common mechanism of injury is a result of eccentric
contraction or stretching of an activated muscle. The
site of injury is influenced by the rate of loading,
mechanism of injury, and local anatomic factors. Low
rates of loading will result in a failure at the tendon
bone junction by bone avulsion or disruption at its
insertion. High rates of loading result in intratendi-
nous or myotendinous juncture injuries.- These injuries can be graded on a three-scale clinical
grading system. Grade 1 injuries involve a simple
stretching of soft tissue fibers. Grade 2 strains involve
partial tearing of the musculotendinous unit; and
Grade 3, which are unusual, are secondary to extreme
violent forces causing complete disruptions.
CONTUSIONS- Among the most frequently experienced hip and
pelvic injuries sustained by athletes are soft tissue
contusions. Contusions usually result from direct
blows to a specific soft tissue area usually overlying a
bony prominence. Contusions are most common in
contact sports, especially football, but are also seen
other sports as well. In contact sports, the blow is usu-
ally caused by contact with another athlete. In non-
contact sports, athletes usually sustain blows from
contact with equipment (gymnastics), contact with
high velocity projectiles (lacrosse ball), or contact
from the playing surface. - Contusions are often found over areas of bony promi-
nences of the pelvis including the iliac crest (hip
pointer), greater trochanter, ischial tuberosity, and
pubic rami. Because of the varied anatomy of the
pelvis, contusions can be superficial, especially when
they overlie a relatively subcutaneous bone or lie deep
within a large muscle mass. It is important to determine