Hybrid fixation and sciatic neurolysis of an ischial tuberosity avulsion fracture with neurologic symptoms: a case report

Introduction Ischial tuberosity apophyseal avulsion fractures (ITAFs) are rare injuries occurring primarily in adolescent males. ITAFs are typically caused by a strong eccentric hamstring contraction that avulses the ischial apophysis before it is fully fused. However, there is currently no consensus on its therapeutic paradigm. Case Presentation A 13-year-old male presented with posterior thigh pain after a twisting injury. On exam, he had ischial tenderness, limited hip flexion, and lower extremity paresthesias. Imaging revealed a proximally displaced ischial tuberosity apophyseal avulsion fracture. Management and Outcomes He underwent open reduction and hybrid fixation with suture anchors and a cannulated screw, and sciatic nerve neurolysis. Postoperatively, neurologic symptoms resolved, and he resumed full activity within five months. Conclusion This case demonstrates the successful and novel use of hybrid fixation for a displaced ITAF with neurologic symptoms. Hybrid fixation provides a stable repair, enabling a safe and timely return to sports for adolescents.