Imaging findings of acute sport-related osseous avulsions and osteochondral injuries

Acute sport-related avulsion fractures and osteochondral injuries are common in athletes, particularly in the pediatric population, and may present diagnostic challenges when radiographic findings are subtle. These injuries occur because of excessive tensile, shear, or impaction forces and most frequently involve apophyses, osteochondral junctions, or articular surfaces. Accurate characterization of injury location, fragment morphology, displacement, and associated soft-tissue abnormalities is essential to guide management, promote healing, and facilitate safe return to play (RTP). Radiographs are the initial imaging modality for evaluation and are useful for identifying osseous avulsion fragments and assessing alignment. Computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound (US) may serve as complementary modalities depending upon the suspected injury. Common injury sites include the shoulder, elbow, pelvis, knee, foot, and ankle. Recognition of characteristic imaging patterns, associated injuries, and potential mimics, particularly in skeletally immature patients, is critical for accurate diagnosis. Management ranges from conservative therapy to surgical fixation or cartilage restoration procedures. This review summarizes the mechanisms, imaging features, treatments, pitfalls, and RTP implications when available of acute sport-related avulsion fractures and osteochondral injuries.