Table 1.

Summary of the case histories of the 12 patients

No/sex	Referral source	Age at time of injury	Age at time of diagnosis	Injury to surgery	Mechanism of injury	Diagnosis	Management	Outcome
Group A	Ischial	Apophysis	Avulsions
1M	St George's clinic	16	16	N/A	Martial arts, high kick	Undisplaced avulsion	Non-operative	Good
2F	Orthopaedic specialist	15	17	30 months	Gymnastics, ‘did the splits’	Displaced avulsion, > 3 cm	Operative (Recon plate and bone graft)	Good
3M	Rheumatology specialist	14	16	36 months	Sprinting	Displaced avulsion, > 3 cm	Operative (Recon plate and bone graft)	Good
4M	Orthopaedic specialist	15	18	30 months	Football, ‘lunged for ball’	Displaced avulsion, > 3 cm	Operative (Recon plate and bone graft)	Screws broke, revised, good outcome (see text)
5M	General practitioner	12	15	N/A	Rugby tackle and fall	Chronic avulsion 3 cm and acute bone bruise	Non-operative	Satisfactory
6M	General practitioner	9	9	3 months	Bad landing after a ski jump	Laterally displaced avulsion, 2 cm	Operative (Recon plate, no bone graft)	Good
Group B	Hamstring	Tendon	Avulsions
7M	Orthopaedic specialist	30	30	5 months	Karate kick, swivelled on back leg	Avulsion of hamstring origin, 3 cm	Operative (4 bone anchors used)	Good (75% strength)
8M	Orthopaedic specialist	23	24	14 months	Football, ‘did the splits’	Avulsion of hamstring origin, 10 cm	Operative (4 bone anchors used)	Good
9M	General practitioner	19	31	12 years	Martial arts kick	Avulsion of hamstring origin, 2 cm	Operative (4 bone anchors used)	Good
10F	St George's orthopaedic specialist	51	51	10 weeks	Running, slipped on wet surface	Avulsion of hamstring origin, 4 cm	Operative (6 bone anchors used)	Good (70% strength)
11F	Orthopaedic specialist	20	22	N/A	Tennis, ‘lunged to reach ball’	Avulsion of hamstring origin, 6 cm	Declined surgery	Poor (unable to compete)
Group C	Ischial	Avulsion	Fracture
12M	Orthopaedic specialist	32	32	< 1 week	Water-skiing, leading leg	Avulsion of large part of ischium	Operative (Recon plate, no bone graft)	Good