Operatively treated ischial tuberosity avulsion in an adolescent snowboarder: treatment, patient's perspective and critical appraisal of current literature on the indication for surgery

Avulsion fractures of the ischial tuberosity (AFIT) are rare and occur almost exclusively in adolescent athletes. Treatment can be either conservative or surgical. The limited literature on this topic debates the criteria for surgical fixation, with various authors citing displacement thresholds of 15 or 20 mm as pivotal for deciding whether early surgical fixation is recommended. Postoperative care typically involves cautious rehabilitation to prevent reavulsion, which includes avoiding forceful hamstring contraction and preventing passive stretching of the hamstrings through full knee extension or hip flexion. We present a case of an early adolescent snowboarder with a left ischial tuberosity avulsion, where the fragment measured 42×19 mm and was displaced by 38 mm. Surgical fixation was performed, followed by careful rehabilitation.This report critically evaluates the epidemiological evidence supporting displacement thresholds used in the literature to guide surgical decision-making and describes the patient's experience with significant postoperative restrictions.