Orthopedics Fractures & Broken Bones Avulsion Fracture Causes and Treatments By Jonathan Cluett, MD twitter linkedin Jonathan Cluett, MD, is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams. Learn about our editorial process Jonathan Cluett, MD Medically reviewed by Medically reviewed by Stuart Hershman, MD on June 21, 2020 linkedin Stuart Hershman, MD, is a board-certified spine surgeon. He specializes in spinal deformity and complex spinal reconstruction. Learn about our Medical Review Board Stuart Hershman, MD on June 21, 2020 Print An avulsion fracture is an injury to the bone in a location where a tendon or ligament attaches to the bone. When an avulsion fracture occurs, the tendon or ligament pulls off a piece of the bone. Avulsion fractures can occur anywhere in the body, but they are more common in a few specific locations. Avulsion fractures are more common in children than in adults. In adults, the ligaments and tendons tend to be injured first, whereas in children the bone may fail before the ligament or tendon is injured. Children have a particularly weak point in their skeleton, called the growth plate. This is the area of bone that is actively growing. In children, tendons or ligaments near a growth plate can pull hard enough to cause the growth plate to fracture. Richard Gerstner / Getty Images Causes Often an avulsion fracture occurs when there is a sudden forceful pull on a tendon while the bone is moving in the opposite direction. An example is an injury to the fifth metatarsal, the bone on the outside of the midfoot. The peroneal tendon attaches to the base of this bone. Often when the foot is twisted, a forceful contraction of the peroneal tendon pulls the foot in one direction, while the twisting force is acting on the foot in the opposite direction. This causes the bone to crack where the tendon attaches to the bone. The good news is that these fractures almost always heal with simple rest and time. Diagnosis An avulsion injury noted on an X-ray film can be confusing, because often these may be related to an old injury. Sometimes a small piece of bone pulled away from the body a long time ago, and only when an X-ray is obtained months or years later is the fragment of bone seen. It's important not to chase down a treatment for something that doesn't require an intervention. That's why it's critical to have a physician who can both interpret your X-rays and put those results into the context of your injury history and examination findings. Treatment Most often, an avulsion fracture can be treated without surgery. Only when the pulled off fragment of bone is pulled more than several centimeters from its normal position does surgery need to be considered. In addition, some avulsion fractures affect such small pieces of bone there's no need to repair them. For example, ankle sprains often cause small avulsion fragments. These injuries typically can be treated like an ankle sprain, as the small piece of bone really does not affect the treatment decisions or outcome of the patient. There are some concerns about treatment when the avulsion fracture involves the growth plate in a child. Because growth plates are important for normal skeletal development, these injuries must be carefully treated. If there is a concern that a growth plate is not correctly positioned, surgery may be performed to align and stabilize the growth plate. How Are Broken Bones in Kids Different? Surgery may not be needed if the avulsion fracture is well aligned, or if the patient is near enough to growth plate closure that this injury will not cause lasting growth problems. Was this page helpful? Thanks for your feedback! Dealing with joint pain can cause major disruptions to your day. Sign up and learn how to better take care of your body. Click below and just hit send! Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Vannabouathong C, Ayeni OR, Bhandari M. A Narrative Review on Avulsion Fractures of the Upper and Lower Limbs. Clin Med Insights Arthritis Musculoskelet Disord. 2018;11:1179544118809050. doi:10.1177/1179544118809050 Frush TJ, Lindenfeld TN. Peri-epiphyseal and Overuse Injuries in Adolescent Athletes. Sports Health. 2009;1(3):201-11. doi:10.1177/1941738109334214 Bowes J, Buckley R. Fifth metatarsal fractures and current treatment. World J Orthop. 2016;7(12):793-800. doi:10.5312/wjo.v7.i12.793 Jarraya M, Hayashi D, Roemer FW, et al. Radiographically occult and subtle fractures: a pictorial review. Radiol Res Pract. 2013;2013:370169. doi:10.1155/2013/370169 Additional Reading Schiller J, DeFroda S, Blood T. "Lower Extremity Avulsion Fractures in the Pediatric and Adolescent Athlete" J Am Acad Orthop Surg. 2017 Apr;25(4):251-259.