Avulsion Fracture Causes and Treatments

An avulsion fracture is a bone injury that occurs when a piece of bone that attaches to a tendon or ligament is pulled off the rest of the bone. Avulsion fractures can occur anywhere in the body, but they are most common in the elbow, ankle, and hip.

Recovery from an avulsion fracture can take six weeks to six months, and surgery is not always needed. However, in children who have an avulsion fracture involving the growth plate, or the area of the bone that is actively growing, surgery may need to be done.

A doctor applies cast material to a patient's leg.
Richard Gerstner / Getty Images


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. 


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.


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.

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.

Frequently Asked Questions

  • How long does it take to recover from an avulsion fracture?

    It can take anywhere from six weeks to six months to fully heal and resume full activities. Exactly how long it takes depends on what area of the body you injured and how serious the avulsion fracture was.

  • Does fracturing a growth plate stop your bone from growing?

    Most growth plate injuries heal without disrupting growth as long as they are treated properly. However, sometimes a bony bar develops along the fracture line. This can stunt growth or cause an abnormal curve in the bone. If the bony bar is caught early, a doctor can correct it. 

  • How do you treat a finger avulsion?

    You should see a hand specialist. Your finger will likely be placed in a splint that lets it remain stable while giving you a chance to move it slightly to avoid losing long-term mobility. Surgery is sometimes needed to insert pins into the bone. Physical therapy is usually recommended.

6 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.
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  4. 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

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  6. Borchers JR, Best TM. Common finger fractures and dislocations. AFP. 2012;85(8):805-810.

Additional Reading

By Jonathan Cluett, MD
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.