Medical Imaging Analysis Report

I. Imaging Findings

1. X-ray images show a small piece of bony shadow in the right pelvic region (at the anteroinferior iliac spine), separated from the surrounding bony cortex, suggesting a local fracture or a separated bone fragment.
2. CT images at the pelvic level show the relationship between this fracture fragment and the adjacent soft tissues. The local soft tissue density may be increased, indicating edema or hemorrhage, which is suggestive of an avulsion fracture at a stress concentration site.
3. On T2/STIR sequence MRI images, there is hyperintense signal of soft tissue edema around the anteroinferior iliac spine (high signal), along with a hypointense avulsed fragment at the bony cortex. The area of abnormal signals is relatively localized, consistent with a localized avulsion fracture.
4. There are no obvious abnormal imaging findings at the contralateral anteroinferior iliac spine; however, comparison is recommended to observe any rare anatomical variants and to rule out false positives.

II. Potential Diagnoses

1. Avulsion Fracture of the Anteroinferior Iliac Spine: This region is commonly affected in adolescents or young athletes. Sudden contraction of the straight head of the quadriceps (often the rectus femoris) can pull on the apophysis or attachment site, causing an avulsion. The patient’s sports history (playing soccer) and injury mechanism support this diagnosis.
2. Simple Soft Tissue Contusion or Tendon Injury: If the fracture fragment is small or difficult to distinguish from soft tissue, it may only be a severe tendon or attachment site injury. However, the distinct visibility of a fracture fragment lowers the likelihood of a purely soft tissue injury.
3. Osteoid Tumor-Like Lesion or Exostosis: Occasionally found in young individuals in the pelvic region, but typically presents without an acute trauma history or pain mechanism. There is also little evidence of soft tissue edema, and the imaging usually lacks avulsion features, placing this possibility lower on the list.

III. Final Diagnosis

Based on the patient’s age of 17, the acute pulling injury sustained while playing soccer, and imaging findings showing a small separated bone fragment at the anteroinferior iliac spine with surrounding soft tissue edema/hemorrhage signals, together with clinical symptoms, the most likely diagnosis is an avulsion fracture of the anteroinferior iliac spine. If needed, further detailed MRI scans or 3D CT reconstructions can be performed to evaluate any extensive avulsion or significant displacement, aiding in surgical decision-making.

IV. Treatment Plan and Rehabilitation

1. Conservative Treatment:
- For avulsion fractures with minor displacement or small fragments, short-term (a few days) bed rest is generally recommended to relieve pain and edema.
- Crutches or braces can be used to reduce pelvic load, transitioning to partial weight-bearing once pain subsides significantly.
- Non-steroidal anti-inflammatory drugs (NSAIDs) may be used for pain relief, while monitoring for gastrointestinal or other adverse effects.
2. Surgical Treatment:
- If fragments are obviously separated or significantly displaced, or if there is severe functional impairment, surgical internal fixation or removal of any localized bony protrusion (in case of a notable exostosis) should be considered.
- Postoperative rehabilitation should follow standard principles of postoperative training, with systematic functional exercises.
3. Recovery Exercise Prescription (FITT-VP Principle):
This applies if the fracture fragment is not significantly displaced and conservative treatment is adopted. It is also applicable during rehabilitation after surgery:
- Type: Start with low-load isometric muscle exercises and mild range-of-motion training, gradually transitioning to cycling, swimming, or other non-weight-bearing or low-impact exercises.
- Frequency: Initially once a day for a short duration; as recovery progresses, 3–5 sessions per week.
- Intensity: Begin at a level that does not cause significant pain, maintaining an RPE (Rate of Perceived Exertion) around 2–3. Increase resistance or range of motion gradually as pain subsides and fractures heal.
- Time: Start with 5–10 minutes of daily joint mobilization and isometric contraction exercises. Eventually, progress to 20–30 minutes as recovery continues.
- Progression: Begin with passive or assisted joint movement, then gradually introduce active, light-load exercises such as elastic band exercises or short-distance walking on flat surfaces. Once pain allows, add light jogging or jumping drills.
- Volume: Total training volume should match the rate of soft tissue and fracture healing. Increase by about 10–15% weekly to avoid overstimulation that might cause reinjury or delayed healing.
4. Precautions:
- Growth plates in adolescents have not completely closed; hence, overuse or repeated pulling stress can lead to secondary injuries.
- If significant pain or swelling occurs during training, reduce or pause exercise and consult a doctor promptly.
- If other conditions are present (e.g., osteoporosis, chronic diseases), rehabilitation should be individualized under professional medical guidance.

V. Disclaimer

This report is intended as a reference analysis and does not replace an in-person clinical consultation or professional medical advice. Actual treatment decisions should be made based on the patient’s specific condition, professional medical judgment, and further diagnostic findings.