Adolescent hamstring avulsions that simulate tumors

Hamstring injuries are common in athletes. Most of these injuries are diagnosed clinically and managed conservatively. Some patients, such as those with atypical clinical presentations or persistent pain, may be referred for imaging evaluation. In this subacute setting, studies obtained may have confusing features, and fractures may be mistaken for neoplasms. Hamstring avulsions, as seen on plain radiographs and conventional tomography, can have an aggressive appearance owing to callus and postfracture osteolysis. Although computed tomography is not usually necessary, it is very helpful in the subacute setting, identifying the healing avulsed apophysis. Familiarity with the appearance of ischial avulsions over time and with different modalities facilitates accurate characterization of hamstring injuries. We present our experience with six ischial avulsion fractures referred to us as tumors.