Have you been diagnosed with a bone tear which in medical terms is called a bone avulsion.
or are you just wondering how long healing will take for you to get back to your normal activities.
I rely on my radiography knowledge to answer your questions and on medical scientific studies on the subject matter.
Happy reading!😃
Any questions? remarks? Let’s meet in the comments section at the end of this article.🙏
Last updated: Feb 2025. Written by Juliet Semakula a diagnostic radiographer
In summary: A bone tear (bone avulsion) affects tendons, muscles or ligaments. This is when the ligament or tendon pulls too hard on the bone and detaches a fragment.
▶️What really causes a bone avulsion or tear?
As a radiographer I have seen so many bone tears /avulsions on x-rays and scans.
Mainly in adolescents who are often more involved in athletes such as football players, ballet dancers, gymnasts and skiers.
These activities do involve a lot of sudden changes in direction, leaping and kicking that can cause a bone tear.
With repetitive stress on the bone while performing these sports leads to a bone avulsion.
▶️What are some of the symptoms of a bone tear?
Depending on the type of bone tear you have got, usually signs and symptoms of a bone avulsion do not differ from other bone injuries such as fractures and sprains.
🟢Pain at the sight of avulsion that spreads to nearby parts of your body, sometimes it will be intensive.
🟢Swelling and bruising around the affected area.
🟢Limping or trouble walking.
🟢You will have limited ability to move the affected area and when you try you will feel pain.
🟢Muscle pain
🟢A popping or cracking sound.
I always hear patients ask questions about how long they will be able to get back to their normal activities. I will explain what a bone tear is, and the recovery timeline needed.
There are a dozen scientific publications devoted to bone tear which in medical terms, this is called a bone avulsion.
Studies on bone tear injuries indexed in the Google of medicine, PubMed.
▶️What is the difference between a bone avulsion tear and a bone fracture?
Your doctor is trained to differentiate an avulsion bone tear from a fracture.
Our bones can break in any part, in different ways. For example a bone can break and remain in place, shift or displace from the impact of a break.
A bone tear in medical terms is the same as an avulsion tear. This is when a small piece of bone attached to a tendon or ligament gets pulled away from the main part of the bone.
It can be pulled off the tissue back from its normal position (retracted) or remain in place (Non retracted).
This means a tear is incomplete involving only part of the tissue in question.
The diagram below shows different types of bone fracture showing how displaced they are, and a bone tear shown in green.
As you can see, I have some radiography drawing skills.
For this article I am going to focus on a bone tear (bone avulsion).
▶️What are the most common sites of bone tears?
Bone tears/avulsion can occur in both adults and children. The most common sites of avulsion injuries I have seen on x-ray are in:
1️⃣Adolescents and children, around the apophyses of the pelvis and knee.
2️⃣In adults they are commonly within the tendon. They occur at the elbow, knee, ankle, foot, Hip, on the shoulder, to the hand (thumb) and wrist
The diagram of the human body shows the most common locations of bone tears/ avulsion.
Choi et al 2021
▶️How can you be sure that the injury you have got is a bone tear?
Bone tears or bone avulsions are always mistaken for fractures because when they occur the ligament or tissue connecting two bones cracks or breaks affecting the ligament.
Your doctor will request an x-ray to help diagnose your injury, usually x-ray is the first imaging modality that diagnoses a bone avulsion or bone tear injury.
♦So, the only way to be sure whether the bone or tissues has been damaged is to have an x-ray.
An x-ray image showing an avulsion of the anterior superior iliac spine on the hip of an adolescent and a knee showing an elliptic bone fragment (arrow) arising from the lateral tibial plateau. Choi et al 2021
♦Other scans such as ultrasound or MRI scan will be required if your doctor wants to diagnose subtle lesions or to see the extent of the injury.
MRI scan is the best imaging modality for the evaluation of soft tissue abnormalities, especially the affected muscles, tendons, and ligaments
MRI scan that shows a high signal intensity (arrow) bone marrow oedema around the proximal rectus femoris tendon
♦CT is good at showing tiny osseous fragments located adjacent to the expected attachment site of a ligament, tendon, or capsule.
A CT scan image showing an avulsion fracture at the greater trochanter (arrow) of the femur (Choi ,2021)
▶️Is a bone avulsion injury serious enough to be a medical emergency.
The truth is symptoms of an avulsion tear may not seem to warrant urgent treatment, but it is very important to understand that any injury can be serious.
Even for avulsion bone tears, get yourself checked to ensure you heal safely and return to your regular routine.
▶️How are bone tears or avulsion managed and treated?
In most acute cases conservative treatment is successful in treating bone tears. However, some cases may require operative intervention.
Treatment and management will depend on which bone is affected.
Conservative treatment
🟤Anti-inflammatory medication to help with pain and swelling.
🟤Some injuries will be immobilisation in a splint, walking boot or cast. Partial or total immobilisation can facilitate healing and consolidation.
🟤You may be told to apply ice in the affected area.
🟤Resting will be recommended to help reduce the stress on the affected area. For example, if you are involved in sports, reduce or rest to speed up healing.
Rehabilitation therapy
🟤Sometimes you will be recommended to do physiotherapy with exercises. This will depend on the severity of your tear and how you recover.
The main goal of physiotherapy sessions is to help you regain all your previous mobility.
Surgical treatment.
Most avulsion bone tears do not need surgery only if your injury where the bone attaches to the tendon or ligament is more than 2 centimetres away from the main bone, surgery may be necessary.
For example:
🟤Open reduction to realign the bone
🟤Internal fixation using metal hardware plates, pins and screws to align the bone.
▶️How long does it take for a torn bone to heal?
Healing is always different for everyone, several factors always come into play in the healing time of a bone tear.
For example:
🟤What was your general state of health before and after the Injury. Some medical conditions can slow down healing.
🟤Are you a smoker or drinker, both slow down healing and consolidation.
🟤Some genetic predispositions recover well then others.
🟤Whether you have already had other injuries in the same area.
🟤Are you having a diet full of vitamin D and calcium good for bones?
🟤Are you taking your immobilisation orders seriously, because this one of the biggest challenges while recovering from a bone tear is to remain immobilised for an extended period.
Nevertheless, even with these factors there is no guarantee that for this ‘x’ amount of time you will be completely healed,
Try to keep the faith, patient and follow your doctor’s orders for a quick recovery.
Here is some proposed healing time-line seen in patients who have had a bone tear.
| Phase | Healing Timeline |
| Less swelling | A few weeks or even months and some a year. |
| Less Pain | A few days |
| Wearing a boot, cast or splint | A few weeks |
| An avulsion fracture in your pelvis or anywhere else where you can’t wear a cast. | Rest needed for a short period of time |
| Start rehabilitation | Right away or when you remove a cast or splint |
| The injured soft tissues | Begins to heal right after they break. It will take several months; ligaments are well advanced after a month. |
| consolidation | 4 to 6 weeks after the injury. It’s normal to have aches and discomfort beyond this |
| You remove the walking boot, splint or cast | After 3 to 6 weeks, often after a follow up x-ray |
| Walking with crutches | Right away, often with or not support |
| Return to sports like bike riding | As tolerable, By 2-3 weeks to 6, other sports, several months. |
| Complete healing | 6 -12 weeks to heal or a few months for some avulsion. |
Wishing a quick recovery! 🙋
Below are some of the articles I have relied on, any questions let’s type in the comments section below.
📚Source:
Choi C, Lee SJ, Choo HJ, Lee IS, Kim SK. Avulsion injuries: an update on radiologic findings. Yeungnam Univ J Med. 2021 Oct;38(4):289-307. doi: 10.12701/yujm.2021.01102. Epub 2021 Aug 13. PMID: 34411477; PMCID: PMC8688780.
Yeager KC, Silva SR, Richter DL. Pelvic Avulsion Injuries in the Adolescent Athlete. Clin Sports Med. 2021 Apr;40(2):375-384. doi: 10.1016/j.csm.2020.12.002. Epub 2021 Feb 5. PMID: 33673893.
Singer G, Eberl R, Wegmann H, Marterer R, Kraus T, Sorantin E. Diagnosis and treatment of apophyseal injuries of the pelvis in adolescents. Semin Musculoskelet Radiol. 2014 Nov;18(5):498-504. doi: 10.1055/s-0034-1389267. Epub 2014 Oct 28. PMID: 25350828.