1
|
Zhao ZY, Zhang HR, Zhou FZ, Wang A, Liu XN. Tibial tubercle avulsion fracture following preexisting Osgood-Schlatter disease in an adolescent: a case report. J Int Med Res 2024; 52:3000605241247683. [PMID: 38676540 DOI: 10.1177/03000605241247683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2024] Open
Abstract
Tibial tubercle avulsion fractures (TTAFs) are rare but typical in children and adolescents and Osgood-Schlatter disease (OSD) may be involved in their pathogenesis. However, few publications have reported the relationship between OSD and TTAF. A 16-year-old healthy male adolescent presented with pain, swelling and limited range of motion of the right knee following sudden acceleration while running. Based on the radiographic evidence, the patient was diagnosed with an avulsion fracture of the right tibial tubercle and OSD. Open reduction and internal fixation were performed using two cannulated screws and two Kirschner wires. The patient returned to preinjury activity levels at the 12-month follow-up postoperatively. This case report aimed to highlight this unique injury pattern. For patients with TTAFs, not only should the fracture be treated, but the cause of the fracture, such as OSD, should also be given appropriate treatment.
Collapse
Affiliation(s)
- Zhi-Yao Zhao
- Department of Orthopaedics, The Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Hai-Rui Zhang
- Department of Orthopaedics, The Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Fang-Zheng Zhou
- Department of Orthopaedics, The Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Ao Wang
- Department of Orthopaedics, The Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Xiao-Ning Liu
- Department of Orthopaedics, The Second Hospital of Jilin University, Changchun, Jilin Province, China
| |
Collapse
|
2
|
Gwak HC, Kim JH, Park DH, Kim JY, Seo WS, Lee HY, Kim DY. Patterns of Anterior Inferior Tibiofibular Ligament Avulsion Fracture Accompanied by Ankle Fracture. J Foot Ankle Surg 2024; 63:127-131. [PMID: 37898330 DOI: 10.1053/j.jfas.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 04/22/2023] [Accepted: 06/23/2023] [Indexed: 10/30/2023]
Abstract
The anterior inferior tibiofibular ligament (AITFL) avulsion fracture accompanying an ankle fracture can compromise ankle stability, necessitating accurate evaluation and a clear understanding of its pathophysiology.. The aim of this study was to investigate the association between AITFL avulsion fracture and Lauge-Hansen, Wagstaffe classification. A retro-prospective study was conducted at a university-affiliated tertiary care medical center. We selected 128 patients who underwent surgery at our institution between January 2013 and July 2017 and analyzed the association between AITFL avulsion fracture and the foot position. According to the modified Wagstaffe classification system, there were 39 cases of type II, followed by 9 cases of type III and 8 cases of type IV. Of the7 pronation-abduction fractures, 3 were AITFL avulsion fracture (43%), while of the 21 pronation-external rotation fractures, 9 were AITFL avulsion fracture (43%). Of the 95 supination-external rotation fractures, there were 56 cases (59%) of AITFL avulsion fractures. Of the pronation fractures, 0% were fibular avulsion fractures and 43% were tibial avulsion fractures. Of the supination fractures, 44% were fibular avulsion fractures and 16% were tibial avulsion fracture. The difference in the ratio of fibular to tibial avulsion fractures between pronation and supination fractures was significant (p < .001). These results suggest that tibial avulsion fractures of type IV in the modified Wagstaffe classification and pronation fractures occur due to collision with the anterolateral corners of the distal bone when the talus externally rotates. Moreover, in cases of pronation fractures, a new type of AITFL avulsion fracture has been observed.
Collapse
Affiliation(s)
| | - Jung-Han Kim
- Department of Orthopedic Surgery, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Dae-Hyun Park
- Department of Orthopedic Surgery, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Ji-Youn Kim
- Department of Orthopedic Surgery, Kosin University Gospel Hospital, Busan, Korea
| | - Won-Seok Seo
- Department of Orthopedic Surgery, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Hyo-Young Lee
- Department of Orthopedic Surgery, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Dae-Yoo Kim
- Department of Orthopedic Surgery, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea.
| |
Collapse
|
3
|
Liu Z, Hou G, Zhang W, Lin J, Yin J, Chen H, Huang G, Li A. Calcaneal tuberosity avulsion fractures - A review. Injury 2024; 55:111207. [PMID: 37984015 DOI: 10.1016/j.injury.2023.111207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 10/30/2023] [Accepted: 11/12/2023] [Indexed: 11/22/2023]
Abstract
Calcaneal tuberosity avulsion fracture, an extra-articular injury, is a rare fracture caused internally by Achilles tendon driven following intense contraction of gastrocnemius-soleus complex, and externally by low-energy (possibly high-energy). Moreover, the risk of injuries of the skin and Achilles tendon around calcaneal tuberosity is closely related to Lee classification and Carnero-Martín de Soto Classification of calcaneal tuberosity avulsion fracture. Although the diagnosis confirmed by X-ray, digital imaging and computed tomography (CT), magnetic resonance imaging (MRI) should also be used to evaluate soft tissue. In recent years, the understanding of this fracture has witnessed the development of different internal fixation devices and surgical procedures. These advances have been further elaborated scientifically in terms of their ability to provide stable fracture reduction ad resistance to Achilles tendon forces. In order to obtain a comprehensive knowledge of the disease, this article reviewed the new understanding of the anatomy, typing, risk factors, and treatment modalities of calcaneal tuberosity avulsion fracture in recent years.
Collapse
Affiliation(s)
- Zhiyi Liu
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China.
| | - Guodong Hou
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Wencong Zhang
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Junyan Lin
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Jinrong Yin
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Huan Chen
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Guowei Huang
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Aiguo Li
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China.
| |
Collapse
|
4
|
Yüce A, Erkurt N, Yerli M, Saygılı MS, Özkan CB. Morphology of Fibular Incisura is a Deciding Factor Between Posterior Malleolus Avulsion Fracture or Syndesmotic Ligament Injury in Ankle Fractures. J Foot Ankle Surg 2024; 63:18-21. [PMID: 37572828 DOI: 10.1053/j.jfas.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/18/2023] [Accepted: 08/03/2023] [Indexed: 08/14/2023]
Abstract
The bone anatomy of tibiofibular syndesmosis has been a topic of interest. Fibular incisura morphology has been analyzed on cadaver specimens, plain radiographs, or CT images. The aim of this study is to examine the effects of fibula incisura features and fibula morphology in ankle injuries, especially involving posterior malleolus and posteroinferior tibiofibular ligament injuries. From 2017 through 2022, A total of 59 patients with isolated lateral malleolar fracture, Mason-Malloy type 1 posterior malleolar fracture, syndesmosis injury in those without posterior malleolar fracture, supination external rotation type 3 injuries according to Lauge-Hansen classification, and preoperative bilateral ankle computed tomography images were included in the study. Fibula morphologies and syndesmosis measurements were made from preoperative computed tomography images using axial CT images from 1 cm proximal to the tibial plafond. The diagnosis of posterior malleolar fractures was made using the CT classification system of Mason and Malloy, and the diagnosis of syndesmosis injury was made with a cotton test during surgery. Age, gender, fractured side, incisura type, incisor depth, width, anterior and posterior facet lengths, incisor version (antevert-retrovert), the angle between the anterior and posterior facets, and fibula type were recorded. There was a statistically significant difference between the groups in posterior facet length and incisura width. Morphological features of fibular incisura may be the determinant of PITFL injury or PMA injury in fibular fractures caused by an external rotation mechanism.
Collapse
Affiliation(s)
- Ali Yüce
- Department of Orthopedic and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey.
| | - Nazım Erkurt
- Department of Orthopedic and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Mustafa Yerli
- Department of Orthopedic and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Mehmet Selçuk Saygılı
- Department of Orthopedic and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Can Burak Özkan
- Department of Orthopedic and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| |
Collapse
|
5
|
Srirangarajan T, Massa E, Kurar L, Abbasian A. Acute surgical treatment of peroneus longus avulsion fracture of the first metatarsal base. BMJ Case Rep 2023; 16:e256000. [PMID: 37993139 PMCID: PMC10668167 DOI: 10.1136/bcr-2023-256000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023] Open
Abstract
Acute avulsion fracture of the base of the first metatarsal is a rare occurrence, caused by an eccentric contraction of the peroneus longus tendon insertion. A number of case reports have been published outlining various treatment strategies for treating this rare injury. Management plans range from conservative to operative options and include both acute and delayed operative treatments.We present our operative management strategy of an acute avulsion fracture of the base of the first metatarsal. It includes a step-by-step approach including intraoperative clinical photographs and intraoperative image intensifier images. We explain the rationale behind our operative approach and provide insight on the importance of recognising and treating this injury. Initially, this avulsion fracture might seem innocuous but if left untreated may result in disabling functional foot problems.
Collapse
Affiliation(s)
| | - Edward Massa
- Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Langhit Kurar
- Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Ali Abbasian
- Guy's and St Thomas' Hospitals NHS Trust, London, UK
| |
Collapse
|
6
|
Ishii T, Hioki S. Apophyseal avulsion fracture of the conjoint tendon of obturator internus and gemellus superior and inferior during apophyseal stage in adolescent athlete. J Orthop Sci 2023; 28:1602-1605. [PMID: 34996700 DOI: 10.1016/j.jos.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/12/2021] [Accepted: 12/13/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Tomoo Ishii
- Department of Orthopedic Surgery, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, Ami, Inashiki, Ibaraki, 300-0395 Japan; Department of Orthopedic Surgery, Miho Clinic, 2500-2 Mikoma, Miho, Inashiki, Ibaraki, 300-0415 Japan.
| | - Shigeru Hioki
- Department of Orthopedic Surgery, Miho Clinic, 2500-2 Mikoma, Miho, Inashiki, Ibaraki, 300-0415 Japan
| |
Collapse
|
7
|
Warren AT, Ahmed A, Raja AE. Ischiofemoral Impingement Due to an Undiagnosed Pelvic Avulsion Fracture. Curr Sports Med Rep 2023; 22:353-357. [PMID: 37800746 DOI: 10.1249/jsr.0000000000001108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
ABSTRACT Ischial tuberosity (IT) avulsion fractures are an uncommon cause of injuries in athletes. In this case, a 26-year-old female suffering from posterior right hip pain for over a decade presented with debility and a decrease in athletic function. Notable history included a hamstring strain while sprinting in elementary school. Clinical examination suggested hamstring tendinopathy and ischiofemoral impingement (IFI). Magnetic resonance imaging (MRI) revealed a chronic, fragmented, IT apophyseal avulsion fracture with ischial bursitis and edema within the fragmented bone, suggesting the development of heterotopic ossification (HO). Diagnostic ultrasound revealed signs of IFI, not evident on MRI. Ultrasound-guided corticosteroid injection in her ischial bursa and ischiofemoral space provided complete relief. The patient was able to resume her activities of daily living and sports-related activities without pain. Although interventional treatments may provide temporary pain relief, a multimodal approach is required for the treatment of HO.
Collapse
Affiliation(s)
- Alec T Warren
- Rowan-Virtua School of Osteopathic Medicine, Sewell, NJ
| | - Abubakar Ahmed
- Temple University Hospital Physical Medicine and Rehabilitation Residency Program, Philadelphia, PA
| | - Altamash E Raja
- Department of Rehabilitation Medicine, Rowan-Virtua School of Osteopathic Medicine, Sewell, NJ
| |
Collapse
|
8
|
Zhou Z, Wang S, Xiao J, Mao Y, Li L, Xu W, She C. The degree of fracture reduction does not compromise the clinical efficacy of arthroscopic reduction and fixation of tibial posterior cruciate ligament avulsion fractures: A retrospective study. Medicine (Baltimore) 2023; 102:e35356. [PMID: 37773785 PMCID: PMC10545087 DOI: 10.1097/md.0000000000035356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 09/01/2023] [Indexed: 10/01/2023] Open
Abstract
This study aimed to explore the postoperative outcomes of patients who underwent arthroscopic internal fixation with repositioning sutures for the treatment of posterior cruciate ligament (PCL) avulsion fractures with poorly reduced fracture fragments. It was hypothesized that improperly repositioned fracture fragments might not influence the postoperative clinical outcomes in patients with PCL avulsion fractures treated by arthroscopic sutures. From January 2020 to December 2021, patients admitted to our hospital with PCL avulsion fractures were evaluated. Our inclusion criteria were as follows: diagnosis of PCL avulsion fracture as Meyers & McKeever Type II or Type III; underwent arthroscopic double tunnel suture fixation; and age below 70. Of the patients meeting these criteria, data from 34 individuals were collected by a designated follow-up officer. Based on postoperative imaging, the patients were divided into 2 groups: well fracture reduction and poor fracture reduction groups. Prior to the surgery, the Lysholm score, knee mobility, and international knee documentation committee (IKDC score) were recorded for both groups. At the 3-month post-surgery mark, CT-3D reconstruction was performed. Statistical analysis was conducted on the collected data. For data that conformed to a normal distribution, the t test was applied. For data that didn't conform, we used a non-parametric test. Both groups achieved successful wound healing without encountering any adverse events, such as fracture nonunion infection. Fracture healing was observed in both groups at the 3-month postoperative mark. The average follow-up duration was 13.24 ± 6.18 months. There were no significant differences in Lysholm score, IKDC score, or knee mobility between the well- and poorly-reduced groups at the final follow-up (P > .05). Postoperatively, both groups demonstrated significant improvements in knee function compared to the preoperative scores, with statistically significant differences observed in Lysholm score, IKDC score, and knee mobility (P < .05). Arthroscopic fixation with double-tunnel sutures proved to be a highly effective treatment approach for PCL avulsion fractures, even in cases where the fractures were poorly reduced. Remarkably, there were no significant differences observed in postoperative knee function between the well- and poorly-reduced groups, indicating that both groups achieved favorable outcomes.
Collapse
Affiliation(s)
- Zhaoxin Zhou
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Shendong Wang
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Jiazheng Xiao
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Yongtao Mao
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Liubing Li
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Wei Xu
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Chang She
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| |
Collapse
|
9
|
Dove JH, Medina Perez G, Boulos A, Eberson CP. Bilateral Tibial Tubercle Avulsion Fractures With an Associated Patellar Tendon Avulsion in an Adolescent Patient. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202309000-00011. [PMID: 37713638 PMCID: PMC10508552 DOI: 10.5435/jaaosglobal-d-22-00105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
Tibial tubercle fractures in pediatric patients are increasing in frequency as more children participate in sports. These injuries are often seen in boys engaging in jumping activities before closure of their proximal tibial physis. Bilateral tibial tubercle fractures have been reported in the literature, but less frequent are associated patellar tendon ruptures with fracture of the tubercle. In this case report, we present an 11-year-old girl who sustained bilateral tibial tubercle fractures, including an associated patellar tendon rupture from the tubercle on the right lower extremity. We describe our technique for the management of both injuries, which included a primary patellar tendon repair for the right leg and Kirschner wire fixation of the displaced tubercle for the left leg. The patient ultimately had a successful outcome at the final follow-up with healed fractures and full range of motion of both knees. In this case report, we also present similar cases from the literature and the differing treatment strategies.
Collapse
Affiliation(s)
- James H Dove
- From the Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University (Dr. Dove, Dr. Boulos, and Dr. Eberson), and the Warren Alpert Medical School of Brown University, Providence, RI (Medina Perez)
| | | | | | | |
Collapse
|
10
|
Chan J, Hourston GJM, Robinson P. Inferior scapula avulsion fracture: an unusual presentation of winged scapula. BMJ Case Rep 2023; 16:e255645. [PMID: 37562859 PMCID: PMC10423800 DOI: 10.1136/bcr-2023-255645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023] Open
Abstract
Inferior scapula avulsion fractures are rare injuries, with few cases reported and only a small number managed operatively discussed in the literature. We report the case of a man in his 40s who fell from a height and presented with right-sided scapular winging and point tenderness at the inferior pole of his right scapula with no neurological deficit. Radiographs and CT diagnosed avulsion fracture of the inferior scapula. The patient underwent surgical fixation and, following a course of physiotherapy, successfully recovered with no residual winging and full range of movement.
Collapse
Affiliation(s)
- Julia Chan
- Leicester Medical School, University of Leicester Medical School, Leicester, UK
| | - George Joseph Michael Hourston
- Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge, UK
- Trauma and Orthopaedics, Peterborough City Hospital, Peterborough, UK
| | - Paul Robinson
- Trauma and Orthopaedics, Peterborough City Hospital, Peterborough, UK
| |
Collapse
|
11
|
Vadhera AS, Lee JS, Sivasundaram L, Ogle M, Westrick JC, Kunze KN, Gursoy S, Chahla J. Apophyseal ilium avulsion fractures in young athletes: a systematic review and return to sport analysis. J Pediatr Orthop B 2023; 32:268-277. [PMID: 36445382 DOI: 10.1097/bpb.0000000000001029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The purpose of the current investigation was to synthesize the epidemiology, cause, management, and return to sport (RTS) outcomes of ilium avulsion fractures sustained during sporting activities in young athletes. Studies reporting on athletes <18 years old sustaining an avulsion fracture along the ilium [injury to the anterior superior or inferior iliac spine (ASIS or AIIS), or the iliac crest (IC)], and the athlete's RTS status were included. RTS was analyzed by injury acuity, location, mechanism of injury, and management, whereas complications were recorded. Seventy studies comprising 286 avulsions (169 ASIS, 87 AIIS, and 30 IC) were included. The mean age of athletes was 14.5 + 1.3 years (range, 8-18 years). Sprinting (n = 103/286; 36.0%) and soccer (n = 97/286; 33.9%) were the most common sports during which injuries occurred. A total of 96.5% (n = 276/286) of athletes reported successful RTS at an average of 16.2 + 19.3 weeks. The RTS rate for patients sustaining ASIS, AIIS, and IC avulsions was 95.3, 97.7, and 100%, respectively. Acute trauma was responsible for 89.8% (n = 158/176) of injuries, which demonstrated a significantly faster (13.3 + 9.3 weeks) and higher RTS rate (99.4%) compared with those with chronic avulsions (74.4 + 40.9 weeks and 83.3%, respectively). Those with complications (18.2%) had a significantly lower RTS rate (90.4%) and longer recovery (23.7 weeks) compared with athletes without complications (97.9% and 14.5 weeks, respectively). Outcomes were not significantly different based on sex or management. However, chronic avulsions and postoperative complications sustained worse RTS results. An accurate and timely diagnosis is crucial when presented with these rare injuries to avoid increasing the chronicity of injury.
Collapse
Affiliation(s)
- Amar S Vadhera
- Department of Orthopaedic Surgery, Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois
- Sidney Kimmel Medical College, Philadelphia, Pennsylvania
| | - Jonathan S Lee
- Department of Orthopaedic Surgery, Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois
| | - Lakshmanan Sivasundaram
- Department of Orthopaedic Surgery, Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois
| | - Miranda Ogle
- Department of Orthopaedic Surgery, Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois
| | - Jennifer C Westrick
- Department of Orthopaedic Surgery, Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois
| | - Kyle N Kunze
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Safa Gursoy
- Department of Orthopaedic Surgery, Faculty of Medicine, Acibadem University, Istanbul, Turkey
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois
| |
Collapse
|
12
|
Saitoh A, Hiranaka T, Arimoto A, Tanaka A, Suda Y, Koide M, Fujishiro T, Okamoto K. Intraoperative avulsion fracture of the intercondylar eminence in Oxford mobile-bearing unicompartmental knee arthroplasty: Case report. Knee 2023; 40:220-226. [PMID: 36512893 DOI: 10.1016/j.knee.2022.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/29/2022] [Accepted: 11/14/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) can provide good postoperative results and long term survival, but there may be complications. We present a rare case of avulsion fracture of the intercondylar eminence during UKA surgery. CASE PRESENTATION An 88-year-old man had right-knee pain with anteromedial osteoarthritis. Oxford partial knee UKA (Zimmer Biomet, Warsaw, IN) was performed by the senior author by the under-vastus approach using Microplasty instruments. During the final check of the range of motion, an avulsion fracture of the intercondylar eminence occurred at the terminal extension. A 4.0 mm cannulated cancellous screw was inserted into the intercondylar eminence from just in front of the anterior cruciate ligament to the posterior tibial cortex. Six months postoperatively, bony fusion was confirmed by lateral radiography. Two years after the surgery, the patient was fully satisfied. The flexion angle was 125°, but still with an extension limit of 10°. DISCUSSION Avulsion fracture of the intercondylar eminence can be caused by hyperextension and/or the ACL becoming tighter in full extension of the knee. In this patient, avulsion fracture also probably occurred due to increased tension of the ACL in the fully extended position. After making the horizontal cut, we inserted a thin metal plate to prevent deeper vertical cuts, but an excessive horizontal cut was a possible cause of the fracture. As treatment for avulsion fracture of the intercondylar eminence, fixation of the cannulated cancellous screw resulted in uneventful bone fusion. We recommend having a cannulated cancellous screw at hand for such complications and for other potential intraoperative problems, such as tibial plateau fracture. Further investigation into limited postoperative extension might be needed. CONCLUSION Our patient had intraoperative avulsion fracture of the intercondylar eminence, a relatively rare complication of Oxford UKA which is probably caused by the extension being tight and/or an excessive horizontal cut. Having a cannulated cancellous screw at hand is advised, and attention should be paid to postoperative limit of extension.
Collapse
Affiliation(s)
- Akira Saitoh
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13 Kosobe-Cho, Takatsuki, Osaka 569-1192, Japan
| | - Takafumi Hiranaka
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13 Kosobe-Cho, Takatsuki, Osaka 569-1192, Japan.
| | - Akihiko Arimoto
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13 Kosobe-Cho, Takatsuki, Osaka 569-1192, Japan
| | - Atsuki Tanaka
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13 Kosobe-Cho, Takatsuki, Osaka 569-1192, Japan
| | - Yoshihito Suda
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13 Kosobe-Cho, Takatsuki, Osaka 569-1192, Japan
| | - Motoki Koide
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13 Kosobe-Cho, Takatsuki, Osaka 569-1192, Japan
| | - Takaaki Fujishiro
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13 Kosobe-Cho, Takatsuki, Osaka 569-1192, Japan
| | - Koji Okamoto
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13 Kosobe-Cho, Takatsuki, Osaka 569-1192, Japan
| |
Collapse
|
13
|
Tang Y, Zeng L, Chen W, Zhang H, Li W. Ultrasonography in the diagnosis of rotator cuff avulsion fracture. J Clin Ultrasound 2022; 50:1432-1435. [PMID: 36063452 DOI: 10.1002/jcu.23317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/23/2022] [Accepted: 08/03/2022] [Indexed: 06/15/2023]
Abstract
Deepening the understanding of morphology and corresponding sonographic features of the greater tuberosity and the various fracture lines in avulsion fracture like the "horizontal line sign" and "double-line sign" and sharp bony prominence besides the defect on the greater tuberosity, can make it simple to identify avulsion fracture accurately and quickly.
Collapse
Affiliation(s)
- Yaqun Tang
- Department of Ultrasound, Zhuhai People's Hospital Medical Group (Zhuhai Hospital Affiliated with Jinan University, The First Affiliated Hospital of Faculty of Medicine Macau University of Technology), Zhuhai, China
| | - Langqing Zeng
- Division of Orthopedics, Zhuhai People's Hospital Medical Group (Zhuhai Hospital Affiliated with Jinan University, The First Affiliated Hospital of Faculty of Medicine Macau University of Technology), Zhuhai, China
| | - Weiwen Chen
- Department of Ultrasound, Zhuhai People's Hospital Medical Group (Zhuhai Hospital Affiliated with Jinan University, The First Affiliated Hospital of Faculty of Medicine Macau University of Technology), Zhuhai, China
| | - Heng Zhang
- Department of Ultrasound, Zhuhai People's Hospital Medical Group (Zhuhai Hospital Affiliated with Jinan University, The First Affiliated Hospital of Faculty of Medicine Macau University of Technology), Zhuhai, China
| | - Wei Li
- Department of Radiology, Zhuhai People's Hospital Medical Group (Zhuhai Hospital Affiliated with Jinan University, The First Affiliated Hospital of Faculty of Medicine Macau University of Technology), Zhuhai, China
| |
Collapse
|
14
|
Zheng Z, Wang L, Tian K, Zhao X, Ma L. Arthroscopically assisted reduction and internal fixation of a femoral anterior cruciate ligament osteochondral avulsion fracture in an 11-year-old girl: A case report. Medicine (Baltimore) 2022; 101:e30321. [PMID: 36107596 PMCID: PMC9439773 DOI: 10.1097/md.0000000000030321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE The anterior cruciate ligament (ACL) is relatively rarely injured in children and adolescents, accounting for just 0.5% of all ACL rips that occur. Avulsion fractures are more common in youngsters because their ligamentous structures are known to be stronger than their physical insertion sites. Tibial eminences have been reported to be the sites of most ACL avulsions, and both cartilaginous and osteochondral avulsion fractures have been observed, whereas the latter occurs more commonly. On the other hand, femoral osteochondral avulsion fractures of the ACL in children are uncommon, as only a few studies describe their occurrence in immature patients. PATIENT CONCERNS In this case report, we present an 11-year-old girl who suffered an ACL femoral attachment avulsion fracture after pivoting her knee during riding. A comprehensive formal evaluation of the knee was impractical due to the persistence of pain and tight haemarthrosis. DIAGNOSES Femoral anterior cruciate ligament osteochondral avulsion fracture. INTERVENTIONS We used Two No.2Ethibond sutures to pick up the osteochondral fragment and passed across the lateral femoral condyle to come out laterally and fixed with a tie proximally, and we recommended the patient perform reasonable functional exercises postoperatively. OUTCOMES The patient had no pain, instability, or activity limitations after 24 months of surgery. Physical examination of the patient revealed full and symmetric ROM, and normal Lachman and pivot shift test performance. LESSONS ACL avulsion fractures can be accurately treated with arthroscopic reduction and sutures via an inside-out technique, which can reduce the risk of persistent ligamentous laxity and reduce open surgery-related morbidity.
Collapse
Affiliation(s)
- Zhongren Zheng
- School of Clinical Medicine, Jining Medical University, Jining, People’s Republic of China
| | - Lei Wang
- Department of Orthopedics, The Affiliated Hospital of Jining Medical University, Jining, People’s Republic of China
| | - Ke Tian
- Department of Orthopedics, The Affiliated Hospital of Jining Medical University, Jining, People’s Republic of China
| | - Xiaowei Zhao
- Department of Orthopedics, The Affiliated Hospital of Jining Medical University, Jining, People’s Republic of China
| | - Longfei Ma
- Department of Orthopedics, The Affiliated Hospital of Jining Medical University, Jining, People’s Republic of China
- *Correspondence: Longfei Ma, Department of Orthopedics, The Affiliated Hospital of Jining Medical University, 89 Guhuai Road, Jining, Shandong, 272067, China (e-mail: )
| |
Collapse
|
15
|
Batley MG, Ashe K, Senese MT, Grady MF, Williams BA. Distal Adductor Magnus Avulsion Fracture Treated with Excision After Failure of Nonoperative Management: A Case Report. JBJS Case Connect 2022; 12:01709767-202206000-00034. [PMID: 36099529 DOI: 10.2106/jbjs.cc.22.00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CASE In this case report, we discuss a skeletally immature gymnast who presented with an isolated distal femoral adductor tubercle avulsion fracture that went on to develop a painful nonunion. After the failure of extensive nonoperative intervention, she had resolution of her symptoms with bony excision and soft-tissue repair. CONCLUSION It is important for clinicians to be aware of this atypical injury pattern and that surgical intervention may be necessary because conservative treatment may not always resolve symptoms.
Collapse
Affiliation(s)
- Morgan G Batley
- Department of Orthopaedics, The Children's Hospital of Philadelphia, Pennsylvania
| | - Katherine Ashe
- Department of Orthopaedics, The Children's Hospital of Philadelphia, Pennsylvania
| | - Matthew T Senese
- Department of Physical Therapy, The Children's Hospital of Philadelphia, Pennsylvania
| | - Matthew F Grady
- Department of Orthopaedics, The Children's Hospital of Philadelphia, Pennsylvania
| | - Brendan A Williams
- Department of Orthopaedics, The Children's Hospital of Philadelphia, Pennsylvania
| |
Collapse
|
16
|
Lima AS, Cabral J, Boavida J, Balacó I, Sá Cardoso P, Tarquini O, Ling TP, Alves C. Tibial tubercle avulsion fractures in adolescents: impact on function and quality of life. J Pediatr Orthop B 2022; 31:e135-e140. [PMID: 34380989 DOI: 10.1097/bpb.0000000000000905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The objective of the study was to assess functional outcomes and quality of life of patients treated for tibial tubercle avulsion fractures (TTAFs). Retrospective study of patients under 18 years of age treated from June 2011 to May 2018. Demographic data included age, gender, mechanism of injury, side, fracture classification, associated injuries, predisposing factors, and type of treatment. Clinical results included knee range of motion, pain, return to sports, overall satisfaction, functional outcomes, and complications. At final follow-up, Tegner Lysholm Knee Scoring Scale, and Kidscreen-10 were applied. Ten patients were included, all males, with a median age of 15 years. Mechanism of injury: football (three patients), basketball (two patients), running (two patients), handball (one patient), gymnastics (one patient), and fall (one patient). Nine were treated surgically with reduction and fixation with cannulated screws or Kirschner wires, plus treatment of associated injuries (three patellar tendon avulsions, one contralateral proximal tibia epiphyseal fracture, and two prophylactic fasciotomies). One patient developed mild recurvatum and two presented minor decreased knee flexion. Eight patients returned to their previous level of sports activity. Median Tegner Lysholm Knee Score was 100/100 and Kidscreen-10 was 50/50. With appropriate treatment, nearly 100% of TTAFs have good functional outcomes and low impact on quality of life.
Collapse
Affiliation(s)
- Ana S Lima
- Department of Pediatric Orthopaedics, Hospital Pediátrico, Centro Hospitalar Universitário de Coimbra, EPE, Coimbra, Portugal
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Cengiz B, Karaoglu S. Case report of concomitant avulsion fractures of the medial meniscus and posterior cruciate ligament. Medicine (Baltimore) 2021; 100:e28273. [PMID: 34918701 PMCID: PMC8677961 DOI: 10.1097/md.0000000000028273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 11/25/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Posterior cruciate ligament (PCL) is the strongest ligament of the knee, and avulsion fractures of PCL are a very rare type of injury. These injuries occur as a result of high-energy traumas, and different accompanying pathologies may be seen. However, tibial avulsion fracture of the PCL associated with a medial meniscus (MM) avulsion fracture has never been reported before. We want to present this unique type of posteromedial knee injury as a case report. PATIENT CONCERN A 42-year-old man presented with severe pain and swelling due to a ski injury. DIAGNOSIS Concomitant avulsion fractures of PCL and MM were detected after imaging. INTERVENTIONS Both avulsion fractures were treated with open reduction and fixation with lag screws using the posterior approach. OUTCOMES No complications were encountered, and the painless full range of motion and weight-bearing was achieved at the third month after the operation. LESSONS Anatomical reduction and stable fixation of these intra-articular fractures are essential for the stability of the knee. The posterior approach should be kept in mind to access these types of fractures safely. Care should be taken in terms of other injuries that may accompany the PCL avulsion fractures caused by high-energy traumas.
Collapse
|
18
|
Zeynalov SI, Alakbarov A, Ergun S. Avulsion Fracture of the Base of the First Metatarsal Bone by Peroneus Longus Tendon. J Am Podiatr Med Assoc 2021; 111. [PMID: 35290213 DOI: 10.7547/18-212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
|
19
|
Johnson J, Gupton M, Schneider J, Deivaraju C. Symptomatic Nonunion After a Tibial-Sided Posterior Cruciate Ligament Avulsion Fracture Treated with Open Repair: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00044. [PMID: 34319933 DOI: 10.2106/jbjs.cc.20.00618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 30-year-old man was in a motorcycle accident resulting in an avulsion fracture of the tibial insertion of the posterior cruciate ligament (PCL). After 19 months of nonoperative treatment, the patient presented with a nonunion and symptoms of pain and instability. He was treated with an open repair with screw fixation through a posterior approach. Six months postoperatively, the patient returned to his work as a heavy laborer with full range of motion and no instability. CONCLUSION PCL avulsion fracture nonunion results in symptoms of swelling, pain, and instability. These symptoms can be treated with screw fixation through a posterior approach.
Collapse
Affiliation(s)
- Jordan Johnson
- Department of Orthopaedic Surgery, MountainView Regional Medical Center, Las Cruces, New Mexico
| | - Marco Gupton
- Department of Orthopaedic Surgery, MountainView Regional Medical Center, Las Cruces, New Mexico
| | - Jonathan Schneider
- Department of Orthopaedic Surgery, Larkin Community Hospital, South Miami, Florida
| | - Chenthuran Deivaraju
- Department of Orthopaedic Surgery, MountainView Regional Medical Center, Las Cruces, New Mexico
| |
Collapse
|
20
|
Itakura T, Tsujii A, Yonetani Y, Hamada M. Posterior Root Avulsion Fracture of the Medial Meniscus in a Skeletally Immature Child: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00022. [PMID: 34264869 DOI: 10.2106/jbjs.cc.20.00765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
CASE We describe a rare case of posterior root avulsion fracture of the medial meniscus in an 11-year-old boy. Previous reports have demonstrated delayed diagnosis, but in this case, multiplanar computed tomography (CT) combined with magnetic resonance imaging (MRI) enabled early diagnosis and treatment. Gradual ossification was observed after arthroscopic suture fixation, and meniscal extrusion did not progress. He returned to sports without any symptoms and showed no degenerative changes at 2.5 years postoperatively. CONCLUSION This is the first case report of early diagnosis and time-course analysis of a rare avulsion fracture, emphasizing the usefulness of CT combined with MRI.
Collapse
Affiliation(s)
- Takumi Itakura
- Department of Orthopaedic Surgery, Osaka General Medical Center, Osaka, Japan
| | - Akira Tsujii
- Department of Orthopaedic Surgery, Osaka University, Osaka, Japan
| | - Yasukazu Yonetani
- Department of Sports Orthopaedic Surgery, Japan Community Health care Organization Hoshigaoka Medical Center, Osaka, Japan
| | - Masayuki Hamada
- Department of Sports Orthopaedic Surgery, Japan Community Health care Organization Hoshigaoka Medical Center, Osaka, Japan
| |
Collapse
|
21
|
Hasegawa S, Hayashi M, Yoshimura H, Ogiuchi T. Anatomical Repair of a Femoral-Sided Avulsion Fracture of the Anterior Cruciate Ligament: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00002. [PMID: 34228660 DOI: 10.2106/jbjs.cc.20.00769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We report a rare case of femoral-sided avulsion fracture of both the anteromedial and posterolateral bundle attachments of the anterior cruciate ligament (ACL). We performed an arthroscopic double-bundle pull-out repair. At the 1-year follow-up, the patient had no deformity, laxity of the knee, and no limitations when engaging in various sports activities. CONCLUSION An avulsion fracture of both the anteromedial and posterolateral bundle attachments is a rare injury. Arthroscopically assisted reduction and fixation demonstrated successful achievement of both bone union and good ACL function.
Collapse
Affiliation(s)
- Shoichi Hasegawa
- Department of Orthopaedic Surgery, Kawaguchi Kogyo General Hospital, Kawaguchi-shi, Saitama, Japan
| | | | | | | |
Collapse
|
22
|
Best R, Meister A, Huth J, Becker U, Meier M. Surgical repair techniques, functional outcome, and return to sports after apophyseal avulsion fractures of the ischial tuberosity in adolescents. Int Orthop 2021; 45:1853-1861. [PMID: 33963885 PMCID: PMC8266717 DOI: 10.1007/s00264-021-04959-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 01/29/2021] [Indexed: 11/26/2022]
Abstract
Purpose Among juvenile apophyseal avulsion injuries of the pelvis in adolescents, fractures of the ischial tuberosity are rare but sustainably debilitating. Also because informations on surgical repair options are very sparse and so far limited to general reviews, reports of individual cases or heterogeous small case series, practitioners, patients and their parental environment still feel a comprehensible hesitation regarding operative treatment. Therefore we intended to investigate patient related outcome measurements and return to sports rates after different types of surgical intervention in an own case series, so far unprecendented in its size. Methods Patient data of adolescents that underwent surgical intervention for a displaced apophyseal avulsion fracture of the ischial tuberosity between 01/2015 and 12/2019 in our institution were gathered. Patients were then evaluated using the hamstring injury specific Perth Hamstring Assessment Tool (PHAT). Furthermore the return to sports level in comparison to the particular pre-injury level was rated. Results Eleven adolescents with an acute or chronic mean fragment dislocation of 3.3 cm (SD ± 1.7) underwent surgical intervention in the assigned period. The mean post-operative PHAT score was 86.9 (0–100, SD ± 11.9) and thus good to excellent. The majority of adolescents (10/11) was able to return to their pre-injury sports, whereas 63.6% achieved full or nearly full level. Conclusions Surgical refixation or restoration of aphoyseal avulsion fractures of the ischial tuberosity result in good to excellent outcomes and return to sport rates, irrespective of the type of intervention. Here prompt diagnosis with a timely intervention seems more promising than delayed interventions in chronic cases. Beyond 1.5 cm of fragment displacement affected patients should be counselled for surgical intervention.
Collapse
Affiliation(s)
- Raymond Best
- Department Orthopeadic and Sports Trauma Surgery, Sportklinik Stuttgart GmbH, Taubenheimstrasse 8, 70372, Stuttgart, Germany.
- Department of Sportsmedicine, University of Tuebingen, Hoppe Seyler Strasse 5, 72074, Tuebingen, Germany.
| | - Anorte Meister
- Department Orthopeadic and Sports Trauma Surgery, Sportklinik Stuttgart GmbH, Taubenheimstrasse 8, 70372, Stuttgart, Germany
| | - Jochen Huth
- Department Orthopeadic and Sports Trauma Surgery, Sportklinik Stuttgart GmbH, Taubenheimstrasse 8, 70372, Stuttgart, Germany
| | - Ulrich Becker
- Department Orthopeadic and Sports Trauma Surgery, Sportklinik Stuttgart GmbH, Taubenheimstrasse 8, 70372, Stuttgart, Germany
| | - Malin Meier
- Department Orthopeadic and Sports Trauma Surgery, Sportklinik Stuttgart GmbH, Taubenheimstrasse 8, 70372, Stuttgart, Germany
| |
Collapse
|
23
|
Schulze A, Schmittenbecher PP. [Apophyseal avulsion in the pelvic region in childhood and adolescence]. Unfallchirurg 2021; 124:519-525. [PMID: 33938973 DOI: 10.1007/s00113-021-01001-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The importance of the apophyseal plates during growth is often underestimated. They act as a muscular insertion and influence the joint mechanics by the load-dependent change in shape. PATHOMECHANISMS An anatomically functional adaptation occurs as protection from overloading. In special kinds of sports with highly dynamic movements, sudden changes of direction and eccentric/concentric muscle activities the resulting stress may exceed the strength of the apophyseal plate. In adolescence this results in a total or partial tearing of the apophysis in the sense of an avulsion injury. In the pelvic region the ischial tuberosity, the anterior superior and inferior iliac spine are mainly affected. DIAGNOSTICS The medical history and clinical diagnostics are supplemented by conventional radiographic imaging. Sectional imaging diagnostics are usually unnecessary. TREATMENT Conservative management by reduced (partial) weight bearing and physiotherapy represents the gold standard in treatment. In cases with a fragment displacement >1.5-2.0 cm and in competitive athletes an open reduction should be considered.
Collapse
Affiliation(s)
- A Schulze
- Klinik für Kinderchirurgie, Städtisches Klinikum Karlsruhe, Moltkestr. 90, 76133, Karlsruhe, Deutschland.
| | - P P Schmittenbecher
- Klinik für Kinderchirurgie, Städtisches Klinikum Karlsruhe, Moltkestr. 90, 76133, Karlsruhe, Deutschland
| |
Collapse
|
24
|
Abstract
BACKGROUND At present, the treatment of base fractures of the fifth metatarsal, especially the area I fractures, is still a controversial topic. The objective of our work was to assess the radiological and clinical outcomes of displaced avulsion fractures of the fifth metatarsal base after treated with conservative treatment or intramedullary screw. METHODS All of the fifth metatarsal fractures patients underwent surgery by the senior authors in our hospital from January 2017 to December 2019 were reviewed. Institutional Review Board in the Subsidiary Hospital of Guizhou Medical University approved this study. Patients with the following conditions can be included:Patients with the following conditions will be excluded: follow-up less than 6 months; open fracture; pathological fracture; osteoporotic fracture; patients have the history of ankle or foot surgery. Radiographs were taken at 1, 3, 6 and 12 months in outpatient follow-up. The following outcomes were assessed in the follow-up: functional outcomes, the score of patient satisfaction, as well as the motion range, and complications. All the statistical analyses were implemented via applying the software of SPSS Version 12 (SPSS Inc, Chicago, IL). RESULTS We hypothesized that there was no remarkable difference between two groups in the outcomes after operation. TRIAL REGISTRATION This study protocol was registered in Research Registry (researchregistry6024).
Collapse
|
25
|
Schmidt-Hebbel A, Eggers F, Schütte V, Achtnich A, Imhoff AB. Patellar sleeve avulsion fracture in a patient with Sinding-Larsen-Johansson syndrome: a case report. BMC Musculoskelet Disord 2020; 21:267. [PMID: 32326930 PMCID: PMC7181494 DOI: 10.1186/s12891-020-03297-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 04/17/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Patellar sleeve avulsion (PSA) fractures are rare injuries that occur in in skeletally immature patients. Initial diagnosis is key to a successful outcome, as these injuries are easily overlooked on plain radiographs with poor results well documented from delayed management. High index of suspicion from the mechanism of injury, thorough clinical examination and Magnetic Resonance Imaging (MRI) help to avoid misdiagnosis. CASE PRESENTATION The case of a 12-year-old male athlete with an acute PSA after a conservative treatment of a SLJ syndrome is described. The patient was referred to our clinic due to severe pain and loss of function after performing a high jump. Plain radiographs (X-ray) and MRI confirmed an inferior pole PSA which was fixed with double trans osseous ultra-high strength tapes. At the 3-month follow- up visit the patient was able to ambulate brace free. At 2-years follow up the patient was able to play soccer and ice hockey. To our knowledge, there are no case reports of inferior pole PSA with prior SLJ syndrome described in literature. CONCLUSIONS Early clinical suspicion and distinguishing this PSA from other enchondral ossification disorders around the knee is critical to avoid misdiagnosis. Whether SLJ syndrome increases the risk of sustaining a PSA is still not clear. Trans osseous fixation with suture tapes leads to good functional results in a young athlete with inferior pole PSA.
Collapse
Affiliation(s)
- Andrés Schmidt-Hebbel
- Clínica Alemana de Santiago, Departamento de Ortopedia y Traumatología, Av. Vitacura 5951, Santiago de, Chile
| | - Felipe Eggers
- Technical University of Munich. Klinikum rechts der Isar, Abt. f. Sportorthopädie- Ismaninger Str. 22, 81675 Munich, Germany
| | - Vincent Schütte
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Klinikum Bergmannstrost, Marseburger Str. 165, 06112 Halle/Saale, Germany
| | - Andrea Achtnich
- Technical University of Munich. Klinikum rechts der Isar, Abt. f. Sportorthopädie- Ismaninger Str. 22, 81675 Munich, Germany
| | - Andreas B. Imhoff
- Technical University of Munich. Klinikum rechts der Isar, Abt. f. Sportorthopädie- Ismaninger Str. 22, 81675 Munich, Germany
| |
Collapse
|
26
|
Hodax JD, Cohen BH, DeFroda SF, Sobel AD, Fadale PD. Comparison of three fixation techniques for arcuate fractures. Injury 2020; 51:478-482. [PMID: 31679831 DOI: 10.1016/j.injury.2019.09.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 09/17/2019] [Accepted: 09/30/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Proximal fibula avulsion fractures, or "arcuate fractures", are an often discussed but poorly defined injury pattern which represent a destabilizing injury to the posterolateral corner of the knee. Historical and recent literature discussing reconstruction and repair techniques exist, but there has been little biomechanical evaluation of repair techniques. The purpose of this study was to evaluate the strength of three type of fixation techniques for arcuate fractures: bone tunnels, a screw and washer, and a novel suture anchor technique. METHODS A laboratory model of the arcuate fracture pattern was developed. This was used to create an arcuate fracture in 24 cadaveric specimens. Knees were randomized into fixation with either suture tunnel (ST), screw and washer (SW), or suture anchor (SA) repair. A previously published model for inducing varus stress was applied and a MTS testing system was used to assess fixation ultimate and yield strength. RESULTS Fibular fracture occurred during the fixation of one specimen from the ST group and one from the SA group. Analysis of the remaining 22 specimens revealed a mean ultimate strength of 2422.48 N for the ST group, 2271.78 for SW, and 3041.66 for SA (p = 0.390). Yield strengths were 2065.28 for ST, 1882.43 for SW, and 2871.92 for SA (p = 0.224). Analyses of stiffness and total energy applied were not statistically different (p = 0.111 and 0.601, respectively). CONCLUSION Biomechanical analysis of three types of arcuate fragment fixation revealed robust fixation among all methods, supporting surgeon preference for fixation. Fixation may depend on the size of bony fragment and whether or not the injury is a bony or soft tissue injury.
Collapse
Affiliation(s)
- Jonathan D Hodax
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, 593 Eddy St, Providence, RI 02906, USA
| | - Brian H Cohen
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, 593 Eddy St, Providence, RI 02906, USA.
| | - Steven F DeFroda
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, 593 Eddy St, Providence, RI 02906, USA
| | - Andrew D Sobel
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, 593 Eddy St, Providence, RI 02906, USA
| | - Paul D Fadale
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, 593 Eddy St, Providence, RI 02906, USA
| |
Collapse
|
27
|
Minoves Font M. Clinical applications of nuclear medicine in the diagnosis and assessment of musculoskeletal sports injuries. Rev Esp Med Nucl Imagen Mol 2019; 39:112-134. [PMID: 31791886 DOI: 10.1016/j.remn.2019.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/15/2019] [Accepted: 09/21/2019] [Indexed: 11/17/2022]
Abstract
Increased participation in sports and physical exercise are widely promoted as an approach to a physically active lifestyle which has a positive effect on healthy aging, in patients and athletes of all ages, beginners and experts, including amateur athletes and professional athletes. Unfortunately, this has caused a higher incidence of sports-related injuries. In the sports context, the early and accurate diagnosis of injuries is of the utmost importance in order to enable early treatment to achieve a full recovery. Imaging techniques are increasingly important for the successful diagnosis and management of the patient. The nuclear medicine techniques with bone tracers provide physiological and metabolic information in the early phases of musculoskeletal injuries, which often precede anatomical changes and they reflect changes in bone turnover. This allows early diagnosis, along with evaluation of the activity and phase of the injury. In this article, the applications of nuclear medicine techniques, focusing on bone scintigraphy, alongside the important contribution of hybrid studies (SPECT/CT), in the diagnosis of bone and soft tissue sports injuries, will be described. In addition, we explain their usefulness in the expression of the pathophysiology of these lesions and their scintigraphic patterns. The article will also describe biomechanical and physiopathological aspects, injury mechanisms and clinical presentations of bone and joint sports injuries, knowledge of this is essential for the correct diagnostic assessment of imaging studies.
Collapse
Affiliation(s)
- Montse Minoves Font
- Cetir-Ascires, Barcelona, España; Vocal del Grupo de Patología Musculoesquelética de la SEMNIM, España.
| |
Collapse
|
28
|
Abstract
Tibial tubercle avulsion fracture caused by knee extensor is very rare; furthermore, non-traumatic fractures during running or bilateral fractures have been reported. The purpose of this study was to evaluate any differences according to the mechanisms of injury in adolescents with tibial tubercle avulsion fracture.Thirty patients with tibial tubercle avulsion fractures were reviewed and the average age was 13 years 1 month. Seven patients (low-stress group) had a spontaneous fracture during running without definite trauma. Twenty-three patients (high-stress group) experienced pain during jumping and landing, or definite trauma. The mechanisms of injury, age, height, weight, body mass index (BMI), BMI percentile, fracture type, as well as any complication, such as limitation of motion and deformity related to the physeal arrest, were compared between groups.There was no definite difference in age, fracture type, and surgical outcomes between groups. There was no patient with significant early physeal arrest in both groups. The weight (P = .02), BMI (P = .03) and BMI percentile (P = .01) in low-stress group were higher than those in high-stress group. In low-stress group, 6 patients' BMIs were in the 97th percentile, and 1 patient's BMI was in the 5th percentile.Extreme BMI may be a risk factor for tibial tubercle avulsion fractures in adolescents during running without definite trauma. However, there was no difference in the final outcome according to injury mechanisms.
Collapse
Affiliation(s)
- Yong-Woon Shin
- Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, Seoul
| | - Dae-Wook Kim
- Department of Orthopaedic Surgery, Inje University Haeundae Paik Hospital, Busan
| | - Kun-Bo Park
- Division of Orthopaedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
29
|
Abstract
BACKGROUND To date, there have been no studies describing the characteristics of posteromedial fragment in the posterior malleolus fracture. The aim was to investigate the variability of posteromedial fracture fragments to enable better surgical planning. METHODS All Mason and Molloy type 2B fractures, defined as fracture of both the posterolateral and the posteromedial fragments of the posterior malleolus, from our database were identified to analyze the preoperative computed tomography scan. The posteromedial fragment was investigated in 47 cases (mean age, 46.6 years; 11 male, 36 female). RESULTS Morphologically, the fracture could be divided into 2 subtypes: (1) a large pilon intra-articular fragment (mean of X axis: 33.0 mm, Y: 30.7 mm, Z: 31.7 mm) presented in 29 cases with mean interfragmentary angle of 32.1 and back of tibia angle of 32.7 degrees (this was seen in 25 of 27 cases with supination injury pattern); and (2) a small extra-articular avulsion fragment (mean of X axis: 9.6 mm, Y: 13.2 mm, Z: 11.5 mm) present in 18 cases with a mean interfragmentary angle of 11.0 and back of tibia angle of 10.1 degrees. It was seen in 80% of pronation injuries. CONCLUSION The avulsion type of the posteromedial fragment of posterior malleolus fracture was more common in pronation injuries, likely the result of traction by the intermalleolar ligament, and the pilon type was more common in supination injuries, likely the result of the rotating talus impaction. Because of the intra-articular involvement, we believe the pilon type should undergo fixation to achieve articular congruity, unlike the avulsion type which may only function as a secondary syndesmotic stabilizer. LEVEL OF EVIDENCE Level III, retrospective comparative series.
Collapse
Affiliation(s)
- Amir Reza Vosoughi
- 1 Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Benjamin Fischer
- 2 Aintree University Hospital, Lower Lane, Liverpool, United Kingdom
| | - Andrew P Molloy
- 2 Aintree University Hospital, Lower Lane, Liverpool, United Kingdom
| | - Lyndon W Mason
- 2 Aintree University Hospital, Lower Lane, Liverpool, United Kingdom
| |
Collapse
|
30
|
Birnie MFN, van Schilt KLJ, Sanders FRK, Kloen P, Schepers T. Anterior inferior tibiofibular ligament avulsion fractures in operatively treated ankle fractures: a retrospective analysis. Arch Orthop Trauma Surg 2019; 139:787-793. [PMID: 30770996 PMCID: PMC6514069 DOI: 10.1007/s00402-019-03138-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is no consensus about the optimal treatment of anterior inferior ligament avulsion fractures of the ankle. The aim of this study is to provide insights regarding the incidence of anterior inferior ligament avulsion fractures, the association with fracture type, and correlation with treatment. METHODS This study is a retrospective analysis in a level-1 trauma center of adult patients with an ankle fracture operated between the dates 01-01-2009 and 01-09-2017 who had a pre- and postoperative CT-scan. Within the study population, the incidence of AITFL avulsion fracture was defined. Primary outcome was the type of avulsion fracture and related treatment. Secondary outcome was additional surgery in relation to the initial treatment. RESULTS In total, 65 of 252 (25.8%) patients were diagnosed with an anterior inferior ligament avulsion fracture. Zero patients had a Wagstaffe type 1 fracture, 28 (43.1%) had a type 2, 32 (49.2%) had a type 3, and 5 (7.7%) had a type 4. There was a correlation between Wagstaffe type 2 and Weber B fractures, p < 0.0001, and Wagstaffe type 3 avulsions were correlated with a Weber C fracture, p < 0.0001. Thirty-five of the avulsed fragments (53.8%) were smaller than 5 mm. In 13 (20%) of patients with anterior inferior ligament avulsion fracture, the avulsed fragments were directly fixated during initial surgery. Size and direct fixation of the fragment were significantly correlated (p < 0.0001). Within the anterior inferior ligament avulsion fracture group, only a total of four patients (6.2%) underwent a revision. CONCLUSION In the current study, an incidence of 25.8% of anterior inferior ligament avulsion fracture in surgically treated ankle fractures is reported. A correlation between the type of Wagstaffe injury and Weber classification was showed. Most fragments smaller than 5 mm were not fixated; however, not all injuries needed syndesmotic screws due to syndesmotic instability. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Merel F N Birnie
- Trauma unit, Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Kaz L J van Schilt
- Trauma unit, Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Fay R K Sanders
- Trauma unit, Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Peter Kloen
- Department of Orthopedic surgery, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Tim Schepers
- Trauma unit, Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| |
Collapse
|
31
|
Alnaif N, Alrobaiea S, Azzi AJ, Thibaudeau S, Martin MH. Diagnosis of isolated extensor carpi radialis longus (ECRL) tendon avulsion fracture using ultrasound: a paradigm shift. Skeletal Radiol 2018. [PMID: 29516111 DOI: 10.1007/s00256-018-2901-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Isolated avulsion fracture of the extensor carpi radialis longus (ECRL) tendon is a rare and poorly understood injury. We present a unique case of a 45-year-old male who fell on his flexed right hand. He presented with a subtle but extremely painful mass on the dorsum of his wrist. Ultrasound (U/S) imaging of the mass revealed an avulsed bone fragment attached to the ECRL tendon, confirming the clinical suspicion of an ECRL avulsion injury. Computed tomography and magnetic resonance imaging are well-documented imaging modalities to detect tendon avulsions. As demonstrated by this case report, U/S is an excellent diagnostic tool for ECRL rupture, a cost-effective alternative that provides real-time dynamic examination of hand injuries. To our knowledge, this is the first case of ECRL avulsion diagnosed by U/S. The purpose of this case report is to educate the reader on detection and diagnosis of ECRL tendon avulsion using U/S, a time-efficient and cost-effective imaging modality that is infrequently used for this purpose.
Collapse
Affiliation(s)
- N Alnaif
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, 1650 Cedar Avenue, Room L9.317, Montreal, Quebec, H3G 1A4, Canada
| | - S Alrobaiea
- Division of Plastic and Reconstructive Surgery, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Alain J Azzi
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, 1650 Cedar Avenue, Room L9.317, Montreal, Quebec, H3G 1A4, Canada.
| | - S Thibaudeau
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, 1650 Cedar Avenue, Room L9.317, Montreal, Quebec, H3G 1A4, Canada
| | - M H Martin
- Department of Radiology, McGill University Health Centre, Montreal, Quebec, Canada
| |
Collapse
|
32
|
Vodnarek J, L'Eplattenier H, Lobacz MA. What Is Your Diagnosis? J Am Vet Med Assoc 2018; 252:399-401. [PMID: 29393736 DOI: 10.2460/javma.252.4.399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
33
|
Matar HE, Tripathi S, Miller DJ. Iliac crest apophyseal insufficiency avulsion fractures. Ann R Coll Surg Engl 2018; 100:e4-e6. [PMID: 29046079 PMCID: PMC5838676 DOI: 10.1308/rcsann.2017.0175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2017] [Indexed: 11/22/2022] Open
Abstract
Iliac crest apophyseal avulsion fractures are rare injuries caused mainly through forceful contraction of attached muscles during high level sporting activities. We present the first case of a spontaneous iliac crest apophyseal avulsion insufficiency fracture in a patient with severe atopic eczema on oral steroids and review the relevant literature.
Collapse
Affiliation(s)
- H E Matar
- Department of Trauma and Orthopaedics, Leighton Hospital , Crewe
| | - S Tripathi
- Department of Trauma and Orthopaedics, Leighton Hospital , Crewe
| | - D J Miller
- Department of Trauma and Orthopaedics, Leighton Hospital , Crewe
| |
Collapse
|
34
|
Scillia AJ, Pierce TP, Festa A, Goljan P, McInerney VK. An Anterior Inferior Iliac Spine Avulsion Fracture in a 14-Year Old Boy on Human Growth Hormone. Surg Technol Int 2017; 30:482-485. [PMID: 28537648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We present the case of a young man with an anterior inferior iliac spine (AIIS) avulsion fracture who was taking human growth hormone (HGH) at the time his injury was diagnosed. He presented with chronic hip pain and no traumatic event. Physical exam revealed symptoms of hip impingement. Upon imaging, he was diagnosed with an AIIS avulsion fracture and underwent surgical repair. He returned to full activity six months post-operatively. At 18-months post-operatively, he was pain-free and performing all activities without difficulty. The role of HGH in his injury or recovery is not well understood and must be studied with large database studies.
Collapse
Affiliation(s)
- Anthony J Scillia
- Seton Hall University, School of Health and Medical Sciences Department of Orthopaedics, South Orange, New Jersey
| | - Todd P Pierce
- Seton Hall University, School of Health and Medical Sciences Department of Orthopaedics, South Orange, New Jersey
| | - Anthony Festa
- Seton Hall University, School of Health and Medical Sciences Department of Orthopaedics, South Orange, New Jersey
| | - Peter Goljan
- Seton Hall University, School of Health and Medical Sciences Department of Orthopaedics, South Orange, New Jersey
| | - Vincent K McInerney
- Seton Hall University, School of Health and Medical Sciences Department of Orthopaedics, South Orange, New Jersey
| |
Collapse
|
35
|
Shibahara M, Ohnishi Y, Honda E, Matsuda DK, Uchida S. Arthroscopic Treatment of a Displaced Nonunion of the Anterior Inferior Iliac Spine Causing Extra-articular Impingement. Orthopedics 2017; 40:e725-e728. [PMID: 28437548 DOI: 10.3928/01477447-20170418-06] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 03/07/2017] [Indexed: 02/03/2023]
Abstract
This report describes a case of nonunion of an anterior inferior iliac spine (AIIS) apophyseal avulsion fracture with resultant subspine impingement combined with symptomatic femoroacetabular impingement (FAI). A 16-year-old male soccer player presented with a 6-month history of right groin pain exacerbated by kicking and running. The patient was diagnosed with a displaced nonunion of the AIIS apophysis avulsion fracture causing secondary extra-articular impingement beyond cam-type FAI by physical examination and radiological findings. The authors performed arthroscopic AIIS decompression, with concurrent FAI correction and labral repair and capsular closure. At 4 months after surgery, a radiograph and a computed tomography scan showed complete bony union of the AIIS apophyseal nonunion. Modified Harris Hip Sore and Nonarthritic Hip Score improved from 74.8 and 61, respectively, to 100 for both at final follow-up. The effectiveness of arthroscopic decompression of the AIIS as part of a comprehensive minimally invasive surgery including FAI correction and labral repair resulted in complete union of the AIIS and pain-free return to sport and bony union. [Orthopedics. 2017; 40(4):e725-e728.].
Collapse
|
36
|
Fadl SA, Robinson JD. Core curriculum case illustration: [Stieda fracture (avulsion fracture of the medial femoral condyle)]. Emerg Radiol 2017; 25:103-105. [PMID: 28378234 DOI: 10.1007/s10140-017-1500-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 03/27/2017] [Indexed: 11/26/2022]
Abstract
This is the 30th installment of a series that will highlight one case per publication issue from the bank of cases available online as part of the American Society of Emergency Radiology (ASER) educational resources. Our goal is to generate more interest in and use of our online materials. To view more cases online please visit the ASER Core Curriculum and Recommendations for Study online at: http://www.erad.org/page/CCIP_TOC . A Stieda fracture is an avulsion injury from the medial femoral condyle of the origin of the medial collateral ligament. The medial collateral ligament originates superiorly from the medial femoral condyle and has superficial and deep fibers. On radiographs, the avulsion fracture at or near the medial femoral condyle near the attachment site of the medial collateral ligament is usually characteristic. Isolated partial or complete MCL injuries can be treated nonoperatively with good outcomes. Reconstruction of the medial ligamentous structures of the knee is usually performed if there is persistent valgus laxity or anteromedial rotatory instability after nonoperative management.
Collapse
Affiliation(s)
- Shaimaa Abdelhassib Fadl
- Department of Radiology, Harborview Medical Center, University of Washington, 325, 9th Avenue, Harborview Medical Center, Seattle, WA, 98104, USA.
| | - Jeffrey D Robinson
- Department of Radiology, Harborview Medical Center, University of Washington, 325, 9th Avenue, Harborview Medical Center, Seattle, WA, 98104, USA
| |
Collapse
|
37
|
Maeda M, Maeda N, Takaoka T, Tanaka Y. Sonographic Findings of Chondral Avulsion Fractures of the Lateral Ankle Ligaments in Children. J Ultrasound Med 2017; 36:421-432. [PMID: 28072472 DOI: 10.7863/ultra.15.09008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 04/29/2016] [Indexed: 06/06/2023]
Abstract
In this series, we aimed to describe the sonographic findings of chondral avulsion fractures that develop concomitant with lateral ankle ligament injury in children. We performed stress sonography during a manual anterior drawer stress procedure of the ankle in 9 skeletally immature patients who had recently had a lateral ankle sprain. Echo videos were obtained through the course of treatment, and all videos were reviewed. We elucidated the common features of chondral avulsion fractures of the lateral ankle ligaments in the children. The features of avulsion fractures on conventional sonography included absence of a fracture with hyperechoic spots (sonographic occult fracture type), cortical discontinuity with hyperechoic spots (cortical disruption fracture type), fracture line in the cortical bone (double-line fracture type), and a step-off deformity of the cortical bone with cartilage (displaced fracture type). In contrast, the features of chondral fractures on stress sonography included abnormal motion of the chondral lesions and mobility/fluidity of hyperechoic spots along the chondral fracture site. The presence of hyperechoic spots around the chondral lesion is an important sonographic sign for diagnosing chondral fractures concomitant with ankle lateral ligament injury. Hence, we believe that stress sonography should be considered for the detection of chondral fractures concomitant with radiographically negative ankle lateral ligament injuries in skeletally immature patients with lateral ankle pain and ankle sprains, if hyperechoic spots are present in the cartilage of the distal fibula.
Collapse
Affiliation(s)
| | | | | | - Yasuhito Tanaka
- Department of Orthopedic Surgery, Nara Medical University, Nara, Japan
| |
Collapse
|
38
|
Bley JA, Pomajzl RJ, Smith PA. Knotless Arthroscopic Reduction and Internal Fixation of a Displaced Anterior Cruciate Ligament Tibial Eminence Avulsion Fracture. Am J Orthop (Belle Mead NJ) 2017; 46:203-208. [PMID: 28856348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Generally occurring in the 8- to 14-year-old population, tibial eminence avulsion fractures are a common variant of anterior cruciate ligament ruptures and represent 2% to 5% of all knee injuries in skeletally immature individuals. In this article, we report on a new arthroscopic reduction and internal fixation technique that involves 2 absorbable anchors with adjustable suture-tensioning technology. This technique optimizes reduction and helps surgeons avoid proximal tibial physeal damage, procedure-related morbidity, and additional surgery.
Collapse
Affiliation(s)
| | | | - Patrick A Smith
- Columbia Orthopaedic Group, and University of Missouri, Columbia, OH.
| |
Collapse
|
39
|
Mizera R, Harcuba R, Kratochvíl J. [Avulsion of the Proximal Hamstring Insertion. Case Reports]. Acta Chir Orthop Traumatol Cech 2016; 83:418-420. [PMID: 28026739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Proximal hamstring avulsion is an uncommon muscle injury with a lack of consensus on indications and the timing and technique of surgery. Poor clinical symptoms and difficulties in the diagnostic process can lead to a false diagnosis. The authors present three cases of proximal hamstring avulsion, two complete and one partial ruptures of the biceps femoris muscle. MRI and ultrasound scans were used for optimal treatment alignment. Acute surgery reconstruction (< 4 weeks) was done in two patients. Re-attachment of the full thickness ruptures was performed to the original place and secured by suture anchors, the partial rupture was fixed by a simple suture. Two patients were free of any symptoms at 6 months after surgery, the last one had pain in the subgluteal area and a mild deficit in hamstring strength. Two interesting systematic reviews published on the treatment of proximal hamstring avulsion are discussed in the final part of the paper. Key words: hamstring, rupture, avulsion.
Collapse
Affiliation(s)
- R Mizera
- Oddělení ortopedie, Traumatologicko-ortopedické centrum, Krajská nemocnice Liberec, a.s
| | | | | |
Collapse
|
40
|
Winther AKN, Øhlenschlæger TF. [Avulsion fracture of the serratus anterior muscle in a golfer]. Ugeskr Laeger 2015; 177:56-57. [PMID: 25612967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Golf is a sport with much repetitive actions often causing overuse injuries. We report a case of a left side avulsion fracture of the anterior serratus at the insertion on costa 4-6. A professionel golfer experienced sudden onset of pain of the chest during a golfswing. Clinically the patient had winging of the scapula and pain at the lateral side of costa 4-6. Ultrasonography showed an avulsion fracture of costa 5 at the insertion of the anterior serratus. The patient was referred to scapula-stabilising rehabilitation and fully recovered.
Collapse
|