Medial malleolar stress fracture in athletes: diagnosis and operative treatment

BACKGROUND AND AIMS

Stress fractures are common overuse injuries in athletes. Medial malleolar stress fractures are rare but they have an important clinical relevance because of their tendency to cause considerable disability and loss of time in sports without proper treatment. The diagnosis of medial malleolar stress fracture is often a challenge and it is therefore often delayed which may cause even further problems in the treatment. The purpose of this study was to increase the awareness of medial malleolar stress fractures as a possible cause for medial ankle pain and to stress the importance of MRI in the diagnostics as well as to evaluate the results of surgical treatment.

PATIENTS AND METHODS

Between 1995 and 2008, a total of ten athletes with a medial malleolar stress fracture were operated at our centre. All operated cases during those years were included in the study. The cases were retrospectively analyzed. Return to pre-injury level of sport was evaluated and considered as an indicator of successful treatment.

RESULTS

Initially all standard radiographs were negative whereas in MRI the fractures were all visible. After operative treatment all medial malleolar stress fractures healed clinically in three to four months and all except one of the athletes were able to return to their pre-injury level of sports.

CONCLUSION

Early MRI is recommended if a medial malleolar stress fracture is suspected. Surgical treatment seems to result in rapid healing of the fracture and return to sports. In our opinion early surgery should be considered especially in athletes.

Operative Results of Periprosthetic Fractures of The Distal Femur In A Single Academic Unit

BACKGROUND AND AIMS

Periprosthetic supracondylar fractures after total knee arthroplasty are often associated with poor bone stock, fracture comminution, and loose components. Current operative methods include plating, intramedullary nailing, and re-arthroplasty, depending on the fracture type. The aim of the study was to assess the outcome of operatively treated periprosthetic supracondylar fractures at our institute with special interest on the use of strut grafts in association with plating.

MATERIALS AND METHODS

In all, 68 patients were included in the study. They had been treated operatively due to a periprosthetic supracondylar fracture at our center between 2000 and 2010. The data of these patients were retrospectively collected from the electronic patient archives. Fractures with a fixed prosthesis component were treated using internal fixation provided that there was enough bone for osteosynthesis in the distal fracture fragment (39 patients). Fractures with a loose prosthesis component were treated using re-arthroplasty (29 patients). The demographics of the two treatment groups did not differ statistically significantly. Death or any re-operation was chosen as the endpoint of follow-up. Cumulative survival percentages were estimated for each treatment group.

RESULTS

There was no statistically significant difference between the treatment groups regarding clinical outcome. Clinical outcome was not assessable in nine patients. A positive clinical outcome was reported in 52 cases (88.1%). The survival of both laminofixation and re-arthroplasty was 75% at 3 years, but the survival of laminofixated fractures with strut graft was 80% compared to that of 51% without strut grafts. In all, 16 patients (24%) had a post-operative surgical site complication: seven infections (10%), six non-unions (15%), and three patellar dislocations (11%).

CONCLUSIONS

Post-operative surgical site complications were relatively common in these mainly elderly female patients. The survival percentages of the re-arthroplasty and laminofixation groups were similar. The use of strut grafts in association with plating may decrease re-operation rate.

Fascial incision and adhesiolysis combined with radiofrequency microtenotomy in treatment of chronic midportion Achilles tendinopathy

BACKGROUND AND AIMS

Achilles tendinopathy is a common problem that can cause disturbing symptoms in activities of daily living as well as prevent sports activities. The purpose of this study was to evaluate the effects of fascial incision and adhesiolysis combined with radiofrequency microtenotomy in treatment of chronic midportion Achilles tendinopathy.

MATERIAL AND METHODS

Twenty-four patients were included in this study. The cases were studied retrospectively. The mean age of the patients was 54 years (range, 39 to 72) and there were 12 women and 12 men. A final evaluation was done at an average of 30 months (range, 18 to 45) after surgery, including radiofrequency microtenotomy.

RESULTS

In all cases the Nirschl Pain Phase Scale of Athletic Overuse Injuries score improved and the difference was statistically significant (p < 0.0001). The patients themselves rated the result excellent in 14 cases and good in 10 cases.

CONCLUSION

Fascial incision and adhesiolysis combined with radiofrequency microtenotomy seems to be a useful alternative in treatment of chronic midportion Achilles tendinopathy in cases of unsuccessful non-operative treatment.

Operative treatment of stress fractures of the proximal second metatarsal

Proximal stress fractures of the second metatarsal are rare. They have been reported mainly in classical ballet dancers. Non-operative treatment has usually led to good results and rapid return to full activities. We present a series of nine cases with stress fractures of the proximal second metatarsal. The patients were all actively involved in sports. None of them were dancers. In all of these patients non-operative treatment lasting for an average of 13 months had failed. All of the patients were operated on using the same method. In the operation drilling was performed around and through the fracture line. The patients were followed for an average of 38 months. All except one of the patients were able to return to their prior level of activity within 4-6 months. In conclusion if non-operative treatment fails surgery seems to give good results in most patients with a stress fracture of the proximal second metatarsal.

Surgical treatment of partial tears of the proximal origin of the hamstring muscles

BACKGROUND

Hamstring injuries are common especially in athletes. Partial and complete tears of the proximal origin may cause pain and functional loss.

OBJECTIVE

To evaluate the results of surgical treatment for partial proximal hamstring tears.

METHODS

Between 1994 and 2005, 47 athletes (48 cases, 1 bilateral) with partial proximal hamstring tears were operated on. The cases were retrospectively analysed. Before surgery, 42 of the patients had undergone conservative treatment with unsatisfactory results, whereas in five patients the operation was performed within four weeks of the injury.

RESULTS

The mean length of the follow up was 36 months (range 6-72). The result of the operation was rated excellent in 33 cases, good in nine, fair in four, and poor in two. Forty one patients were able to return to their former level of sport after an average of five months (range 1-12).

CONCLUSION

In most cases, excellent or good results can be expected after surgical repair of partial proximal hamstring tears even after conservative treatment has failed.

Total proximal tendon avulsion of the rectus femoris muscle

Total proximal avulsions of the quadriceps femoris muscle group are rare injuries. Between the years 2001 and 2004 five patients with a total proximal avulsion of the tendon of the rectus femoris muscle were treated surgically in Mehiläinen Hospital in Turku, Finland. The median age of the patients was 21 years (range, 19-27) and the patients were all men. There were four soccer players and one hurdler. In all cases an avulsion of the proximal tendon of the rectus femoris muscle was confirmed by MRI. All of the patients were operated on and the delay from the injury to surgery ranged from 18 to 102 days. The result of the surgical treatment was rated good in all cases. All of the patients were able to return to their pre-injury level of activity 5-10 months after surgery. The median follow-up time was 20 months (range, 9-38). Surgical treatment of a total proximal avulsion of the tendon of the rectus femoris muscle seems to result in return to the pre-injury activity level in most cases.

Acute traumatic extension deficit of the knee

The purpose of this study was to evaluate the events leading to acute traumatic extension deficit of the knee and the arthroscopic findings in these patients. A total of 78 consecutive patients treated in the Turku university hospital during the years 1994-1996 were included. The mean annual incidence of acute traumatic extension deficits of the knee in our study was 1.1 per 10 000 inhabitants. The single most common (33%) event causing the extension deficit was non-sports related twisting of the knee. Various sports related activities accounted for 42% of the extension deficits, and soccer was the most common sport in this group. In conclusion, acute traumatic extension deficit of the knee is usually a sign of serious intra-articular damage, and the most likely finding (in 82% of the patients in our study) is either a meniscal rupture, an anterior cruciate ligament (ACL) rupture, a patellar dislocation, or a combination of these. The lesions in these knees require prompt evaluation by an orthopaedic surgeon mainly because of the high number of bucket-handle and menisco-capsular insertion ruptures of the menisci, which are possibly suitable for repair.

Acute traumatic hemarthrosis of the knee. Is routine arthroscopic examination necessary? A study of 320 consecutive patients

BACKGROUND AND AIMS

Distortions and contusions of the knee are common. Fairly often they will result in hemarthrosis. The purpose of this study was to evaluate the findings in patients with acute traumatic hemarthrosis of the knee and based on these findings estimate the necessity of acute arthroscopic examination.

MATERIAL AND METHODS

A total of 320 patients were examined arthroscopically between the years 1994 to 96 in the Turku University Hospital. Patients with other than chondral or osteochondral fractures were excluded.

RESULTS

The most common arthroscopic findings were rupture of the ACL (45%), dislocation of the patella (23%) and meniscal tear (21%). In only 113 (35%) cases an immediate therapeutic procedure was performed in addition to the arthroscopic examination.

CONCLUSIONS

Based on our findings we believe that routine arthroscopic examination is not necessary in patients with acute traumatic hemarthrosis of the knee. In our opinion the patient should be examined and followed by an orthopedic surgeon and if a lesion requiring operative treatment is diagnosed or suspected, an arthroscopic examination should be scheduled. The timing of the procedure should be such that all possible lesions encountered can be treated in the same operation.