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Journal of Infection and Public Health Dec 2020In order to study the three-dimensional information of skeletal data from CT (Computed Tomography) serial medical images, 100 cases of distal posterior tibial fracture...
In order to study the three-dimensional information of skeletal data from CT (Computed Tomography) serial medical images, 100 cases of distal posterior tibial fracture were selected, X-ray films of ankle joint were taken, and plain CT scan and three-dimensional reconstruction were performed to evaluate the fracture situation. According to the CT images, the cases were divided into posterior Pilon fracture and posterior ankle fracture. The results showed that Pilon fracture accounted for 62% and there were 39 males and 23 females, 32 left and 30 right. There were 38 cases of posterior ankle fracture, 28 males and 10 females, 20 left and 18 right. There were many types and forms of posterior Pilon fracture and posterior ankle fracture. It showed that the main cause of distal posterior tibial fracture is violence. Axial violence of tibia or torsional violence of lower limbs often causes Pilon fracture. Avulsion fracture caused by torsional violence mostly belongs to posterior ankle fracture. To sum up, stereoscopic information of bone data was obtained through CT images of tibia.
Topics: Ankle Fractures; Female; Fracture Fixation, Internal; Humans; Male; Retrospective Studies; Tibial Fractures; Tomography, X-Ray Computed
PubMed: 31431421
DOI: 10.1016/j.jiph.2019.06.022 -
The Journal of International Medical... Oct 2022The low-energy 'Logsplitter' fracture, caused by a sprain or fall, is characterized by an intact or slightly separated inferior tibiofibular joint. Compared with the...
The low-energy 'Logsplitter' fracture, caused by a sprain or fall, is characterized by an intact or slightly separated inferior tibiofibular joint. Compared with the high-energy 'Logsplitter' fracture, this atypical subtype is rarely seen and is easily missed. Here, the case of a 33-year-old male patient with a fractured right ankle as a result of a sprain during walking is reported. The patient initially received routine surgical treatment comprising internal fixation of the fibular, medial and posterior malleoli. Unexpectedly, post-surgery imaging examinations revealed that the medial clear space of the right ankle had widened to 6 mm, due to incomplete reduction of the lateral malleolus, shortening and rotation of the fibula, and an unreduced avulsion fracture block of the anterior malleolus. A revision surgery was then performed to anatomically reduce and fix the lateral malleolus, as well as the anterior malleolus avulsion fracture. During 5 months following surgery, the patient achieved good fracture union and functional restoration of the right ankle. For this rare injury, the present case demonstrates that complete restoration of the fracture is required to achieve good clinical efficacy.
Topics: Adult; Ankle Fractures; Fibula; Fracture Fixation, Internal; Fractures, Avulsion; Humans; Male; Sprains and Strains; Treatment Outcome
PubMed: 36224748
DOI: 10.1177/03000605221090849 -
Arthroscopy Techniques Oct 2022Ischial avulsion fractures classically occur in the pediatric population and are relatively uncommon. These injuries are treated conservatively; however, in cases where...
Ischial avulsion fractures classically occur in the pediatric population and are relatively uncommon. These injuries are treated conservatively; however, in cases where there is greater than 2 cm of displacement, surgical intervention is recommended. In some cases, displaced fractures are either misdiagnosed or proper treatment is neglected, and patients who transition into adulthood are left with chronic nonunions that can become a source of pain and disability. Here we present a surgical technique for a chronic ischial avulsion fracture nonunion that is excised, and the hamstring tendons are then primarily repaired to the ischium using suture anchors.
PubMed: 36311327
DOI: 10.1016/j.eats.2022.06.017 -
Arthroscopy Techniques May 2021The fracture avulsion of the greater tuberosity (GT) represents 2% of all humerus fractures, but the true incidence is likely to be higher, being challenging the initial...
The fracture avulsion of the greater tuberosity (GT) represents 2% of all humerus fractures, but the true incidence is likely to be higher, being challenging the initial diagnosis on radiograph. The fracture avulsion of the GT could have different treatments: nondisplaced or minimally displaced fractures are treated conservatively, whereas for displaced or comminuted fractures surgical treatment is preferred. The most important finding of this study is the employment of an all-arthroscopic transosseous augmented technique for the treatment of a displaced humeral GT fracture avulsion. This technique shows all the advantages of the transosseous fixation and arthroscopic approach.
PubMed: 34141537
DOI: 10.1016/j.eats.2021.01.017 -
Medical Science Monitor : International... Dec 2018Avulsion fracture of the ischial tuberosity (AFIT) is a rare adolescent sports injury. At present, there is no consensus on its therapeutic paradigm, but conservative... (Review)
Review
Avulsion Fractures of the Ischial Tuberosity: Progress of Injury, Mechanism, Clinical Manifestations, Imaging Examination, Diagnosis and Differential Diagnosis and Treatment.
Avulsion fracture of the ischial tuberosity (AFIT) is a rare adolescent sports injury. At present, there is no consensus on its therapeutic paradigm, but conservative treatment appears to be the predominate choice. Furthermore, the degree of fracture displacement (DFD) remains as an important factor in determining whether AFIT needs internal fixation. The aim of the present study was to review and update the injury mechanism, clinical manifestations, imaging examination, diagnosis and differential diagnosis, and treatment of AFIT. A literature search was performed on a variety of databases using text words, and the results were limited to the English language. This review provides an important reference for the diagnosis and treatment of AFIT. AFIT can be easily misdiagnosed. Therefore, a detailed medical history and imaging examination are crucial for a correct diagnosis and differential diagnosis. For the choice of treatment of AFIT, it is necessary to consider not only the size of the fracture and DFD, but also the long-term functional needs of the patient.
Topics: Adolescent; Athletic Injuries; Diagnosis, Differential; Female; Fracture Fixation, Internal; Fractures, Bone; Humans; Ischium; Male
PubMed: 30589058
DOI: 10.12659/MSM.913799 -
Journal of the Belgian Society of... 2022A posterior tibial lip fracture is a rare avulsion fracture at the tibial insertion of the posterior tibiofibular ligament that causes significant ankle instability and...
A posterior tibial lip fracture is a rare avulsion fracture at the tibial insertion of the posterior tibiofibular ligament that causes significant ankle instability and often requires surgical intervention.
PubMed: 36213375
DOI: 10.5334/jbsr.2881 -
BMC Musculoskeletal Disorders Jun 2022Complete isolated calcaneal dislocation, defined as dislocation of talocalcaneal and calcaneocuboid joints with intact talonavicular joint without significant fracture,...
BACKGROUND
Complete isolated calcaneal dislocation, defined as dislocation of talocalcaneal and calcaneocuboid joints with intact talonavicular joint without significant fracture, is an exceedingly rare injury.
CASE PRESENTATION
A 49-year-old man, after a motor vehicle collision, presented with a closed isolated anterolateral dislocation of the calcaneus associated with fracture of the sustentaculum tali, cuboid, lateral process of the talus, and avulsion fracture of superior peroneal retinaculum. Urgent successful closed reduction was immediately performed in the emergency room under sedation. Two days later, through sinus tarsi approach extended proximally to posterior of the lateral malleolus and distally to the calcaneocuboid joint, peroneal tendons were reduced in the retromalleolar groove and avulsion fracture of the superior peroneal retinaculum was reduced and fixed by a suture anchor. A chondral lesion (6 × 8 mm) was seen in the posterior facet of the calcaneus for that chondroplasty and microfracture were performed. Also, small bony fragments from the cuboid were excised. The reduced calcaneocuboid joint was fixed by two Kirschner wires. In the second stage, 10 days later, through medial approach to the talocalcaneal joint, multiple free bony fragments were excised. Then sustentaculum tali was reduced and fixed using a lag screw. Postoperatively, a non-weight bearing short leg cast was applied for six weeks. The patient had permission to start partial weight bearing 6 weeks after removal of K-wires. Finally, at the 10th postoperative week, he had full weight-bearing without any aid instrument. He was able to return to his regular activities about 6 months after the injury. At 34 months, the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale was 92 from 100. The foot function index percentile was 7% and the visual analogue score for pain was 1.9. The last radiographs revealed normal configuration of talocalcaneal, calcaneocuboid, and talonavicular joints with a little joint space narrowing in posterior part of the subtalar joint.
CONCLUSION
Patients with isolated anterolateral calcaneal dislocations, even with multiple associated fractures, can have acceptable outcomes, if it is urgently diagnosed and properly managed.
Topics: Bone Screws; Calcaneus; Fractures, Avulsion; Fractures, Bone; Humans; Joint Dislocations; Male; Middle Aged; Subtalar Joint
PubMed: 35668415
DOI: 10.1186/s12891-022-05506-3 -
Orthopaedic Journal of Sports Medicine Jun 2021Sternal fractures are rare, and they can be treated nonoperatively. Vertical sternal fractures have rarely been reported.
BACKGROUND
Sternal fractures are rare, and they can be treated nonoperatively. Vertical sternal fractures have rarely been reported.
PURPOSE
To describe the management and surgical treatment of a series of elite-level athletes who presented with symptomatic nonunions of a vertical sternal fracture.
STUDY DESIGN
Case series; Level of evidence, 4.
METHODS
Patients with an established symptomatic nonunion of a vertical sternal fracture, as diagnosed by computed tomography (CT) or magnetic resonance imaging (MRI), underwent open reduction and internal fixation using autologous bone graft and cannulated lag screws. The patients were assessed preoperatively and at the final follow-up using the Rockwood sternoclavicular joint (SCJ) score; Constant score; and shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores. Bony union was confirmed on postoperative CT scan.
RESULTS
Five patients (4 men and 1 woman) were included; all were national- or international-level athletes (rugby, judo, show-jumping, and MotoGP). The mean age at surgery was 23.4 years (range, 19-27 years), the mean time from injury to referral was 13.6 months (range, 10-17 months), and the mean time from injury to surgery was 15.8 months (range, 11-20 months). The mean follow-up was 99.4 months (range, 25-168 months). There was a significant improvement after surgery in the mean Rockwood SCJ score (from 12.6 to 14.8 [ < .05]), Constant score (from 84 to 96.4 [ < .05]; 80% met the minimal clinically important difference [MCID] of 10.4 points), and QuickDASH (from 6.8 to 0.98 [ < .05]; 0% met the MCID of 15.9 points). Four of the patients were able to return to sport at their preinjury level, and 1 patient retired for nonmedical reasons. All of the fractures had united on the postoperative CT scan. There were no postoperative complications.
CONCLUSION
Vertical fractures of the sternum are very rare and tend to behave clinically like an avulsion fracture injury to the capsuloligamentous structure of the inferior SCJ. The requirement of advanced imaging to diagnose this injury means that the actual incidence and natural history are not known. For high-demand athletes, early identification, surgical reduction, and fixation are likely to achieve the best outcome.
PubMed: 34250172
DOI: 10.1177/23259671211010804 -
Cureus Mar 2023Avulsion fractures of the extensor carpi ulnaris (ECU) insertion are rare injuries that are poorly described in the literature. Several case reports detail closed ECU...
Avulsion fractures of the extensor carpi ulnaris (ECU) insertion are rare injuries that are poorly described in the literature. Several case reports detail closed ECU ruptures, however, only one previous case report describes an ECU avulsion fracture from the insertion on the fifth metacarpal base in the setting of multiple wrist and hand injuries. To our knowledge, we present the only case report of an isolated ECU avulsion fracture. In our case, a 35-year-old female presented with ulnar-sided wrist pain after forcefully impacting a steering wheel while radially deviating her wrist. She was diagnosed with an ECU avulsion fracture and elected to undergo open repair with a suture button technique. The patient recovered to nearly full strength and range of motion compared to her contralateral side by her eight-week visit. She returned back to work without restrictions after completing hand therapy.
PubMed: 37090358
DOI: 10.7759/cureus.36504 -
Orthopaedic Surgery Aug 2023In complicated Neer three- and four-part proximal humerus fracture (PHF), greater tuberosity (GT) fragments are often comminuted, and the currently widely used locking...
OBJECTIVE
In complicated Neer three- and four-part proximal humerus fracture (PHF), greater tuberosity (GT) fragments are often comminuted, and the currently widely used locking plate may not fix GT fragments effectively. A further understanding of morphological characteristics of the GT fragments may help explore new fixation devices. This study aimed to determine the fracture line morphology of the GT fragment of Neer three- or four-part PHF and analyze the location relationship between the locking plate and the GT fragment.
METHODS
Seventy-one three-dimensional computed tomography scans of Neer three- and four-part PHF were retrospectively reviewed between January 2014 and June 2019. Fracture fragments were reconstructed and virtually reduced in the Mimics software, and fracture lines of GT fragments were depicted on a humerus template in the 3-matic software and then were superimposed altogether. The common sites of the GT fracture were identified, and the location relationship between the locking plate and GT fragments was analyzed in a computer-simulated scenario.
RESULTS
The fracture line morphology of GT fragments was similar between Neer three- and four-part PHF. The overall morphology of GT fragments was in a fan shape, which could be summarized as anterior, superior, posterior, and middle lines. Of these, we identified 51 split and 29 avulsion type GT fragments based on the Mutch classification, and they could occur simultaneously in a PHF. The overall morphology of split type fragments was in a fan shape, and avulsion type fragments showed a quite distinguishable distribution pattern. A GT fragment could be classified as anterior-split, posterior-split, complete-split, anterior -avulsion, and posterior-avulsion type based on its morphology and location. The median percentage of fragment area covered by the plate was 32.3% in all of the fragments, and it was 69.4%, 23.0%, 37.2%, 21.8%, 0.0% in anterior-split, posterior-split, complete-split, anterior-avulsion, and posterior-avulsion type GT fragments. We defined the posterior-split, anterior-avulsion, and posterior-avulsion type GT fragments as the risky GT fragments, and they occurred in 43 (60.6%) Neer three- and four-part PHFs.
CONCLUSION
The fracture line morphology of GT fragments of Neer three- and four-part PHF was in a fan shape. GT fragments could be classified based on their location and morphology. The extent of GT fragment coverage provided by the locking plate differed in various fragment types, and we identified the anterior-avulsion, posterior-avulsion, and posterior-split type fragments as the risky GT fragments with a high incidence rate in Neer three- and four-part PHFs.
Topics: Humans; Retrospective Studies; Fracture Fixation, Internal; Shoulder Fractures; Tomography, X-Ray Computed; Humerus; Bone Plates; Humeral Fractures
PubMed: 36274213
DOI: 10.1111/os.13523