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Orthopaedic Surgery Nov 2022The patella's inferior pole transmits force generated by contraction of the quadriceps muscle to the tibial tuberosity through the attached patellar ligament, thus... (Review)
Review
The patella's inferior pole transmits force generated by contraction of the quadriceps muscle to the tibial tuberosity through the attached patellar ligament, thus completing knee extension. Therefore, fractures of the patella's inferior pole disrupt the coherence of mechanical transmission in the lower extremities. There appears to be no consensus among trauma centers regarding the treatment of infrapatellar pole fractures, primarily because there is no consistent design or application of internal fixation for this type of fracture. We designed a new internal implant similar to the smile necklace based on our previous study. This smile-necklace plate (SNP) has the advantage of both plate fixation and tension-band wiring fixation, permitting early rehabilitation, especially in osteoporotic comminuted infrapatellar pole fractures. Finite element analysis helped verify the biomechanical advantages of the SNP in comparison with existing studies. Hence, this novel implant is a promising treatment option for inferior pole patellar fractures.
Topics: Humans; Patella; Bone Wires; Fractures, Avulsion; Bone Plates; Fracture Fixation, Internal; Fractures, Comminuted; Fractures, Bone
PubMed: 36125193
DOI: 10.1111/os.13490 -
Orthopaedics & Traumatology, Surgery &... Apr 2021Tibial avulsion fracture of the posterior cruciate ligament is not rare in the clinic. Arthroscopic treatment is increasingly accepted, but the choice of fixation has...
Clinical outcomes of acute displaced posterior cruciate ligament tibial avulsion fracture: A retrospective comparative study between the arthroscopic suture and EndoButton fixation techniques.
BACKGROUND
Tibial avulsion fracture of the posterior cruciate ligament is not rare in the clinic. Arthroscopic treatment is increasingly accepted, but the choice of fixation has been debated. This study aims to compare the clinical outcomes of suture and EndoButton fixation under arthroscopy for acute displaced posterior cruciate ligament avulsion fractures.
METHODS
A total 68 of 83 PCL tibial avulsion fracture cases from 2009 to 2016 were retrospectively reviewed. Some patients received arthroscopic suture initially, and later the others received arthroscopic EndoButton fixation. Associated lesions were treated if present. The Lysholm and International Knee Documentation Committee (IKDC) scores, KT-1000 arthrometry and plain radiography were evaluated at follow-up. The assessment data at two years of follow-up were used for comparing the two different fixation groups.
RESULTS
The follow-up time of 63 patients was more than 2 years. In total, 32 of the 63 patients were in the suture group, and 31 were in the EndoButton group. At two years of follow-up, knee function according to the Lysholm score was a mean of 92.5 with a 95% confidence interval [CI] of 89.45 to 96.40 in the suture group and a mean of 93.5 with a 95% CI of 90.52 to 97.28 in the EndoButton group (P=.785). More than 90% of patients in both groups rated their knee function as normal or nearly normal on IKDC subjective evaluation. KT-1000 arthrometry showed that there was no difference between the two groups, with 0 to 3mm of laxity in 91% of the cases in the suture group versus 90% of cases in the EndoButton group. All patients achieved bony healing within 3 months. No significant complications were noted in the study.
CONCLUSIONS
Both the arthroscopic suture and EndoButton fixation methods for acute displaced posterior cruciate ligament avulsion fractures resulted in comparably good clinical outcomes, radiologic healing, and stable knees at mid-term follow-up.
LEVEL OF EVIDENCE
III; retrospective comparative study.
Topics: Arthroscopy; Fractures, Avulsion; Humans; Posterior Cruciate Ligament; Retrospective Studies; Suture Techniques; Sutures; Tibial Fractures; Treatment Outcome
PubMed: 33340707
DOI: 10.1016/j.otsr.2020.102798 -
Journal of Hand Surgery Global Online Sep 2021To describe patient-reported outcomes following simple elbow dislocation and to identify the baseline factors that predict outcomes.
PURPOSE
To describe patient-reported outcomes following simple elbow dislocation and to identify the baseline factors that predict outcomes.
METHODS
Adult patients treated with a closed reduction for a simple elbow dislocation with or without minor fracture (coronoid avulsion, radial head fracture, or epicondyle avulsion) from 2000 to 2018 completed outcome instruments including Disabilities of the Arm, Shoulder and Hand (DASH) via Research Electronic Data Capture. Descriptive statistics were calculated. Univariate followed by multivariate Tobit regression models were used to determine factors associated with clinical outcomes on DASH. Social deprivation was measured using the Area Deprivation Index. Patients with additional upper-extremity injuries or associated major fractures (Monteggia or terrible triad injuries, distal humerus fractures, etc) were excluded.
RESULTS
At a mean follow-up of 67.5 months, 95% (38/40) of patients reported satisfaction with treatment, and clinical outcomes were good (DASH 9.0 ± 14.8). Univariate analysis showed that higher Area Deprivation Index, older age, female sex, high-energy mechanism of injury, and worker's compensation (WC) or Medicare insurance status (vs commercial) was associated with significantly worse DASH scores at follow-up. Early therapy, dominant elbow involvement, presence of minor fractures (minimally displaced radial head, coronoid tip, or epicondylar avulsion fractures), race, and treating service did not influence outcomes in univariate analyses. Multivariate analysis demonstrated a significant association between increased social deprivation, WC insurance, and Medicare insurance and worse DASH scores while controlling for new upper-extremity injury, age, sex, and mechanism of injury.
CONCLUSIONS
Outcomes and treatment satisfaction following simple elbow dislocation are generally good but are significantly worse for the patients with greater levels of social deprivation and WC or Medicare insurance. Although surgeons should be aware of the possibility that specific subsets of patients may benefit from early therapy, this factor did not appear to influence long-term outcomes in this small cohort.
TYPE OF STUDY/LEVEL OF EVIDENCE
Prognostic III.
PubMed: 34632352
DOI: 10.1016/j.jhsg.2021.05.011 -
Medicine Sep 2023This study aimed to explore the postoperative outcomes of patients who underwent arthroscopic internal fixation with repositioning sutures for the treatment of posterior...
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.
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.
Topics: Humans; Posterior Cruciate Ligament; Fractures, Avulsion; Retrospective Studies; Knee Joint; Tibial Fractures; Treatment Outcome; Fracture Fixation, Internal; Arthroscopy; Suture Techniques
PubMed: 37773785
DOI: 10.1097/MD.0000000000035356 -
Knee Surgery, Sports Traumatology,... Jun 2021To compare outcome of operative and non-operative treatment of avulsion fractures of the hamstring origin, with minor (< 1.5 cm) and major (≥ 1.5 cm)...
Satisfactory clinical outcome of operative and non-operative treatment of avulsion fracture of the hamstring origin with treatment selection based on extent of displacement: a systematic review.
PURPOSE
To compare outcome of operative and non-operative treatment of avulsion fractures of the hamstring origin, with minor (< 1.5 cm) and major (≥ 1.5 cm) displacement, and early (≤ 4 weeks) and delayed (> 4 weeks) surgery.
METHODS
A systematic literature search was performed using PubMed, Cochrane, Embase, CINAHL and SPORTDiscus. A quality assessment was performed using the Physiotherapy Evidence Database (PEDro) scale.
RESULTS
Eight studies with 90 patients (mean age: 16 years) were included. All studies had low methodological quality (PEDro score ≤ 5). Operative treatment yielded a return to preinjury activity rate (RTPA) of 87% (95% CI: 68-95), return to sports (RTS) rate of 100% (95% CI: 82-100), Harris hip score (HHS) of 99 (range 96-100) and a University of California Los Angeles activity scale (UCLA) score of 100%. Non-operative treatment yielded a RTPA rate of 100% (95% CI:68-100), RTS rate of 86% (95% CI: 69-94), HHS score of 99 (range 96-100), and non-union rate of 18% (95% CI: 9-34). All patients with minor displacement were treated non-operatively (RTPA: 100% [95% CI: 21-100], RTS: 100% [95% CI: 51-100]). For major displacement, operative treatment led to RTPA and RTS rates of 86% (95% CI: 65-95) and 100% (95% CI: 84-100), and 0% (0/1, 95% CI: 0-79) and 100% (95% CI: 51-100) for non-operative treatment. Early surgery yielded RTPA and RTS rates of 100% (95% CI: 34-100 & 57-100) compared to 100 (95% CI: 72-100) and 90% (95% CI: 60-98) for delayed repair.
CONCLUSION
All included studies have high risk of bias. There is only low level of evidence with a limited number of included patients to compare outcome of operative and non-operative treatment. Overall outcome was satisfactory. There is a treatment selection phenomenon based on displacement, with acceptable outcome in both groups. There is insufficient data to draw conclusions regarding timing of surgery.
LEVEL OF EVIDENCE
IV.
Topics: Adolescent; Adult; Athletic Injuries; Female; Fractures, Avulsion; Hamstring Muscles; Humans; Lysholm Knee Score; Male; Orthopedic Procedures; Return to Sport; Treatment Outcome; Young Adult
PubMed: 32809117
DOI: 10.1007/s00167-020-06222-y -
Journal of Orthopaedic Case Reports 2018Isolated tibial tubercle fractures or patellar tendon ruptures are common injuries in adolescents. However, combined tubercle fractures with patellar tendon ruptures are...
INTRODUCTION
Isolated tibial tubercle fractures or patellar tendon ruptures are common injuries in adolescents. However, combined tubercle fractures with patellar tendon ruptures are rare, and hence, there are no definitive methods of surgical fixation or post-operative protocols.
CASE REPORT
A 13-year-old healthy girl sustained an extensor mechanism injury after the left knee hyperflexion during a fall from skateboarding. On examination, the extensor mechanism was not functional against gravity. Radiographic imaging revealed a displaced tibial tubercle fracture with patella alta, and magnetic resonance imaging revealed a concomitant patellar tendon avulsion from the tubercle. From a supine position on a radiolucent table, under general anesthesia and a femoral nerve block, the tibial tubercle fracture was fixed using two fully-threaded cortical screws. The patellar tendon was repaired with Fiber Wire through the Krakow method and secured through a tibial transosseous tunnel. A supplemental Fiber Wire was passed through a patellar tunnel and into a tibial tunnel to mitigate tension on the tendon repair. Post-operative knee motion was limited for 1 week to 60° of passive flexion, and full weight-bearing was permitted in a knee immobilizer.
CONCLUSION
Given the rarity of this combined extensor mechanism injury in adolescents and despite several different fixation methods reported in the literature, there is no clearly superior surgical technique. This case demonstrates a technique allowing for stability of the tubercle fracture and robust repair of the patellar tendon that permits early range of motion and weight-bearing.
PubMed: 30584509
DOI: 10.13107/jocr.2250-0685.1090 -
Journal of Orthopaedic Surgery (Hong... 2022To investigate the curative effects of improved non-absorbable high-strength fixation under arthroscopy on posterior cruciate ligament (PCL) avulsion fracture. A...
To investigate the curative effects of improved non-absorbable high-strength fixation under arthroscopy on posterior cruciate ligament (PCL) avulsion fracture. A retrospective analysis was performed on 16 cases of PCL avulsion fracture in 15 patients who underwent high-strength suture fixation under arthroscopy from December 2017 to November 2019. According to the Meyers-McKeever classification, there were 2 cases of type II and 14 cases of type III. The fracture was reduced under arthroscopy, and knotted and fixed under the anterior and medial skin of the knee joint with high-strength sutures and a button plate. Regular follow-up of the knee joint healing and stability, the range of motion and the functional recovery of affected limb was conducted. The last follow-up was completed after the button plate was taken out. The Lysholm score was used to assess the recovery situation. The button plate was taken out 6-9 months (average 7.2 months) after surgery. At the last follow-up, the fractures of the 15 patients were all healed. Moreover, six patients were positive for posterior drawer test within Grade 1 and the others were negative. All patients had no knee extension limitation, and the range of knee flexion reached more than 120°, with an average of (132.4 ± 3.6)°. The average Lysholm score was (93.1 ± 4.7). There were significant differences in knee flexion angle and Lysholm score at different time points after operation, = 0.000. For the treatment of PCL avulsion fracture, the optimized arthroscopic high-strength suture fixation is easy to perform and repeat, and the fixation is strong and solid. The functions of the knee joint experienced good recovery after the surgery.
Topics: Arthroscopy; Fractures, Avulsion; Humans; Knee Joint; Muscular Diseases; Posterior Cruciate Ligament; Retrospective Studies; Suture Techniques; Sutures; Tibial Fractures; Treatment Outcome
PubMed: 35596555
DOI: 10.1177/10225536221101701 -
Case Reports in Orthopedics 2022Avulsion injuries of the LCL most commonly occur at the fibular insertion. Femoral LCL avulsion injuries have only been previously described in pediatric patients or as...
Avulsion injuries of the LCL most commonly occur at the fibular insertion. Femoral LCL avulsion injuries have only been previously described in pediatric patients or as multiligament knee injury components among adults. This case series with comprehensive literature review describes for the first time 2 cases of isolated LCL femoral avulsion fractures in adults including conservative treatment outcomes. Both patients sustained a strong varus stress mechanism to their right knee, following sport injury or road traffic accident. For both patients, a complete radiographic evaluation including X-rays, MRI, and CT scan confirmed no other associated knee lesions. The femoral LCL avulsion fractures that were observed were minimally displaced and noncomminuted. Furthermore, imagery suggested preserved integrity at the superior lateral genicular artery, adjacent articular capsule, and IT band. Based on clinical and imaging evaluations, the decision was made to follow conservative treatment. By 10 weeks postinjury, both patients were asymptomatic with early radiological fracture healing evidence. Comparative varus stress radiographs at 20° knee flexion revealed no side-to-side differences and clinical exam showed no posterolateral rotatory instability. The second patient case presented with mild femoral LCL attachment calcification on follow-up CT-scan. Following a detailed analysis of anatomic injury characteristics, we suggest that patients with isolated femoral LCL avulsion fractures have low secondary displacement risk provided SLGA, articular capsule, and IT band integrity are present. In contrast to high-grade ligamentous and distal avulsion LCL injuries, we recommend conservative treatment for patients who sustain these lesions.
PubMed: 35496950
DOI: 10.1155/2022/6507577 -
Trauma Case Reports Apr 2020Hoffa fracture combined with tibial shaft fracture and multiple ligament avulsion injuries is extremely rare. Herein, we report a case of medial Hoffa fracture with...
Hoffa fracture combined with tibial shaft fracture and multiple ligament avulsion injuries is extremely rare. Herein, we report a case of medial Hoffa fracture with associated fracture of tibial shaft and avulsion fractures of multiple ligaments secondary to knee dislocation. A 17-year-old female with history of a motorcycle accident was referred to our hospital after knee joint reduction at a regional trauma center. Preoperative radiology revealed a medial Hoffa fracture associated with tibial shaft fracture, inferior pole patellar fracture, fibular head fracture and multiple ligament avulsion fractures including anterior cruciate ligament, posterior cruciate ligament and medial collateral ligament. A less invasive approach via arthroscopy-assisted technique and minimally invasive plate osteosynthesis (MIPO) technique was used for fracture reduction and fixation. Six months postoperatively, the patient had arthrofibrosis and adhesiolysis under arthroscopy was performed. At the last follow-up of 24 months, the patient regained knee full range of motion and returned to pre-injury level of activities. Although minimally invasive techniques were used to speed recovery, the orthopaedic surgeon should still be aware of the possibility of postoperative arthrofibrosis as multiple site fractures may need longer immobilization.
PubMed: 31989015
DOI: 10.1016/j.tcr.2020.100277 -
British Medical Bulletin Jun 2016Arthroscopy procedures are the gold standard for the management of tibial spine avulsion. This review evaluates and compares different arthroscopic treatment options for... (Review)
Review
INTRODUCTION
Arthroscopy procedures are the gold standard for the management of tibial spine avulsion. This review evaluates and compares different arthroscopic treatment options for tibial spine fractures.
SOURCE OF DATA
PubMed, Medline, Ovid, Google Scholar and Embase databases were systematically searched with no limit regarding the year of publication.
AREAS OF AGREEMENT
An arthroscopic approach compared with arthrotomy reduces complications such as soft-tissue lesions, post-operative pain and length of hospitalization.
AREAS OF CONTROVERSY
The use of suture techniques, compared to cannulated screw technique, avoids a second surgery for removal of the screws, but requires longer immobilization and partial weight bearing.
GROWING POINTS
Clinical outcomes and radiographic results do not seem to differ in relation to the chosen method of fixation.
AREAS TIMELY FOR DEVELOPING RESEARCH
Further studies are needed to produce clear guidelines to define the best choice in terms of clinical outcomes, function and complications.
Topics: Arthroscopy; Bone Screws; Fracture Fixation, Internal; Fracture Healing; Humans; Length of Stay; Pain, Postoperative; Radiography; Reproducibility of Results; Soft Tissue Injuries; Suture Techniques; Tibial Fractures; Treatment Outcome; Weight-Bearing
PubMed: 27151952
DOI: 10.1093/bmb/ldw018