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Journal of Orthopaedic Case Reports Jul 2023Tibial tuberosity avulsion fractures in adolescents are one of the rare physeal injuries. Sudden powerful contraction of quadriceps muscle leads to avulsion fractures...
INTRODUCTION
Tibial tuberosity avulsion fractures in adolescents are one of the rare physeal injuries. Sudden powerful contraction of quadriceps muscle leads to avulsion fractures and varying degrees of disruption of extensor mechanism.
CASE REPORT
A 16-year-old boy sustained tibial tuberosity avulsion fracture while playing football and presented with sudden onset of pain, massive swelling, and loss of active extension of the left knee along with inability to bear weight on the left leg. Due to imminent risk of development of compartment, patient was taken for surgical correction immediately. Open reduction and internal fixation were done using 02 × 4 mm partially threaded cannulated cancellous screws. Patient was immobilized with above knee cast and kept non-weight bearing for 6 weeks. Later, gradual weight bearing ambulation was allowed and ROM and strengthening of knee was carried out. Patient had regained complete ROM of knee and returned to sporting activities by end of 6 months.
CONCLUSION
Tibial tuberosity avulsion fractures are a rare occurrence and even rarer is them getting complicated by compartment syndrome. A high index of suspicion for development of compartment syndrome in an avulsion fracture of tibial tuberosity and a timely management can avert such potential complications and enables to achieve an optimal results.
PubMed: 37521387
DOI: 10.13107/jocr.2023.v13.i07.3752 -
Journal of Neurosurgery. Case Lessons Dec 2023Bilateral occipital condyle fractures (OCFs) with involvement of the inferior clivus, otherwise known as "avulsion of the anterior foramen magnum," are an exceedingly...
BACKGROUND
Bilateral occipital condyle fractures (OCFs) with involvement of the inferior clivus, otherwise known as "avulsion of the anterior foramen magnum," are an exceedingly rare injury with only a few published reports.
OBSERVATIONS
A 24-year-old male presented with bilateral OCFs with involvement of the clivus after a motor vehicle accident. The patient had no neurological deficits and was successfully managed nonoperatively using a halo vest. The authors used a traction test to guide the duration of nonoperative care. The operative and nonoperative management of this rare injury is discussed with respect to other cases in the literature.
LESSONS
External immobilization through a halo vest is an effective treatment option for bilateral OCFs with clivus involvement. The traction test can be used, along with computed tomography, to guide the duration of treatment.
PubMed: 38109729
DOI: 10.3171/CASE23577 -
Journal of the Korean Association of... Dec 2023This analysis details the characteristics of dental trauma in South Korea during the coronavirus disease 2019 (COVID-19) (DC) pandemic and compares them in patients...
OBJECTIVES
This analysis details the characteristics of dental trauma in South Korea during the coronavirus disease 2019 (COVID-19) (DC) pandemic and compares them in patients before and after COVID-19 (BC and AC, respectively).
MATERIALS AND METHODS
Data were collected from medical records of patients who visited Seoul National University Bundang Hospital's Emergency Dental Care Center during three 12-month periods: BC, DC, and AC (BC from March 1, 2019 to February 29, 2020; DC from March 1, 2020 to February 28, 2021; AC from March 1, 2022 to February 28, 2023). A retrospective review was conducted to investigate patient age, sex, time of visit, cause, and diagnosis. The study included 1,544 patients: 660 BC, 374 DC, and 510 AC.
RESULTS
Significant difference in age and sex was not observed among the three periods; 1-9 years of age was the largest group (38.3% in BC, 29.6% in DC, and 27.8% in AC), and the percentage of male patients was greater than of female patients (male proportion as 63.5% in BC, 67.4% in DC, and 64.9% in AC). The number of patients generally peaked at a Saturday night in spring (for BC: May, Saturday, 18:00-19:59; for DC: March, Saturday, 18:00-19:59; for AC: April as the second most (October as the most peaked), Saturday, 20:00-21:59). The primary etiology of the dental trauma was identical in the three periods: falls, followed by sports. The most frequent diagnosis was laceration, followed by tooth avulsion and jaw fracture.
CONCLUSION
Significant differences were not found between the characteristics and patterns of dental trauma in the BC, DC, and AC periods. However, due to the pandemic and social distancing, activities decreased and associated dental trauma-related incidents declined.
PubMed: 38155087
DOI: 10.5125/jkaoms.2023.49.6.339 -
Bone & Joint Research Aug 2023This study aimed to establish the optimal fixation methods for calcaneal tuberosity avulsion fractures with different fragment thicknesses in a porcine model.
AIMS
This study aimed to establish the optimal fixation methods for calcaneal tuberosity avulsion fractures with different fragment thicknesses in a porcine model.
METHODS
A total of 36 porcine calcanea were sawed to create simple avulsion fractures with three different fragment thicknesses (5, 10, and 15 mm). They were randomly fixed with either two suture anchors or one headless screw. Load-to-failure and cyclic loading tension tests were performed for the biomechanical analysis.
RESULTS
This biomechanical study predicts that headless screw fixation is a better option if fragment thickness is over 15 mm in terms of the comparable peak failure load to suture anchor fixation (headless screw: 432.55 N (SD 62.25); suture anchor: 446.58 N (SD 84.97)), and less fracture fragment displacement after cyclic loading (headless screw: 3.94 N (SD 1.76); suture anchor: 8.68 N (SD 1.84)). Given that the fragment thickness is less than 10 mm, suture anchor fixation is a safer option.
CONCLUSION
Fracture fragment thickness helps in making the decision of either using headless screw or suture anchor fixation in treating calcaneal tuberosity avulsion fracture, based on the regression models of our study.
PubMed: 37607719
DOI: 10.1302/2046-3758.128.BJR-2023-0060.R1 -
Journal of Orthopaedic Case Reports Jan 2024Acute avulsion of the tibial tubercle is an uncommon fracture, with reported incidence rates of 0.4-2.7% of all epiphyseal injuries and <1% of all physeal injuries....
INTRODUCTION
Acute avulsion of the tibial tubercle is an uncommon fracture, with reported incidence rates of 0.4-2.7% of all epiphyseal injuries and <1% of all physeal injuries. Typically, these fractures present with marked displacement of the entire proximal apophysis, with or without intra-articular extension, and variable associated soft-tissue injury. The Ogden classification has historically directed both non-operative and operative treatment of this injury. The overarching objective of several fracture fixation techniques has been outlined as being to restore the joint surface and the extensor mechanism.
CASE REPORT
This case report describes the management of a 14-year-old male who sustained a rare avulsion fracture of the left tibial tuberosity with epiphyseal injury during a soccer game. The fracture was classified as Ogden Type III-B, indicating an intra-articular extension. The patient underwent open reduction and internal fixation with three cannulated screws and tension band wiring.
CONCLUSION
The fracture united with no residual deformity and return of full range of motion. Tension band wiring provides stable reduction; hence, prompt diagnosis and appropriate surgical intervention in similar cases is important to optimize outcomes.
PubMed: 38292087
DOI: 10.13107/jocr.2024.v14.i01.4150 -
Trauma Case Reports Aug 2024A terrible triad fracture of the elbow is defined as an elbow dislocation with associated fractures of the coronoid process and radial head. This injury is uncommon in...
A terrible triad fracture of the elbow is defined as an elbow dislocation with associated fractures of the coronoid process and radial head. This injury is uncommon in adults and exceptional in immature skeletons. We report a rare case of a terrible triad in a 14-year-old boy with a lateral epicondyle fracture. The diagnosis was suspected by the X-ray and confirmed by a CT scan after a closed reduction of the elbow, which was unstable. After a lateral approach of the elbow, the radial head and the lateral epicondyle were fixed by K-wire, and the fragment of the coronoid process was fixed by a bone suture. At two years of follow-up, the clinical and radiological outcomes were good. The terrible triad of the elbow is an exceptional trauma in children. Fracture avulsion of the lateral epicondyle is a particularity in the immature skeleton, equivalent to the lateral ligament injury in adults. A CT scan is mandatory after the reduction of the elbow to evaluate bone lesions. Open reduction by a single-lateral approach is indicated in cases of instability in extension.
PubMed: 38784219
DOI: 10.1016/j.tcr.2024.101036 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... Nov 2023To summarize the effectiveness of Kirschner wire buckling combined with bone fixation in the treatment of metacarpal avulsion fracture.
OBJECTIVE
To summarize the effectiveness of Kirschner wire buckling combined with bone fixation in the treatment of metacarpal avulsion fracture.
METHODS
The clinical data of 35 patients of metacarpal avulsion fracture admitted between March 2017 and June 2022 were retrospectively analyzed. There were 22 males and 13 females; the age ranged from 20 to 55 years, with an average of 31.6 years. There were 17 cases of the second metacarpal avulsion fracture, 6 cases of the fourth metacarpal avulsion fracture, and 12 cases of the fifth metacarpal avulsion fracture. The causes of injury included 21 cases of strangulation, 8 cases of sprain, and 6 cases of sports injury. X-ray film examination showed that the size of the avulsion fracture of metacarpal bone ranged from 0.30 cm×0.20 cm to 0.55 cm×0.45 cm. The total active motion (TAM) of the injured finger before operation was (154.00±17.38)°. The time from injury to operation was 3-10 days, with an average of 5.8 days. Follow-up regularly after operation, X-ray film and CT examination were performed to evaluate fracture healing and TAM of injured finger was measured. The finger function was evaluated by the trial standard of upper limb function evaluation of Hand Surgery Society of Chinese Medical Association.
RESULTS
All the incisions healed by first intention. All 35 patients were followed up 9-36 months, with an average of 28 months. All metacarpal avulsion fractures achieved bony healing, and the healing time was 4-6 weeks, with an average of 4.8 weeks. The metacarpophalangeal joint of the patient was stable, without stiffness, and the flexion and extension activities were good. At last follow-up, the TAM of the injured finger reached (261.88±6.23)°, which was significantly different from that before operation ( =-35.351, <0.001). The finger function was evaluated according to the trial standard of upper limb function evaluation of the Society of Hand Surgery of Chinese Medical Association, and 33 cases were excellent and 2 cases were good, with an excellent and good rate of 100%.
CONCLUSION
The treatment of metacarpal avulsion fracture with Kirschner wire buckling combined with bone fixation has the advantages of less trauma, firm fixation, and less interference to the soft tissue around metacarpophalangeal joints, which is a good alternative method for the metacarpal avulsion fracture.
Topics: Male; Female; Humans; Young Adult; Adult; Middle Aged; Fractures, Avulsion; Fracture Fixation, Internal; Metacarpal Bones; Bone Wires; Retrospective Studies; Treatment Outcome; Fractures, Bone; Hand Injuries
PubMed: 37987050
DOI: 10.7507/1002-1892.202309024 -
Acute Medicine & Surgery 2024Traumatic pneumocephalus is commonly encountered after basal skull fractures and rarely associated with blunt chest trauma. Here, we report a case of pneumocephalus...
BACKGROUND
Traumatic pneumocephalus is commonly encountered after basal skull fractures and rarely associated with blunt chest trauma. Here, we report a case of pneumocephalus caused by traumatic pneumothorax and brachial plexus avulsion.
CASE PRESENTATION
A 20-year-old male was admitted to our hospital following a motorcycle accident with complete paralysis of the right upper limb. 2 days later, follow-up computed tomography revealed a slight right pneumothorax, pneumomediastinum around the neck, and intracranial air without skull fracture. Air migrates into the subarachnoid space through a dural tear caused by a brachial plexus avulsion. The pneumocephalus immediately improved after the insertion of a chest drain.
CONCLUSION
Pneumothorax combined with brachial plexus avulsion could lead to pneumocephalus. Immediate chest drainage might be the best way to stop the migration of air; however, care should be taken to not worsen cerebrospinal fluid leakage.
PubMed: 38765777
DOI: 10.1002/ams2.956 -
Quantitative Imaging in Medicine and... Oct 2023Extremities fractures are a leading cause of death and disability, especially in the elderly. Avulsion fracture are also the most commonly missed diagnosis, and delayed...
BACKGROUND
Extremities fractures are a leading cause of death and disability, especially in the elderly. Avulsion fracture are also the most commonly missed diagnosis, and delayed diagnosis leads to higher litigation rates. Therefore, this study evaluates the diagnostic efficiency of the artificial intelligence (AI) model before and after optimization based on computed tomography (CT) images and then compares it with that of radiologists, especially for avulsion fractures.
METHODS
The digital X-ray photography [digital radiography (DR)] and CT images of adult limb trauma in our hospital from 2017 to 2020 were retrospectively collected, with or without 1 or more fractures of the shoulder, elbow, wrist, hand, hip, knee, ankle, and foot. Labeling of the fracture referred to the visualization of the fracture on the corresponding CT images. After training the pre-optimized AI model, the diagnostic performance of the pre-optimized AI, optimized AI model, and the initial radiological reports were evaluated. For the lesion level, the detection rate of avulsion and non-avulsion fractures was analyzed, whereas for the case level, the accuracy, sensitivity, and specificity were compared among them.
RESULTS
The total datasets (1,035 cases) were divided into a training set (n=675), a validation set (n=169), and a test set (n=191) in a balanced joint distribution. At the lesion level, the detection rates of avulsion fracture (57.89% 35.09%, P=0.004) and non-avulsion fracture (85.64% 71.29%, P<0.001) by the optimized AI were significantly higher than that by pre-optimized AI. The average precision (AP) of the optimized AI model for all lesions was higher than that of pre-optimized AI model (0.582 0.425). The detection rate of avulsion fracture by the optimized AI model was significantly higher than that by radiologists (57.89% 29.82%, P=0.002). For the non-avulsion fracture, there was no significant difference of detection rate between the optimized AI model and radiologists (P=0.853). At the case level, the accuracy (86.40% 71.93%, P<0.001) and sensitivity (87.29% 73.48%, P<0.001) of the optimized AI were significantly higher than those of the pre-optimized AI model. There was no statistical difference in accuracy, sensitivity, and specificity between the optimized AI model and the radiologists (P>0.05).
CONCLUSIONS
The optimized AI model improves the diagnostic efficacy in detecting extremity fractures on radiographs, and the optimized AI model is significantly better than radiologists in detecting avulsion fractures, which may be helpful in the clinical practice of orthopedic emergency.
PubMed: 37869340
DOI: 10.21037/qims-23-428 -
Patellar Sleeve Avulsion Fracture Repair: Suture Anchor Technique With Suture Cerclage Augmentation.Arthroscopy Techniques Dec 2023Patella sleeve fractures are rare injuries that occur in pediatric patients. For minimally displaced fractures, nonoperative treatment with immobilization is possible....
Patella sleeve fractures are rare injuries that occur in pediatric patients. For minimally displaced fractures, nonoperative treatment with immobilization is possible. When fractures are displaced, surgical repair is indicated. Previously described operative techniques include transosseous sutures and tension band wiring. We describe a surgical technique to repair distal pole and patella sleeve avulsion fractures in pediatric patients using intraosseous suture anchors with suture cerclage augmentation.
PubMed: 38196863
DOI: 10.1016/j.eats.2023.07.045