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Foot & Ankle International Sep 2023We aimed to find the prevalence of peroneal tendon instability (PTI) accompanying different types of calcaneal fractures and to determine predictors of PTI based on...
BACKGROUND
We aimed to find the prevalence of peroneal tendon instability (PTI) accompanying different types of calcaneal fractures and to determine predictors of PTI based on preoperative CT scanning.
METHODS
In a retrospective cross-sectional study, preoperative CT scans of 400 consecutive calcaneal fractures undergoing surgery were reviewed for comminuted fragments in the lateral gutter of the ankle, fractures at the tip of the lateral malleolus, dislocated peroneal tendons, excessive displacement of the lateral calcaneal wall, calcaneal fracture-dislocation, superior peroneal retinaculum (SPR) avulsion fracture (fleck sign), and shape of the retromalleolar groove. The correlation of these variables with intraoperative SPR stress test, defined as the diagnostic criteria for PTI in calcaneal fractures, was evaluated.
RESULTS
In total, 369 patients (mean age, 39 ± 13; range, 11-72 years), with 321 (87.0%) of them male, were included. Among all calcaneal fractures, 67 cases (16.7%) had associated PTI as confirmed intraoperatively by an SPR stress test. A statistically significant association was found between PTI in calcaneal fractures and comminuted fragments in the lateral gutter of the ankle ( = .03), dislocated peroneal tendons ( < .001), calcaneal fracture-dislocation ( < .001), SPR avulsion fracture ( < .001), and Sanders type IV of calcaneal fracture ( = .02). There was no statistically significant relationship between PTI and the mechanism of injury ( = .98), side of fracture ( = .30), uni- or bilateral calcaneal fractures ( = .27), a fracture at the tip of lateral malleolus ( = .69), shape of the retromalleolar groove ( = .78), or excessive displacement of the lateral calcaneal wall ( = .06). The most specific CT finding to predict PTI accompanying calcaneal fractures was calcaneal fracture-dislocation (99.1%).
CONCLUSION
Following calcaneal fracture fixation, PTI was confirmed with intraoperative SPR stress test in one-sixth of cases. With the exception of calcaneal fracture-dislocation, preoperative findings on CT scanning and calcaneal fracture pathoanatomy are insufficient to diagnose PTI accompanying calcaneal fractures.
LEVEL OF EVIDENCE
Level III, retrospective case control study.
Topics: Humans; Male; Adult; Middle Aged; Fractures, Avulsion; Case-Control Studies; Cross-Sectional Studies; Prevalence; Retrospective Studies; Fractures, Bone; Fracture Dislocation; Ankle Injuries; Fractures, Comminuted; Joint Dislocations
PubMed: 37658714
DOI: 10.1177/10711007231175666 -
Arthroscopy Techniques Sep 2022Combined anterior cruciate ligament and posterior cruciate ligament tibial avulsion fractures are rare knee injuries that are primarily seen in adults. Prompt surgical...
Combined anterior cruciate ligament and posterior cruciate ligament tibial avulsion fractures are rare knee injuries that are primarily seen in adults. Prompt surgical intervention is indicated for displaced fractures to restore knee stability. Arthroscopic techniques are now the preferred method for treating anterior tibial spine avulsion fractures with posterior cruciate ligament tibial avulsion fractures being treated arthroscopically or with open reduction and internal fixation methods. This Technical Note and accompanying video demonstrate an arthroscopically assisted repair of bicruciate tibial avulsion fractures using an arthroscopic lever push technique. Two sutures are passed through the anterior cruciate ligament and pulled down through two bone tunnels placed within the tibial fracture bed, and one suture is passed around the posterior cruciate ligament and pulled down through one bone tunnel passing from the anterior tibia to the tibial fracture bed. Our technique is simple and effective in reducing bicruciate tibial avulsion fractures to anatomic position.
PubMed: 36185125
DOI: 10.1016/j.eats.2022.04.008 -
Emergency Radiology Aug 2021To describe the first "arcuate sign" case series in the pediatric population, radiologic features of the associated injuries, management, and how they compare with the...
PURPOSE
To describe the first "arcuate sign" case series in the pediatric population, radiologic features of the associated injuries, management, and how they compare with the adult population.
METHODS
Retrospective study included patients under 18 years of age with a classic "arcuate sign" on radiographs. Data collected included patient demographics, mechanism of injury, and management. Radiographs and advanced imaging (MRI, CT) were reviewed by two musculoskeletal radiologists in a blinded fashion and findings recorded.
RESULTS
Seven patients (4 males, 3 females) with mean age 15 years (range 14-17 years) were included in the study. All 7 injuries were related to sports, 5/7 (71%) being non-contact injuries. Five patients had MRI done-1 LCL injury, MPFL sprain, and MCL sprain were reported; 3 popliteofibular ligament and popliteus sprains were seen; and 3 bone contusions were present on imaging. None of the patients had meniscus or cruciate ligament tears. One patient had an additional fracture of the lateral tibial plateau at the ilio-tibial band attachment and an associated peroneal nerve injury. Five out of seven (71.4%) were treated non-operatively and were able to return back to activity at a mean of 7.2 weeks from injury. Two out of seven (28.6%) needed operative intervention for the fracture but not arthroscopic repair.
CONCLUSION
Pediatric patients with a radiographic arcuate sign tend not to have ACL, PCL, or meniscal injuries, and treatment is predominantly non-operative in contrast to literature reported in adults.
Topics: Adolescent; Adult; Anterior Cruciate Ligament Injuries; Child; Female; Fibula; Fractures, Avulsion; Humans; Knee Injuries; Ligaments, Articular; Magnetic Resonance Imaging; Male; Retrospective Studies
PubMed: 33566239
DOI: 10.1007/s10140-021-01910-9 -
The Journal of Knee Surgery Feb 2021Patellar sleeve fractures primarily occur in the adolescent population from a rapid contraction of the quadriceps with the knee in a flexed position. Several small case...
Patellar sleeve fractures primarily occur in the adolescent population from a rapid contraction of the quadriceps with the knee in a flexed position. Several small case reports describe operative reduction and fixation for displaced fractures. However, there is sparse literature on nonoperative management of these injuries. Retrospective review and prospective follow-up of all patients diagnosed with patellar sleeve fracture between 1991 and 2014 at a single institution. Patients with superior pole avulsion fractures, history of prior knee surgery, and fractures managed operatively were excluded. Patients with a clinical diagnosis without support of advanced imaging were also excluded. Radiographs and magnetic resonance imaging (MRI) were reviewed for initial fracture displacement, time until fracture union, and the presence of patellar tendon ossification. Outcome was assessed using the Tegner's activity scale, Kujala's Score and the International Knee Documentation Committee (IKDC) subjective knee evaluation score at final follow-up. Eighteen nonoperatively treated distal patellar pole sleeve fractures were identified, while five patients had advanced imaging to support their diagnosis. All were males with a mean age of 15.1 (range: 12-18). Traumatic and sport-related injuries were noted in the majority of patients. Only one patient had any appreciable displacement, but still < 2 mm. Final radiographic evaluation revealed fracture healing without patellar tendon ossification in all patients. All five patients had full terminal knee extension and symmetric range of motion. Mean IKDC score was 96.4 (range: 82-100) mean Tegner's activity score was 60 (range: 5-8), and mean Kujala's score was 89.7 (range: 63-100) at final follow-up. Of the five cases, three patients presented in a delayed fashion, and all went on to have surgical treatment. Two required arthroscopic loose body removal, while the other had an open patellar debridement and platelet-rich plasma (PRP) injection. Minimally displaced patellar sleeve fractures can be successfully managed nonoperatively with excellent clinical outcomes. However, delayed in presentation may be associated with worse outcome. This study of case series reflects level of evidence IV.
Topics: Adolescent; Athletic Injuries; Casts, Surgical; Child; Female; Fracture Fixation; Fracture Healing; Fractures, Avulsion; Fractures, Bone; Humans; Knee Injuries; Knee Joint; Magnetic Resonance Imaging; Male; Patella; Range of Motion, Articular; Retrospective Studies; Treatment Outcome
PubMed: 31434147
DOI: 10.1055/s-0039-1694742 -
The Journal of Bone and Joint Surgery.... Jun 2021We propose a new classification system for ischial tuberosity fractures in adolescents that is based on the ossification pattern of the apophysis.
BACKGROUND
We propose a new classification system for ischial tuberosity fractures in adolescents that is based on the ossification pattern of the apophysis.
METHODS
We performed a retrospective review of patients who were diagnosed with ischial tuberosity avulsion fractures at a single institution from 2008 to 2018. Skeletal maturity and fracture location, size, and displacement were recorded based on initial injury radiographs. The fractures were classified by location as being lateral (type 1) or complete (type 2). Pelvic computed tomography (CT) review demonstrated 5 stages of ossification. We then reviewed pelvic CT and magnetic resonance imaging scans to assess the tendinous insertions at the ischial tuberosity apophysis. Reliability analysis was performed.
RESULTS
We identified 45 ischial tuberosity fractures. The mean patient age was 14.4 years (range, 10.3 to 18.0 years). Boys accounted for 82% of the cohort. Forty-seven percent of the fractures were classified as type 1, and 53% were classified as type 2. Type-1 fractures were associated with younger age (p = 0.001), lower Risser score (p = 0.002), lower modified Oxford score (p = 0.002), less displacement (p = 0.001), and smaller size (p < 0.001) when compared with type-2 fractures. Of the 45 patients, 18 had follow-up of >6 months, with 56% going on to nonunion. Nonunion was associated with greater displacement (p = 0.016) and size (p = 0.027). When comparing union rates by fracture type, 33% of type-1 fractures progressed to nonunion, while 78% percent of type-2 fractures progressed to nonunion; however, this difference was not significant (p = 0.153). A review of the advanced imaging indicated that type-1 fractures involved the semimembranosus and conjoined tendons, whereas type-2 fractures also involved the adductor magnus tendon.
CONCLUSIONS
We propose a new classification system based on the ossification pattern of the ischial tuberosity apophysis that reflects the skeletal maturity of the patient, the size and location of the fracture, and the amount of displacement, and likely predicts the probability of subsequent nonunion. The ischial tuberosity ossifies in a pattern similar to the iliac crest as described by Risser, and this pattern of ossification dictates the size of the ischial tuberosity avulsion fracture fragments and the involved tendons.
Topics: Adolescent; Child; Female; Fractures, Avulsion; Humans; Ischium; Magnetic Resonance Imaging; Male; Osteogenesis; Retrospective Studies; Tendons; Tomography, X-Ray Computed
PubMed: 33724973
DOI: 10.2106/JBJS.20.01318 -
Orthopaedic Surgery Dec 2021To propose an updated definition of proximal tibia and fibula fracture (PTFF) and establish a three-dimensional (3D) structure-based classification of PTFF.
OBJECTIVES
To propose an updated definition of proximal tibia and fibula fracture (PTFF) and establish a three-dimensional (3D) structure-based classification of PTFF.
METHODS
In total, 1358 adult patients (837 males and 521 females; 43.61 ± 15.13 years, 1364 affected knees) who were diagnosed with PTFF at the departments of orthopaedic surgery of four hospitals from January 2010 to December 2019 were enrolled. The new classification of PTFF, termed Wu classification, included three parts: classification of columns in the horizontal plane, regions in the frontal plane, and segments in the sagittal plane. All PTFFs were classified according to Schatzker, Luo, and Wu classification systems. Additionally, the incidence and characteristics of PTFFs were analyzed.
RESULTS
The major internal structural fractures of PTFF were tibial plateau fracture (TPF) only (725, 53.15%), TPF and proximal fibular fracture (274, 20.09%), and isolated avulsion fracture of the posterior cruciate ligament (PCL) (189, 13.86%). Approximately a quarter of PTFF cases could not be classified using Schatzker or Luo classifications, but all PTFF cases could be classified using Wu classification. The most frequent PTFFs included all four columns in region IV, segment 2 (235, 17.23%); the posterolateral and posteromedial columns in region II, segment 2 (191, 14.00%); and the lateral and posterolateral columns in region IV, segment 2 (136, 9.97%). Isolated avulsion fracture of the anterior cruciate ligament (ACL) was categorized as three injury types, most of which involved the lateral and medial columns in region II, segment 1 (40/63, 64%). More than 97% of cases of isolated fractures of the PCL involved the posterolateral and posteromedial columns in region II, segment 2. The most frequent combined avulsion fracture of the ACL and PCL included all four columns in region II, segment 2 (18/24, 75%). All of the isolated avulsion fractures of the ACL were located in segment 1, and all those of the PCL in segment 2. The most common type of isolated proximal fibular fracture involved the posterolateral column in region III, segment 2 (23/26, 88%). The most frequent combined TPF and proximal fibular fracture involved all four columns in region IV, segment 2 (107/274, 39.05%).
CONCLUSIONS
All cases of PTFF could be classified by the new 3D Wu classification which should be beneficial for clinical diagnosis, guidance of treatment, statistical analysis, academic communication, and prognosis, and the most frequent PTFF involved all four columns in region IV, segment 2.
Topics: Adult; Anatomic Landmarks; Female; Humans; Imaging, Three-Dimensional; Male; Middle Aged; Radiography; Tibial Fractures; Tomography, X-Ray Computed
PubMed: 34672099
DOI: 10.1111/os.13161 -
Revista Brasileira de Ortopedia Aug 2021A deviated osteochondral fracture of the anterolateral tibia associated with fibular head avulsion in a 50-year-old patient is reported. In general, avulsion fracture of...
A deviated osteochondral fracture of the anterolateral tibia associated with fibular head avulsion in a 50-year-old patient is reported. In general, avulsion fracture of the iliotibial tract is associated with injuries in the cruciate ligament, in the meniscus and in lateral knee structures, as in the case herein reported.
PubMed: 34483400
DOI: 10.1055/s-0040-1702956 -
Frontiers in Pediatrics 2022Avulsion fractures of the pelvis and hip region are typical injuries in adolescent athletes. Avulsion sites include the muscle tendon origin or insertion, and treating...
Avulsion fractures of the pelvis and hip region are typical injuries in adolescent athletes. Avulsion sites include the muscle tendon origin or insertion, and treating these injuries surgically or conservatively remains a debated issue. The main goals of this review were to assess and summarize injury types and sites, treatment-related clinical outcomes, and return to sport for adolescent patients with a pelvis avulsion fracture and to provide support for making treatment decisions. The PubMed database was searched in November 2021 to identify all published articles from 2000 to 2021 that reported the outcome and return to sport after conservative or surgical treatment. Eighteen studies with 453 patients were included in this review. The age range was 13.6-16.8 years. The most common injury site the was anterior superior iliac spine (37%), followed by the anterior inferior iliac spine (31%), ischial tuberosity (14%), lesser trochanter (9%), iliac crest (8%), and superior corner of the pubic symphysis (1%). Overall complications were lower in the surgical group compared to the conservative group. The rate of return to pre-injury activity level was greater in patients who underwent surgical treatment ( < 0.05). In conclusion, surgery is preferred for major dislocation and fragment size, providing a better return-to-sport rate and decreasing the risk of complications.
PubMed: 36210934
DOI: 10.3389/fped.2022.947463 -
Journal of Orthopaedic Surgery and... Jan 2022Fifth metatarsal base fracture (fifth MBF) and lateral collateral ankle ligament (LCAL) injury are mainly caused by plantar flexion and inversion of the foot. However,...
BACKGROUND
Fifth metatarsal base fracture (fifth MBF) and lateral collateral ankle ligament (LCAL) injury are mainly caused by plantar flexion and inversion of the foot. However, there is no relevant report on the incidence, injury type and treatment principle of the fifth MBF combined with an LCAL injury.
MATERIALS AND METHODS
We retrospectively analyzed 61 patients with fifth MBF. After admission, patients were given the symptomatic treatment and underwent standard anteroposterior (AP), 30-degree oblique foot radiographs, ankle MR and/or ultrasonic examination. The type of surgery varied base on the individual patients (type of fracture with/without lateral collateral ankle ligament injury).
RESULTS
In 61 patients, there were 39 patients with LCAL injury. Among the 39 patients with LCAL injury, 24 patients with Grade I-II injury, 6 patients with Grade III injury, and 9 patients with avulsion fractures. There was no significant difference between the patients without LCAL injury and the patients with LCAL injury in terms of age (p = 0.67) and gender (p = 0.575). The incidence of fifth MBF with LCAL injury accounted for 63.93% of fifth metatarsal base fracture; the most common causes of injury included sprains and falls. The average fracture healing time was 8.3 (range, 6-12) weeks. For fifth MBF with displaced more than 2 mm, hook plate or lag screw was used for fixation; for complete rupture of LCAL, suture anchor was used to repairing the ligament; for partial LCAL injury, plaster was used for fixation after surgery; for avulsion fractures, cannulated screw or suture anchor was used for repair. None of the patients had complications such as delayed union, nonunion, and incision infection.
CONCLUSION
Early diagnosis and appropriate treatment can obtain good therapeutic results in fifth MBF patients combined with LCAL injury. Moreover, defining a treatment plan for ligament injury is essential for reducing postoperative complications. This study provides a basis for epidemiology, diagnosis, and treatment of fifth MBF with LCAL injury.
Topics: Adult; Aged; Female; Fracture Fixation, Internal; Fractures, Avulsion; Fractures, Bone; Humans; Lateral Ligament, Ankle; Male; Metatarsal Bones; Middle Aged; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 35073951
DOI: 10.1186/s13018-022-02935-7 -
Patterns of Anterior Inferior Tibiofibular Ligament Avulsion Fracture Accompanied by Ankle Fracture.The Journal of Foot and Ankle Surgery :... 2024The anterior inferior tibiofibular ligament (AITFL) avulsion fracture accompanying an ankle fracture can compromise ankle stability, necessitating accurate evaluation...
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.
Topics: Humans; Ankle Fractures; Fractures, Avulsion; Lateral Ligament, Ankle; Prospective Studies; Retrospective Studies; Tibial Fractures; Fracture Fixation, Internal
PubMed: 37898330
DOI: 10.1053/j.jfas.2023.06.006