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Journal of Orthopaedic Trauma Feb 2022Triceps avulsion fractures have become an increasingly common postoperative complication of olecranon fracture repair with proximal ulna plate (PUP) fixation. The...
OBJECTIVES
Triceps avulsion fractures have become an increasingly common postoperative complication of olecranon fracture repair with proximal ulna plate (PUP) fixation. The purpose of this study is to create an efficient, reproducible mechanism to mitigate this issue.
METHODS
Ten matched pair cadaveric specimens underwent a complete transverse osteotomy to simulate an olecranon fracture, followed by fracture reduction with a PUP. One arm from each pair underwent an additional augmented suture repair, where the triceps tendon was sutured directly to the plate. A custom jig was used to hold the specimen in position and apply a tensile force on the triceps until mechanical failure.
RESULTS
All control specimens (without augmented suture repair) failed through a full-thickness triceps avulsion fracture at an average force of 967.7 N. The augmented suture-repaired specimens failed at an average force of 1204.3 N through partial avulsion fractures, widening of the osteotomy site, and triceps ruptures.
CONCLUSIONS
Our study demonstrated that an augmented suture repair of PUP fixation for olecranon fractures is a simple and effective way to significantly increase fixation strength and change the potential failure mechanism.
Topics: Biomechanical Phenomena; Fracture Fixation, Internal; Fractures, Avulsion; Humans; Olecranon Process; Ulna; Ulna Fractures
PubMed: 34145209
DOI: 10.1097/BOT.0000000000002189 -
International Journal of Surgery Case... Sep 2021Posterior cruciate ligament (PCL) avulsion fracture is an uncommon entity, but it poses significant morbidity to patient's knee and activities. A combination of PCL...
INTRODUCTION AND IMPORTANCE
Posterior cruciate ligament (PCL) avulsion fracture is an uncommon entity, but it poses significant morbidity to patient's knee and activities. A combination of PCL avulsion fracture with Segond fracture is rare and has not been described much before in known literature. In this case report, we present a rare case of a combination of these two injuries.
CASE PRESENTATION
A 16-year-old cyclist who sustained left knee injury after a high-velocity fall while cycling. He fell with his anteromedial side of his left knee hitting the ground in flexion. After the fall, he felt excruciating pain and unable to bear weight. Examination revealed severe joint effusion, tenderness on posterior and lateral side of the left knee, no vascular injury and neurological deficit present. Radiographic examination revealed PCL avulsion fracture and Segond fracture. Five days after the injury, the avulsed PCL fragment and the lateral tibial plateau fragment were reduced and fixed with 3.5 mm cortical screw and washers. On the follow up, the patient stated that there is no pain on weightbearing position and after evaluated with Knee injury and Osteoarthritis Outcome Score (KOOS), the result is 90%.
CLINICAL DISCUSSION
Although the combination of PCL avulsion fracture and Segond fracture is rare, this pattern of injury could happen and could be considered when evaluating knee injuries.
CONCLUSION
Both fractures need to be addressed and managed adequately to restore knee stability and prevent early joint degeneration.
PubMed: 34509156
DOI: 10.1016/j.ijscr.2021.106380 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... Jan 2022To summarize the diagnosis and treatment of fibular fracture in ankle fracture.
OBJECTIVE
To summarize the diagnosis and treatment of fibular fracture in ankle fracture.
METHODS
Relevant literature at home and abroad in recent years was widely consulted, and various types of fractures were discussed and summarized according to Danis-Weber classification.
RESULTS
Conservative treatment is not an ideal treatment for type A avulsion fracture. The operation method should be determined according to the position and size of bone mass. For simple type B fracture, both conservative treatment and surgical treatment can achieve good results. When the position of type C fracture is high and does not affect the stability of ankle joint, it can be treated conservatively, while when the position is low and affects the stability of ankle joint, it needs surgical treatment.
CONCLUSION
First of all, whether the fibular fracture in the ankle fracture is stable or not should be determined. Whether it is treated surgically or not, the purpose is to restore the tibiofibular syndesmosis and restore the motor function of the ankle.
Topics: Ankle; Ankle Fractures; Ankle Injuries; Ankle Joint; Fibula; Fracture Fixation, Internal; Humans
PubMed: 35038809
DOI: 10.7507/1002-1892.202108091 -
Journal of Wrist Surgery Apr 2023The pathogenesis of Kienbock's disease is poorly understood. The coronal fracture line is acknowledged as a poor prognostic marker in the disease. Other fracture...
The pathogenesis of Kienbock's disease is poorly understood. The coronal fracture line is acknowledged as a poor prognostic marker in the disease. Other fracture types in the Kienbock's wrist have subsequently been identified. The aim is to study the fracture morphology of the lunate in a cohort of patients using computed tomography. Patient images were acquired using a set protocol with four-dimensional computed tomography scanning. Images were reviewed by two orthopaedic surgeons and a consultant radiologist. Static and dynamic images were assessed and a fracture map created. The relationship of fracture type to other parameters was then analyzed. Twenty-three patients were included in the study, including 11 males and 12 females, with a mean age of 43 years. Total frequency of fracture lines in the cohort was coronal - 26, proximal subchondral bone plate type - 24, avulsion - 19, sagittal - 16, and distal subchondral bone plate type - 11. There were statistically significantly more proximal than distal subchondral bone plate fractures ( = 0.03), and more coronal fractures than distal subchondral bone plate fractures ( = 0.01). There were statistically significantly more radiolunate ligament-avulsion types ( <0.001) than other types. The sagittal fracture line through the lunate approximated closely to the ulnar edge of the capitate and the ulnar edge of the radius. Study on the fracture morphology in the Kienbock's wrist has improved our understanding of the disease pathogenesis. Fracture lines may correspond to loading points, intrinsic and extrinsic ligament avulsions. These fracture types may play a role in disease progression and are important to identify when considering lunate salvage surgery.
PubMed: 36926207
DOI: 10.1055/s-0042-1756497 -
Journal of Clinical Orthopaedics and... Feb 2021The fifth metatarsal diaphyseal fracture is a common fracture. However, clear consensus about the treatment is lacking. Unlike the avulsion fracture or Jones' fracture,...
INTRODUCTION
The fifth metatarsal diaphyseal fracture is a common fracture. However, clear consensus about the treatment is lacking. Unlike the avulsion fracture or Jones' fracture, literature available on the treatment and long-term outcome of the diaphyseal fracture is scarce.The purpose of this study is to demonstrate a substantial number of conservatively treated patients with persistent pain and to evaluate metatarsal shortening and displacement within this group.
METHODS
In this retrospective study, 106 patients who had experienced a fifth metatarsal diaphyseal fracture were included and evaluated. The minimum follow-up period was three months. FAAM, AOFAS and NRS scores were used as outcome measurements for function and pain. Length and displacement were analysed on plain X-rays.
RESULTS
At least 11% of the patients who received conservative treatment for their fifth metatarsal diaphyseal fracture had persistent pain at least 3 months after initiation of conservative treatment. No relationship has been found between the length of the fifth metatarsal and the FAAM (r( Petrisor et al., 2006) 2 = 0,051), AOFAS (r( Petrisor et al., 2006) 2 = 0,009) and NRS (r( Petrisor et al., 2006) 2 = 0,001). Furthermore, there was no association between patients with a shorter fifth metatarsal and FAAM, AOFAS, NRS, displacement and BMI.
DISCUSSION AND CONCLUSION
The finding of persistent pain in at least 11% of all patients at long-term follow-up confirms our hypothesis on long-term symptoms. However, the results suggest that these persistent symptoms are not related to metatarsal shortening or displacement.
PubMed: 33680806
DOI: 10.1016/j.jcot.2020.08.013 -
Children (Basel, Switzerland) Aug 2023Tibial eminence fractures (TEF) of Meyers-McKeever type II-III-IV usually require surgical management. No consensus in the literature has been achieved regarding the... (Review)
Review
BACKGROUND
Tibial eminence fractures (TEF) of Meyers-McKeever type II-III-IV usually require surgical management. No consensus in the literature has been achieved regarding the best treatment option. The aims of the present systematic review were (1) to analyze the current literature and describe the outcomes of surgical treatment for TEF; and (2) to compare the outcomes of different surgical options using arthroscopic reduction and internal fixation (ARIF) with sutures or screws and open reduction and internal fixation (ORIF).
METHODS
A search was carried out with Pubmed, Medline, and Cochrane. Key terms were used "tibial" AND "eminence" or "spine" or "intercondylar" AND "paediatric" or "children" AND "fracture" or "avulsion" AND "treatment". Twelve articles met the inclusion criteria. Demographic data, clinical outcomes, and complication rates were evaluated for each study. Means/standard deviation and sum/percentage were used for continuous and categorical variables, respectively. Chi-square or t-student tests were applied. A -value < 0.05 was considered statistically significant.
RESULTS
ORIF showed superior clinical outcomes (Tegner ( < 0.05) and Lysholm ( < 0.001) scores) relative to ARIF and a lower incidence of arthrofibrosis ( < 0.05) and implant removal ( < 0.01). The Tegner, IKDC, and Lysholm scores showed statistically significant superior results following arthroscopic sutures compared to arthroscopic screws ( < 0.001). The incidence of arthrofibrosis was higher after arthroscopic sutures ( < 0.05), the implant removal was higher after screw fixation ( < 0.001) Conclusions: Better clinical results with low complication rates were achieved with ORIF surgery rather than ARIF; arthroscopic suture fixation resulted in higher clinical results compared to arthroscopic screw fixation and reduced the incidence of postoperative complications.
PubMed: 37628378
DOI: 10.3390/children10081379 -
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 -
Asia-Pacific Journal of Sports... Oct 2022The Segond fracture is an avulsion fracture of the lateral tibial plateau and is widely considered to be pathognomonic of anterior cruciate ligament (ACL) rupture. In...
INTRODUCTION
The Segond fracture is an avulsion fracture of the lateral tibial plateau and is widely considered to be pathognomonic of anterior cruciate ligament (ACL) rupture. In addition to ACL rupture, Segond fractures have also been noted to be associated with significant intra-articular pathology such as meniscal injuries as well as extra-articular pathology such as collateral ligament injuries. This is likely due to the fact that the presence of a Segond fracture may represent increased rotatory instability. Whilst several studies have demonstrated the association of a Segond fracture with significant intra-articular pathology, there is a paucity of literature assessing if the combination of an ACL rupture and Segond fracture gives rise to higher rates of concomitant ligamentous and meniscal injuries. The primary objective of this study is to determine if patients with ACL ruptures associated with Segond fractures have higher rates of concomitant ligamentous and meniscal injury, when compared to patients with ACL ruptures without a Segond fracture.
METHODS
A retrospective review of all patients who underwent ACL reconstruction in a single institution between 2014 to 2018 was conducted. A review of the patients' demographics, operative notes, and radiographs was performed. X-rays and MRI scans were double-read by a board-certified radiologist and Orthopaedic surgeon.
RESULTS
A total of 414 subjects were included. The incidence of Segond fracture was 2.4%. The mean age was 24.7±7.4 (range 16 to 60) years and 26.7±7.6 (range 16 to 38) years in patients with and without Segond fractures respectively. 89.9% of patients suffered a non-contact mechanism of injury, with sports injuries being most common (79.5%). There was a significantly higher rate of isolated lateral meniscus tears in patients with Segond fractures compared to those without (50% v.s. 20.8%) based on pre-operative MRI. (p<0.05) There were no other significant differences in associated ligamentous injuries.
CONCLUSION
The incidence of Segond fracture associated with ACL rupture is 2.4%. There is a significantly higher risk of a concomitant isolated lateral meniscus tear in ACL ruptures associated with a Segond fracture. There is no significantly higher risk of concomitant ligamentous injuries in ACL ruptures associated with a Segond fracture.
PubMed: 36312215
DOI: 10.1016/j.asmart.2022.09.002 -
Journal of Shoulder and Elbow Surgery Apr 2021Fractures of the anteromedial facet (AMF) of the coronoid process are caused by a varus posteromedial rotational injury force, leading to instability in the ulnohumeral... (Review)
Review
BACKGROUND
Fractures of the anteromedial facet (AMF) of the coronoid process are caused by a varus posteromedial rotational injury force, leading to instability in the ulnohumeral joint. AMF fractures are usually accompanied by avulsion of the lateral ulnar collateral ligament (LUCL). O'Driscoll's description and classification of AMF coronoid fractures has increased awareness and interest in this injury, but the optimal treatment has yet to be decided.
METHODS
We systematically reviewed the available literature searching electronic databases, MEDLINE using the PubMed interface and Embase. The primary objective was to determine outcome scores but also complication and revision rates depending on the fracture and its therapy in order to gain a more comprehensive picture. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were applied.
RESULTS
Initially, 304 publications were identified. Finally, 10 studies were left for inclusion, all of them retrospective in design, comprising 128 patients; the majority of them were male (75.7%). A total of 114 patients (89.1%) were treated surgically and 14 patients (10.9%) were treated conservatively. Among the surgically treated patients, 70.2% were treated with LUCL refixation. The average Mayo Elbow Performance Score of the surgically treated patients was 91.5 points. The average Mayo Elbow Performance Score of the conservatively treated patients was 91.4 points. A total of 10 patients (7.8%) required reoperation.
CONCLUSION
Surgery of AMF fractures leads to a satisfactory functional outcome in the vast majority of patients independent of the subtype. An algorithm for LUCL fixation is still pending. Conservative treatment may be considered under strict preconditions, especially for nondisplaced subtype 1 and 2 fractures, as these fractures show satisfactory functional outcomes when treated nonoperatively.
Topics: Collateral Ligaments; Elbow Joint; Fracture Fixation, Internal; Fractures, Bone; Humans; Range of Motion, Articular; Retrospective Studies; Treatment Outcome
PubMed: 33010433
DOI: 10.1016/j.jse.2020.09.008 -
BMC Musculoskeletal Disorders Feb 2022To compare the clinical results of homemade hook plates and hollow lag screws combined with spacers in the treatment of posterior cruciate tibial ligament avulsion...
Open reduction and internal fixation of the tibial avulsion fracture of the posterior cruciate ligament: which is better, a hollow lag screw combined with a gasket or a homemade hook plate?
OBJECTIVE
To compare the clinical results of homemade hook plates and hollow lag screws combined with spacers in the treatment of posterior cruciate tibial ligament avulsion fractures.
MATERIALS AND METHODS
This was a retrospective clinical cohort study that included 64 patients with PCL tibial avulsion fractures. Thirty-two of them were fixed with a homemade hook plate (hook plate group), and 32 were fixed with a hollow lag screen combined with a gasket (hollow lag screen group). By reviewing the medical record data and follow-up results, the operation time, postoperative drainage, fracture healing time, surgical complications, knee mobility, recovery of joint function, and whether postoperative gastrocnemius muscle strength changed in the two groups were compared.
RESULTS
All patients had successful wound and fracture healing. No adverse events, such as bone nonunion, infection, wound haematoma, or joint stiffness, occurred in either group. There were no patients with decreased gastrocnemius muscle strength in either group. Internal fixation failure occurred in 2 cases in the hollow lag screen group but not in the hook plate group. There were no significant differences between the two groups in terms of operative time, postoperative drainage, fracture healing time, knee mobility at the last follow-up, or Lysholm score.
CONCLUSION
It is safe and effective to use a homemade hook plate to fix PCL tibial avulsion fractures through an inverted L-shaped posterior medial approach. A homemade hook plate may have potential advantages over a hollow lag screen combined with gasket fixation.
Topics: Arthroscopy; Bone Screws; Cohort Studies; Fracture Fixation, Internal; Fractures, Avulsion; Humans; Posterior Cruciate Ligament; Retrospective Studies; Tibial Fractures; Treatment Outcome
PubMed: 35148737
DOI: 10.1186/s12891-022-05096-0