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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 -
Orthopaedic Surgery Jun 2021To investigate the manifestation, mechanisms, and treatment of isolated partial femoral avulsion fractures of the posterior cruciate ligament (PCL) in adults.
OBJECTIVE
To investigate the manifestation, mechanisms, and treatment of isolated partial femoral avulsion fractures of the posterior cruciate ligament (PCL) in adults.
METHODS
From January 2011 to December 2018, we retrospectively reviewed the clinical data of three patients with isolated partial femoral avulsion fractures of the PCL who were admitted to our institution. All of these patients were admitted to our emergency department within 24 h after injury. After physical examination and radiographs were taken and reviewed, all patients were admitted and underwent surgical treatment. In a 26-year-old man who underwent arthroscopic surgery through the traditional medial and lateral approach before finally converting to open surgery with the posterior approach, the fragment that was finally removed was partially attached to the PCL. In the other two patients, women aged 63 and 68 years, who underwent arthroscopic surgery via the traditional medial and lateral approach, the fragments were large and attached to most fibers of the PCL. We fixed the fragments using hollow screws in arthroscopic view. In addition, in the 63-year-old patient, an anchor was embedded to restore the tension of the PCL. Four weeks after surgery, the patients started to wear long leg braces in full extension with the tibia blocked up by cushion. Physical examinations were conducted and radiographs were taken preoperatively and at 4 weeks and 3 months after surgery to evaluate the condition of the injury. The range of motion and the Lysholm knee scoring scale for the knee joint were compared before and after the surgery.
RESULTS
For the three patients, the radiographs taken at 3 months postoperatively showed that the fixation of the screws did not fail, and the subchondral bone was generally normal compared to the preoperative radiographs. CT scanning at 3 months after surgery showed that the fracture healed in the original position of the avulsion site. For all patients, the affected knees presented as stable at physical examination 3 months after surgery; the Lachmann test and the anterior drawer test results were negative. In addition, the flexion-extension, internal rotation, and external rotation were approximately 0°-130°, 0°-30°, and 0°-40° in the 26-year-old patient, respectively. The flexion-extension, internal rotation, and external rotation were approximately 0°-100°, 0°-20°, and 0°-35° for the 63-year-old patient, respectively. The flexion-extension, internal rotation, and external rotation were approximately 0°-100°, 0°-15°, and 0°-20° for the 68-year-old patient, respectively. There was no pain or only little pain 3 months after surgery. There was no swelling or discomfort at the 3-month follow up. The Lysholm knee scores of the 68-year-old, 63-year-old, and 26-year-old patient were 80, 87, and 95 at 3 months after surgery, respectively, which were obviously improved postoperatively.
CONCLUSION
The manifestation of isolated partial femoral avulsion fractures of the PCL in adults is often related to the injury mechanism, and surgery is essential for the treatment of these patients. Most of these fractures can be repaired by arthroscopic surgery, but some have to be treated by open surgery.
Topics: Adult; Aged; Female; Femoral Fractures; Fractures, Avulsion; Humans; Knee Injuries; Male; Middle Aged; Posterior Cruciate Ligament Reconstruction; Range of Motion, Articular; Retrospective Studies; Surveys and Questionnaires
PubMed: 33960134
DOI: 10.1111/os.12951 -
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 -
Frontiers in Surgery 2022The posterior cruciate ligament (PCL) plays an important role in maintaining the stability of the knee joint. To date, researchers have not reached agreement on which...
BACKGROUND
The posterior cruciate ligament (PCL) plays an important role in maintaining the stability of the knee joint. To date, researchers have not reached agreement on which type of fixation material should be used to treat PCL tibial avulsion fractures. The aim of this study was to investigate the effects of double button plate and cannulated screw fixation in the treatment of PCL avulsion fractures.
METHODS
We retrospectively reviewed our database, which was collected prospectively. From January 2019 to January 2020, 46 patients with posterior cruciate ligament avulsion fractures who were treated with double button plate and cannulated screw fixation. The primary outcomes of this study were surgical complications (fixation failure/displacement, implant breakage, nonunion, infection), radiological parameters, and knee function and secondary outcomes included reoperation rates for the fixation methods and the prevalence of symptomatic hardware causing soft tissue irritation outcomes were included. Values were analysed using multiple comparisons, where -values of 0.05 or less were considered significant.
RESULTS
Double button plate fixation had significantly higher values than cannulated screw fixation. The results showed that double button plate fixation was related to greater decreases in the length of surgery, intraoperative blood loss, hospital days, full weight bearing time, and incidence of complications, as well as greater increases in postoperative range of motion and Knee Society Score function and Lysholm scores.
CONCLUSION
Compared with cannulated screw fixation, the use of double button plate fixation technology has the following advantages: less trauma, shorter operation time, convenient use of instruments and fixtures, and it does not need to be removed, thus avoiding secondary trauma. Moreover, double button plate fixation under direct vision is safe and reliable without the need for additional equipment.
PubMed: 36713664
DOI: 10.3389/fsurg.2022.887010 -
Orthopaedic Journal of Sports Medicine Apr 2022Although arthroscopic screw fixation and suture fixation are mainstream interventions for displaced anterior cruciate ligament avulsion fractures of the tibia, the... (Review)
Review
Functional Outcomes and Subsequent Surgical Procedures After Arthroscopic Suture Versus Screw Fixation for ACL Tibial Avulsion Fractures: A Systematic Review and Meta-analysis.
BACKGROUND
Although arthroscopic screw fixation and suture fixation are mainstream interventions for displaced anterior cruciate ligament avulsion fractures of the tibia, the differences in clinical outcomes between them remain inconclusive.
PURPOSE
To conduct a meta-analysis comparing the clinical and functional outcomes between arthroscopic screw fixation and suture fixation for tibial avulsion fractures.
STUDY DESIGN
Systematic review; Level of evidence, 3.
METHODS
A systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and using the PubMed, Embase, and Cochrane Central Register of Controlled Trials databases. Inclusion criteria were English-language articles that compared functional outcomes after screw fixation versus suture fixation for tibial avulsion fractures and had at least 1-year follow-up. Relevant data were extracted and analyzed statistically using the Mantel-Haenszel method and variance-weighted means. Random-effects models were used to generate pooled relative risk (RR) estimates with confidence intervals (CIs).
RESULTS
Of 1395 articles initially identified, we included 5 studies with 184 patients (91 patients with screw fixations and 93 patients with suture fixations). The pooled results indicated similar postoperative outcomes for screw fixation and suture fixation: Lysholm score (mean difference [MD], -0.32 [95% CI, -6.08 to 5.44]; = .91), proportion of International Knee Documentation Committee score grade A (74% vs 74%; RR, 0.63 [95% CI, 0.10-3.95]; = .63), Tegner score (MD, 0.10 [95% CI: -1.73 to 1.92]; = .92), and Lachman test results (stable knee joint, 82% vs 82%; RR, 0.99; 95% CI: 0.85-1.16; = .90). Patients in the screw fixation group had a significantly higher overall subsequent surgery rate (46% vs 19%; RR, 2.33; 95% CI,1.51-3.60; = .0001) and implant removal rate (44% vs 3%; RR, 8.52; 95% CI, 3.58-20.29; < .00001) compared with those in the suture fixation group. Nonimplant-related subsequent surgery rates were similar for the 2 groups.
CONCLUSION
The findings indicated a higher risk of subsequent surgery (RR, 2.33) and implant removal (RR, 8.52) after screw fixation when compared with suture fixation for tibial avulsion fractures. However, there were no significant differences in clinical outcome scores between the 2 techniques.
PubMed: 35400137
DOI: 10.1177/23259671221085945 -
BMC Urology Nov 2020Girls' pelvic fracture bladder neck avulsion and urethral rupture is rare however it causes great morbidity. The management is complex and not standard yet. We report...
BACKGROUND
Girls' pelvic fracture bladder neck avulsion and urethral rupture is rare however it causes great morbidity. The management is complex and not standard yet. We report our experience and a technique of bladder neck reconstruction with anterior bladder wall flap.
METHODS
We retrospectively analysed data of 5 girls with pelvic fracture bladder neck avulsion and urethral rupture admitted to our institution from July 2017 to October 2019. They all came to our institution with a suprapubic tube. Patients' trauma was all initially treated at other hospitals, 4 had suprapubic cystotomy and 1 had urethral realignment. One girl also had three other urethroplasties at other hospitals. We took pubectomy, posterior ureth roplasty and bladder neck reconstruction with anterior bladder wall flap in these 5 girls. Post-operative assessments included voiding cystourethrography, uroflowmetry and urethroscopy after urethral catheter removal. Verbal consent to participate was obtained from the parent or legal guardian of the children.
RESULTS
Operation time ranged from 120 to 180 min. Follow-up time is 12 to 27 months. Uroflowmetry showed that maximum urine flow rate improved significantly. Cystourethrography indicated good continuity of the urethra. Two girls had urinary incontinence postoperatively but were continent 3 months later. One patient developed vesical-abdominal fistula and got repaired by surgery 6 months later. She was continent ever since. Other complications were not observed during the follow-up period.
CONCLUSIONS
Our method of bladder neck reconstruction using bladder flap as a patch is feasible and provides good continence, especially for those with serious bladder neck avulsion and urethral rupture caused by extensive trauma and those who had posttraumatic urethral distraction needed second repair.
Topics: Adolescent; Child; Child, Preschool; Female; Fractures, Bone; Humans; Infant; Pelvic Bones; Retrospective Studies; Urethra; Urinary Bladder; Urologic Surgical Procedures
PubMed: 33148253
DOI: 10.1186/s12894-020-00741-z -
Arthroscopy Techniques Oct 2022Ankle fractures are one of the most common orthopaedic injuries. The surgical principle is to restore anatomy and stability of the ankle mortise. Repositioning of the...
Ankle fractures are one of the most common orthopaedic injuries. The surgical principle is to restore anatomy and stability of the ankle mortise. Repositioning of the talus under the tibia with normalization of the medial clear space is mandatory for a good outcome. Deltoid ligament injuries can present as an avulsion fracture of the medial malleolus. The purpose of this Technical Note is to describe the details of arthroscopically assisted reduction and fixation of deltoid ligament avulsion fracture from medial malleolus. This can restore the medial stability of the ankle.
PubMed: 36311332
DOI: 10.1016/j.eats.2022.06.001 -
Arthroscopy, Sports Medicine, and... Feb 2021To highlight important diagnostic and treatment considerations in patients who present with bifocal patellar tendon avulsion fractures from the tibial tubercle and...
PURPOSE
To highlight important diagnostic and treatment considerations in patients who present with bifocal patellar tendon avulsion fractures from the tibial tubercle and inferior patellar pole.
METHODS
Radiographic presentation, surgical technique, and complications of 5 children who sustained bifocal patellar tendon avulsion fractures with ≥6 months postoperative follow-up were retrospectively reviewed. Hospital for Special Surgery (HSS) Brief Functional Activity Scale (HSS Pedi-FABS), Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference, PROMIS mobility, and Pediatric International Knee Documentation Committee Scale (Pedi-IKDC) were assessed at most recent follow-up.
RESULTS
Five children (4 boys, 1 girl) presented with bifocal patellar tendon avulsion fractures with a median follow-up of 12.8 months (range 7.7 to 26.4). In 1 case, advanced imaging was not pursued, and the bifocal nature of injury was subsequently discovered intraoperatively. In all other cases, magnetic resonance imaging (MRI) correctly characterized the bifocal injuries and revealed the full extent of fractures and soft tissue injury. Surgical management involved suture anchor repair with heavy nonabsorbable sutures. Postoperative functional and patient-reported outcomes were within the range of population healthy/normative values (for those that were available for comparison, e.g., Pedi-IKDC), and clinically relevant improvement was noted when comparing preoperative and postoperative patient-reported outcome measures of both pain and mobility.
CONCLUSIONS
Advanced imaging (e.g., MRI) is required to understand the full extent of injury and should be obtained in the setting of traumatic patella alta to evaluate for the presence of a bifocal lesion and plan surgical intervention accordingly. These patients demonstrate satisfactory functional and patient-reported outcomes after operative repair.
LEVEL OF EVIDENCE
IV, therapeutic case series.
PubMed: 33615253
DOI: 10.1016/j.asmr.2020.08.013