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Arthroplasty Today Aug 2022Tibial intercondylar fracture with anterior cruciate ligament avulsion is a unique but rare complication of bicruciate-retaining total knee arthroplasty. Here, we...
Tibial intercondylar fracture with anterior cruciate ligament avulsion is a unique but rare complication of bicruciate-retaining total knee arthroplasty. Here, we describe an even rarer condition that the tibial intercondylar fracture involved bicruciate ligament and partial patellar tendon avulsion fracture resulting in significant clinical instability in a 70-year-old woman, a combination not yet reported in the literature. Dual-energy computed tomography helped characterize the fracture. During revision surgery, the bicruciate retaining total knee arthroplasty was revised to posterior-stabilized total knee arthroplasty and the patellar tendon was repaired with a suture anchor. She recovered well progressively, and at 6 months, she could walk with the use of an assisted walking device.
PubMed: 35662997
DOI: 10.1016/j.artd.2022.04.013 -
BMC Musculoskeletal Disorders Jun 2022Complete isolated calcaneal dislocation, defined as dislocation of talocalcaneal and calcaneocuboid joints with intact talonavicular joint without significant fracture,...
BACKGROUND
Complete isolated calcaneal dislocation, defined as dislocation of talocalcaneal and calcaneocuboid joints with intact talonavicular joint without significant fracture, is an exceedingly rare injury.
CASE PRESENTATION
A 49-year-old man, after a motor vehicle collision, presented with a closed isolated anterolateral dislocation of the calcaneus associated with fracture of the sustentaculum tali, cuboid, lateral process of the talus, and avulsion fracture of superior peroneal retinaculum. Urgent successful closed reduction was immediately performed in the emergency room under sedation. Two days later, through sinus tarsi approach extended proximally to posterior of the lateral malleolus and distally to the calcaneocuboid joint, peroneal tendons were reduced in the retromalleolar groove and avulsion fracture of the superior peroneal retinaculum was reduced and fixed by a suture anchor. A chondral lesion (6 × 8 mm) was seen in the posterior facet of the calcaneus for that chondroplasty and microfracture were performed. Also, small bony fragments from the cuboid were excised. The reduced calcaneocuboid joint was fixed by two Kirschner wires. In the second stage, 10 days later, through medial approach to the talocalcaneal joint, multiple free bony fragments were excised. Then sustentaculum tali was reduced and fixed using a lag screw. Postoperatively, a non-weight bearing short leg cast was applied for six weeks. The patient had permission to start partial weight bearing 6 weeks after removal of K-wires. Finally, at the 10th postoperative week, he had full weight-bearing without any aid instrument. He was able to return to his regular activities about 6 months after the injury. At 34 months, the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale was 92 from 100. The foot function index percentile was 7% and the visual analogue score for pain was 1.9. The last radiographs revealed normal configuration of talocalcaneal, calcaneocuboid, and talonavicular joints with a little joint space narrowing in posterior part of the subtalar joint.
CONCLUSION
Patients with isolated anterolateral calcaneal dislocations, even with multiple associated fractures, can have acceptable outcomes, if it is urgently diagnosed and properly managed.
Topics: Bone Screws; Calcaneus; Fractures, Avulsion; Fractures, Bone; Humans; Joint Dislocations; Male; Middle Aged; Subtalar Joint
PubMed: 35668415
DOI: 10.1186/s12891-022-05506-3 -
Orthopaedic Journal of Sports Medicine Jun 2021Sternal fractures are rare, and they can be treated nonoperatively. Vertical sternal fractures have rarely been reported.
BACKGROUND
Sternal fractures are rare, and they can be treated nonoperatively. Vertical sternal fractures have rarely been reported.
PURPOSE
To describe the management and surgical treatment of a series of elite-level athletes who presented with symptomatic nonunions of a vertical sternal fracture.
STUDY DESIGN
Case series; Level of evidence, 4.
METHODS
Patients with an established symptomatic nonunion of a vertical sternal fracture, as diagnosed by computed tomography (CT) or magnetic resonance imaging (MRI), underwent open reduction and internal fixation using autologous bone graft and cannulated lag screws. The patients were assessed preoperatively and at the final follow-up using the Rockwood sternoclavicular joint (SCJ) score; Constant score; and shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores. Bony union was confirmed on postoperative CT scan.
RESULTS
Five patients (4 men and 1 woman) were included; all were national- or international-level athletes (rugby, judo, show-jumping, and MotoGP). The mean age at surgery was 23.4 years (range, 19-27 years), the mean time from injury to referral was 13.6 months (range, 10-17 months), and the mean time from injury to surgery was 15.8 months (range, 11-20 months). The mean follow-up was 99.4 months (range, 25-168 months). There was a significant improvement after surgery in the mean Rockwood SCJ score (from 12.6 to 14.8 [ < .05]), Constant score (from 84 to 96.4 [ < .05]; 80% met the minimal clinically important difference [MCID] of 10.4 points), and QuickDASH (from 6.8 to 0.98 [ < .05]; 0% met the MCID of 15.9 points). Four of the patients were able to return to sport at their preinjury level, and 1 patient retired for nonmedical reasons. All of the fractures had united on the postoperative CT scan. There were no postoperative complications.
CONCLUSION
Vertical fractures of the sternum are very rare and tend to behave clinically like an avulsion fracture injury to the capsuloligamentous structure of the inferior SCJ. The requirement of advanced imaging to diagnose this injury means that the actual incidence and natural history are not known. For high-demand athletes, early identification, surgical reduction, and fixation are likely to achieve the best outcome.
PubMed: 34250172
DOI: 10.1177/23259671211010804 -
Cureus Mar 2023Avulsion fractures of the extensor carpi ulnaris (ECU) insertion are rare injuries that are poorly described in the literature. Several case reports detail closed ECU...
Avulsion fractures of the extensor carpi ulnaris (ECU) insertion are rare injuries that are poorly described in the literature. Several case reports detail closed ECU ruptures, however, only one previous case report describes an ECU avulsion fracture from the insertion on the fifth metacarpal base in the setting of multiple wrist and hand injuries. To our knowledge, we present the only case report of an isolated ECU avulsion fracture. In our case, a 35-year-old female presented with ulnar-sided wrist pain after forcefully impacting a steering wheel while radially deviating her wrist. She was diagnosed with an ECU avulsion fracture and elected to undergo open repair with a suture button technique. The patient recovered to nearly full strength and range of motion compared to her contralateral side by her eight-week visit. She returned back to work without restrictions after completing hand therapy.
PubMed: 37090358
DOI: 10.7759/cureus.36504 -
Acta Orthopaedica Et Traumatologica... Jul 2022The aim of this study was to propose a new classification of combined greater tuberosity (GT) fractures and anterior shoulder dislocation and studied the degree of...
OBJECTIVE
The aim of this study was to propose a new classification of combined greater tuberosity (GT) fractures and anterior shoulder dislocation and studied the degree of displacement, functional outcomes, and need for additional surgery after reduction.
METHODS
A cross-sectional study was conducted. We evaluated radiographs of patients treated for combined GT fractures and anterior shoulder dislocation. Three morphologies were proposed; type 1 (a small avulsion), type 2 (GT fractures without articular head involvement), and type 3 (GT associated with articular head fractures). Two orthopedic surgeons independently measured all radiographs and classified fractures into three types. Patients were interviewed by telephone to assess functional outcomes (the simple shoulder test (SST) and EQ-5D-5L), and additional shoulder surgery was also performed.
RESULTS
There were 52 eligible patients; 32 were male (61.5%) and the mean age was 57.3 · 17.1 years. Most cases were low-energy injuries (61.5%). Of all the cases, 32.7% were type I, 59.6% type II, and 7.7% type III cases. There were differences in the degree of displacement in each group at pre, post-reduction (both horizontal and vertical planes) and at two weeks post-reduction for HD (p < 0.05). Type III had more displacement than type I at pre- and post-reduction with a P value of less than 0.05. Type III also had higher rates of displacement than type II at post-reduction and at two-week postreduction (vertical plane). The intra and inter-rater reliabilities of measurement (ICC > 0.8) were in good to excellent agreement with the kappa value (>0.9). Three out of 52 cases (5.8%) required an additional surgery after closed reduction. Patients had good functional outcomes (SST score of 8) with an excellent utility index of EQ-5D-5L (0.9).
CONCLUSION
This new classification exhibited good-to-excellent intra-and inter-rater reliabilities, with an ability to determine injury type. Type III seems to be linked to higher risk of fracture displacement and may require additional surgery.
LEVEL OF EVIDENCE
Level IV, Diagnostic Study.
Topics: Cross-Sectional Studies; Female; Fracture Fixation, Internal; Humans; Male; Middle Aged; Retrospective Studies; Shoulder; Shoulder Dislocation; Shoulder Fractures
PubMed: 35943077
DOI: 10.5152/j.aott.2022.21316 -
Orthopaedic Surgery Aug 2023In complicated Neer three- and four-part proximal humerus fracture (PHF), greater tuberosity (GT) fragments are often comminuted, and the currently widely used locking...
OBJECTIVE
In complicated Neer three- and four-part proximal humerus fracture (PHF), greater tuberosity (GT) fragments are often comminuted, and the currently widely used locking plate may not fix GT fragments effectively. A further understanding of morphological characteristics of the GT fragments may help explore new fixation devices. This study aimed to determine the fracture line morphology of the GT fragment of Neer three- or four-part PHF and analyze the location relationship between the locking plate and the GT fragment.
METHODS
Seventy-one three-dimensional computed tomography scans of Neer three- and four-part PHF were retrospectively reviewed between January 2014 and June 2019. Fracture fragments were reconstructed and virtually reduced in the Mimics software, and fracture lines of GT fragments were depicted on a humerus template in the 3-matic software and then were superimposed altogether. The common sites of the GT fracture were identified, and the location relationship between the locking plate and GT fragments was analyzed in a computer-simulated scenario.
RESULTS
The fracture line morphology of GT fragments was similar between Neer three- and four-part PHF. The overall morphology of GT fragments was in a fan shape, which could be summarized as anterior, superior, posterior, and middle lines. Of these, we identified 51 split and 29 avulsion type GT fragments based on the Mutch classification, and they could occur simultaneously in a PHF. The overall morphology of split type fragments was in a fan shape, and avulsion type fragments showed a quite distinguishable distribution pattern. A GT fragment could be classified as anterior-split, posterior-split, complete-split, anterior -avulsion, and posterior-avulsion type based on its morphology and location. The median percentage of fragment area covered by the plate was 32.3% in all of the fragments, and it was 69.4%, 23.0%, 37.2%, 21.8%, 0.0% in anterior-split, posterior-split, complete-split, anterior-avulsion, and posterior-avulsion type GT fragments. We defined the posterior-split, anterior-avulsion, and posterior-avulsion type GT fragments as the risky GT fragments, and they occurred in 43 (60.6%) Neer three- and four-part PHFs.
CONCLUSION
The fracture line morphology of GT fragments of Neer three- and four-part PHF was in a fan shape. GT fragments could be classified based on their location and morphology. The extent of GT fragment coverage provided by the locking plate differed in various fragment types, and we identified the anterior-avulsion, posterior-avulsion, and posterior-split type fragments as the risky GT fragments with a high incidence rate in Neer three- and four-part PHFs.
Topics: Humans; Retrospective Studies; Fracture Fixation, Internal; Shoulder Fractures; Tomography, X-Ray Computed; Humerus; Bone Plates; Humeral Fractures
PubMed: 36274213
DOI: 10.1111/os.13523 -
Acta Bio-medica : Atenei Parmensis Mar 2022Bony Mallet Finger or Mallet Fracture is a common injury of the hand, which follows a forced flexion of the extended distal interphalangeal joint, that leads to a bony...
BACKGROUND AND AIM
Bony Mallet Finger or Mallet Fracture is a common injury of the hand, which follows a forced flexion of the extended distal interphalangeal joint, that leads to a bony avulsion of the distal phalanx. Depending on fracture extension and dislocation, those lesions can either be treated conservatively or surgically. Several surgical options have been described in the literature. The aim of this study is to compare retrospectively two percutaneous pinning techniques: the extension block technique according to Ishiguro vs an original single Kirshner wiring (Umbrella technique).
METHODS
Between January 1998 and December 2019, among all patients treated surgically for a Mallet Fracture with either the Ishiguro' and the Umbrella technique, 98 have been included in this study. All patients have been assessed one year after surgery using the Crawford method.
RESULTS
With both techniques better results have been achieved in younger patients and for those treated early. The umbrella technique seems to have better results in patients with fracture classified as 2b or 2c (Wehbe and Schneider classification), whereas the Ishiguro technique seems more appropriate for patients with a 1b fracture. Complication rate and typology vary depending on the used technique.
CONCLUSIONS
The Ishiguro' and the Umbrella technique both lead to good results for the treatment of surgical Mallet Fractures. The choice of the best type of pinning should mainly depend on fracture extension and time elapsed from trauma.
Topics: Bone Wires; Finger Injuries; Finger Phalanges; Fracture Fixation, Internal; Fractures, Bone; Hand Deformities, Acquired; Humans; Retrospective Studies; Tendon Injuries; Treatment Outcome
PubMed: 35604272
DOI: 10.23750/abm.v92iS3.12484 -
Medicine Aug 2019Tibial tubercle avulsion fracture caused by knee extensor is very rare; furthermore, non-traumatic fractures during running or bilateral fractures have been reported.... (Observational Study)
Observational Study
Tibial tubercle avulsion fracture caused by knee extensor is very rare; furthermore, non-traumatic fractures during running or bilateral fractures have been reported. The purpose of this study was to evaluate any differences according to the mechanisms of injury in adolescents with tibial tubercle avulsion fracture.Thirty patients with tibial tubercle avulsion fractures were reviewed and the average age was 13 years 1 month. Seven patients (low-stress group) had a spontaneous fracture during running without definite trauma. Twenty-three patients (high-stress group) experienced pain during jumping and landing, or definite trauma. The mechanisms of injury, age, height, weight, body mass index (BMI), BMI percentile, fracture type, as well as any complication, such as limitation of motion and deformity related to the physeal arrest, were compared between groups.There was no definite difference in age, fracture type, and surgical outcomes between groups. There was no patient with significant early physeal arrest in both groups. The weight (P = .02), BMI (P = .03) and BMI percentile (P = .01) in low-stress group were higher than those in high-stress group. In low-stress group, 6 patients' BMIs were in the 97th percentile, and 1 patient's BMI was in the 5th percentile.Extreme BMI may be a risk factor for tibial tubercle avulsion fractures in adolescents during running without definite trauma. However, there was no difference in the final outcome according to injury mechanisms.
Topics: Adolescent; Athletic Injuries; Body Mass Index; Child; Female; Fracture Fixation, Internal; Fractures, Avulsion; Humans; Male; Radiography; Retrospective Studies; Risk Factors; Tibial Fractures
PubMed: 31393372
DOI: 10.1097/MD.0000000000016700 -
The Journal of International Medical... Apr 2020We aimed to present the radiographic and functional outcomes of anatomical reduction and fixation of anterior inferior tibiofibular ligament (AITFL) avulsion fracture...
OBJECTIVE
We aimed to present the radiographic and functional outcomes of anatomical reduction and fixation of anterior inferior tibiofibular ligament (AITFL) avulsion fracture without syndesmotic screw fixation in rotational ankle fracture.
METHODS
We retrospectively reviewed 66 consecutive patients with displaced malleolar fracture combined with AITFL avulsion fracture. We performed reduction and fixation for the AITFL avulsion fracture when syndesmotic instability was present after malleolar fracture fixation. A syndesmotic screw was inserted only when residual syndesmotic instability was present even after AITFL avulsion fracture fixation. The radiographic parameters were compared with those of the contralateral uninjured ankles. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores were assessed 1 year postoperatively.
RESULTS
Fifty-four patients showed syndesmotic instability after malleolar fracture fixation and underwent reduction and fixation for AITFL avulsion fracture. Among them, 45 (83.3%) patients achieved syndesmotic stability, while 9 (16.7%) patients with residual syndesmotic instability needed additional syndesmotic screw fixation. The postoperative radiographic parameters were not significantly different from those of the uninjured ankles. The mean AOFAS score was 94.
CONCLUSION
Reduction and fixation of AITFL avulsion fracture obviated the need for syndesmotic screw fixation in more than 80% of patients with AITFL avulsion fracture and syndesmotic instability.
Topics: Ankle Fractures; Bone Screws; Fracture Fixation, Internal; Fractures, Avulsion; Humans; Lateral Ligament, Ankle; Retrospective Studies; Treatment Outcome
PubMed: 31885342
DOI: 10.1177/0300060519882550 -
Journal of Wrist Surgery Dec 2019Using three-dimensional (3D) computed tomography models of acute scaphoid fractures, we looked for differences between volumetric size of the fracture fragments,...
Using three-dimensional (3D) computed tomography models of acute scaphoid fractures, we looked for differences between volumetric size of the fracture fragments, recognizable groups, or a shared common fracture area. We studied 51 patients with an adequate computed tomography scan of an acute scaphoid fracture using 3D modeling. Fracture surfaces were identified and fragment volumetric size of the fracture fragments was measured. A principal component analysis was used to find groups. Density mapping was used to image probable common fracture areas in the scaphoid. Forty-nine of 51 fractures had a similar pattern. It was not possible to identify subgroups based on fracture pattern. The mean volumetric size of the fracture fragments of the proximal (1.45 cm ± 0.49 cm standard deviation [SD]) and distal fracture fragments (1.53 cm ± 0.48 cm SD) was similar. There was a single common fracture area in the middle third of the bone. In the distal third, there were no horizontal fractures through-but only directly proximal to-the tubercle suggesting that these would be best classified as distal waist fractures. Acute scaphoid fractures mainly occur in the middle third of the bone and tend to divide the scaphoid in half by volumetric size of the fracture fragments. There were two distinct grouping patterns: fractures through the proximal and middle third were horizontal oblique, whereas fractures of the distal third were vertical oblique. It seems that scaphoid fractures might be classified into proximal pole fractures, a range of waist fractures, and tubercle avulsion fractures. This is a Level IV study.
PubMed: 31815056
DOI: 10.1055/s-0039-1693050