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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 -
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 -
Injury Jul 2021To compare the clinical effects of an inverted L-shaped postero-medial approach with a homemade hook plate and arthroscopic fixation with Endobutton for tibial avulsion...
OBJECTIVE
To compare the clinical effects of an inverted L-shaped postero-medial approach with a homemade hook plate and arthroscopic fixation with Endobutton for tibial avulsion fractures of the posterior cruciate ligament.
METHODS
The clinical data of 36 patients with PCL tibial avulsion fractures from January 2012 to December 2019 were analyzed retrospectively. The fractures were classified into Meyers-McKeever types II and III. Among them, 20 cases were treated with a homemade hook plate through an inverted L-shaped postero-medial approach (incision group), and 16 cases were treated with Endobutton under arthroscopy (arthroscopic group). The operative time, fracture union time, operative complications and range of motion of the knee joint were compared between the two groups. The stability of the knee joint was tested by the posterior drawer test, the functional recovery of the knee joint was evaluated by the Lysholm score, and the gastrocnemius muscle strength of the incision group was tested by performing heel raises with a single leg stance.
RESULTS
There were no adverse events, such as fracture nonunion, infection, deep-vein thrombosis, abnormal hematoma or joint stiffness, in either group. The operative time was shorter in the incision group, and the difference was statistically significant (P < 0.05). There was no significant difference in fracture union time between the two groups (P > 0.05). At the last follow-up, there was no significant difference in range of motion or the Lysholm score between the two groups. There was no decrease in gastrocnemius muscle strength in the incision group.
CONCLUSIONS
The fixation of PCL tibial avulsion fractures with a homemade hook plate through an inverted L-shaped postero-medial approach is safe and effective. It showed almost the same satisfactory outcomes as arthroscopic Endobutton fixation.
Topics: Arthroscopy; Fracture Fixation, Internal; Fractures, Avulsion; Humans; Posterior Cruciate Ligament; Retrospective Studies; Suture Techniques; Tibial Fractures; Treatment Outcome
PubMed: 33934882
DOI: 10.1016/j.injury.2021.04.042 -
Journal of Orthopaedic Case Reports Dec 2021Lesser tuberosity avulsion fractures are rare and often missed. Patients often complain only of heaviness around the shoulder and some loss in range of motion.
INTRODUCTION
Lesser tuberosity avulsion fractures are rare and often missed. Patients often complain only of heaviness around the shoulder and some loss in range of motion.
CASE REPORT
This is a rare case of a lesser tuberosity avulsion fracture with displacement. The patient was a 29-year-old male who suffered an injury to the right shoulder due to a fall. Post-fall, the patient developed typical heaviness and restrictions in the range of motion of his right shoulder. Radiographs initially taken were not true anteroposterior (AP) views. The fracture was primarily missed by another surgeon, after which on opting for a true AP radiographs, the fracture was diagnosed. The fracture was managed by an open deltopectoral approach. Fracture fragment was reduced to its footprint and was fixed using 2 × 4.0 mm cancellous screws. Post-surgery, the patient was advised 3 weeks of immobilization after which mobilization was started. By monitored physiotherapy, consistent results can be obtained without loss of reduction. In this case too, full ranges with strength were achieved by 3 months postoperatively.
CONCLUSION
Such fractures often missed may cause loss of external rotation movements in the patient and eventually malunion of the fragment if displaced. Watchfulness and timely management of the fractures can give excellent results. This case report aims at increasing the awareness among the budding shoulder surgeons in identifying such injuries at the earliest, and the means of managing them.
PubMed: 35415148
DOI: 10.13107/jocr.2021.v11.i12.2544 -
SICOT-J 2021Posterior Cruciate Ligaments injuries are rare in children and usually due to bony avulsion fractures or midsubstance tears. This study focused on cartilaginous...
Posterior Cruciate Ligaments injuries are rare in children and usually due to bony avulsion fractures or midsubstance tears. This study focused on cartilaginous avulsions initially misdiagnosed despite of MRI assessment. Two 6-year-old boys had cartilaginous avulsion fracture injury at the femoral attachment of the PCL. One had associated medial meniscal lesion and was reinserted. The other conducted to non-union. MRI second lecture reveals an original description with nail-biting sign on cartilage surface of anterior notch, and a close PCL angle without anterior tibial translation. No bone bruise was associated. Similarly, to ACL cartilaginous tibial avulsions, PCL cartilaginous femoral avulsions are underdiagnosed. When knee hemarthrosis occurs under the age of nine, clinician and radiologist should be aware that cartilaginous avulsion of ACL and PCL also could be the main pattern of lesion.
PubMed: 34797212
DOI: 10.1051/sicotj/2021052 -
Medicine May 2021Childhood obesity is a growing epidemic in the United States, and is associated with an increased risk of lower-extremity physeal fractures, and fractures requiring... (Comparative Study)
Comparative Study
Childhood obesity is a growing epidemic in the United States, and is associated with an increased risk of lower-extremity physeal fractures, and fractures requiring operative intervention. However, no study has assessed the risk upper extremity physeal fractures among overweight children. Our purpose was to compare the following upper-extremity fracture characteristics in overweight and obese children with those of normal-weight/underweight children (herein, "normal weight"): mechanism of injury, anatomical location, fracture pattern, physeal involvement, and treatment types. We hypothesized that overweight and obese children would be higher risk for physeal and complete fractures with low-energy mechanisms and would therefore more frequently require operative intervention compared with normal-weight children.We performed a cross-sectional review of our database of 608 patients aged 2 to 16 years, and included patients who sustained isolated upper-extremity fractures at our level-1 pediatric tertiary care center from January 2014 to August 2017. Excluded were patients who sustained pathologic fractures and those without basic demographic or radiologic information. Using body mass index percentile for age and sex, we categorized patients as obese (≥95th percentile), overweight (85th to <95th percentile), normal weight (5th to <85th percentile), or underweight (<5th percentile). The obese and overweight groups were analyzed both separately and as a combined overweight/obese group. Demographic data included age, sex, height, and weight. Fractures were classified based on fracture location, fracture pattern (transverse, comminuted, buckle, greenstick, avulsion, or oblique), physeal involvement, and treatment type. Of the 608 patients, 58% were normal weight, 23% were overweight, and 19% were obese. There were no differences in the mean ages or sex distributions among the 3 groups.Among patients with low-energy mechanisms of injury, overweight/obese patients had significantly greater proportions of complete fractures compared with normal-weight children (complete: 65% vs 55%, P = .001; transverse: 43% vs 27%, P = .006). In addition, the overweight/obese group sustained significantly more upper-extremity physeal fractures (37%) than did the normal-weight group (23%) (P = .007).Compared with those in normal-weight children, upper-extremity fracture patterns differ in overweight and obese children, who have higher risk of physeal injuries and complete fractures caused by low-energy mechanisms.Level of Evidence: Level III, retrospective comparative study.
Topics: Age Distribution; Bones of Upper Extremity; Child; Child, Preschool; Cross-Sectional Studies; Female; Fractures, Bone; Hospitals, Pediatric; Humans; Male; Pediatric Obesity; Retrospective Studies; Risk Factors; Sex Distribution; Tertiary Care Centers; United States
PubMed: 33950919
DOI: 10.1097/MD.0000000000025302 -
Medicine Sep 2023This study aimed to explore the postoperative outcomes of patients who underwent arthroscopic internal fixation with repositioning sutures for the treatment of posterior...
The degree of fracture reduction does not compromise the clinical efficacy of arthroscopic reduction and fixation of tibial posterior cruciate ligament avulsion fractures: A retrospective study.
This study aimed to explore the postoperative outcomes of patients who underwent arthroscopic internal fixation with repositioning sutures for the treatment of posterior cruciate ligament (PCL) avulsion fractures with poorly reduced fracture fragments. It was hypothesized that improperly repositioned fracture fragments might not influence the postoperative clinical outcomes in patients with PCL avulsion fractures treated by arthroscopic sutures. From January 2020 to December 2021, patients admitted to our hospital with PCL avulsion fractures were evaluated. Our inclusion criteria were as follows: diagnosis of PCL avulsion fracture as Meyers & McKeever Type II or Type III; underwent arthroscopic double tunnel suture fixation; and age below 70. Of the patients meeting these criteria, data from 34 individuals were collected by a designated follow-up officer. Based on postoperative imaging, the patients were divided into 2 groups: well fracture reduction and poor fracture reduction groups. Prior to the surgery, the Lysholm score, knee mobility, and international knee documentation committee (IKDC score) were recorded for both groups. At the 3-month post-surgery mark, CT-3D reconstruction was performed. Statistical analysis was conducted on the collected data. For data that conformed to a normal distribution, the t test was applied. For data that didn't conform, we used a non-parametric test. Both groups achieved successful wound healing without encountering any adverse events, such as fracture nonunion infection. Fracture healing was observed in both groups at the 3-month postoperative mark. The average follow-up duration was 13.24 ± 6.18 months. There were no significant differences in Lysholm score, IKDC score, or knee mobility between the well- and poorly-reduced groups at the final follow-up (P > .05). Postoperatively, both groups demonstrated significant improvements in knee function compared to the preoperative scores, with statistically significant differences observed in Lysholm score, IKDC score, and knee mobility (P < .05). Arthroscopic fixation with double-tunnel sutures proved to be a highly effective treatment approach for PCL avulsion fractures, even in cases where the fractures were poorly reduced. Remarkably, there were no significant differences observed in postoperative knee function between the well- and poorly-reduced groups, indicating that both groups achieved favorable outcomes.
Topics: Humans; Posterior Cruciate Ligament; Fractures, Avulsion; Retrospective Studies; Knee Joint; Tibial Fractures; Treatment Outcome; Fracture Fixation, Internal; Arthroscopy; Suture Techniques
PubMed: 37773785
DOI: 10.1097/MD.0000000000035356 -
OTA International : the Open Access... Jun 2020Ankle fracture treatment involves reduction of the bone fragments and stabilization of the joint by reversing the mechanics of injury. For posterior malleolar fracture...
OBJECTIVES
Ankle fracture treatment involves reduction of the bone fragments and stabilization of the joint by reversing the mechanics of injury. For posterior malleolar fracture however, the true mechanism is not understood, leading to a lack of consistent guidance on how to best treat this injury.
METHODS
Fifteen cadaver ankles were subjected to fracture loading that replicated the Lauge-Hansen pronation-external rotation mechanism. An axial load was applied to each specimen, which was mounted on a materials testing machine, and the foot was rotated externally to failure. Digital video cameras recorded the failure sequence of specific anatomic structures.
RESULTS
Posterior malleolar fracture occurred in 7 specimens. Of these, 1 was an intra-articular fracture, another was a fracture involving the entire posterior tibial margin consisting of 2 fragments: that of the posterior tubercle and that of the posteromedial margin of the tibial plafond, with the former judged to be a consequence of avulsion by the posterior inferior tibiofibular ligament and the latter a consequence of axial loading from the talus. In the remaining 5 specimens, the posterior malleolar fracture was a small extra-articular avulsion fracture.
CONCLUSIONS
Fractures at the posterolateral corner of the distal tibia were shown to be avulsion fractures attributed to the posterior inferior tibiofibular ligament and produced by external rotation of the talus. A fracture involving the entire posterior tibial margin consisting of 2 fragments can be produced by a combination of avulsion by the posterior inferior tibiofibular ligament and axial loading from the talus.
PubMed: 33937695
DOI: 10.1097/OI9.0000000000000060 -
Orthopaedic Surgery Nov 2022The patella's inferior pole transmits force generated by contraction of the quadriceps muscle to the tibial tuberosity through the attached patellar ligament, thus... (Review)
Review
The patella's inferior pole transmits force generated by contraction of the quadriceps muscle to the tibial tuberosity through the attached patellar ligament, thus completing knee extension. Therefore, fractures of the patella's inferior pole disrupt the coherence of mechanical transmission in the lower extremities. There appears to be no consensus among trauma centers regarding the treatment of infrapatellar pole fractures, primarily because there is no consistent design or application of internal fixation for this type of fracture. We designed a new internal implant similar to the smile necklace based on our previous study. This smile-necklace plate (SNP) has the advantage of both plate fixation and tension-band wiring fixation, permitting early rehabilitation, especially in osteoporotic comminuted infrapatellar pole fractures. Finite element analysis helped verify the biomechanical advantages of the SNP in comparison with existing studies. Hence, this novel implant is a promising treatment option for inferior pole patellar fractures.
Topics: Humans; Patella; Bone Wires; Fractures, Avulsion; Bone Plates; Fracture Fixation, Internal; Fractures, Comminuted; Fractures, Bone
PubMed: 36125193
DOI: 10.1111/os.13490 -
Frontiers in Surgery 2022Avulsion fracture of the anterior tibia with proximal fibular fracture commonly occurs in Maisonneuve fracture, which generally involves ankle instability and requires...
BACKGROUND
Avulsion fracture of the anterior tibia with proximal fibular fracture commonly occurs in Maisonneuve fracture, which generally involves ankle instability and requires surgical correction. Nonoperative treatment of this type of fracture has been rarely reported in the literature.
CASE PRESENTATION
A 48-year-old male reported pain in the lateral part of his left lower leg and ankle during a badminton play. Physical examination revealed tenderness and swelling of the lateral aspects of the left ankle, as well as the proximal aspect of the fibula. Preoperative plain x-ray image, computed tomography, and magnetic resonance imaging revealed an avulsion fracture of the anterior tibia by the anterior inferior tibiofibular ligament without medial and posterior fracture, rupture of the deltoid ligament, or interosseous membrane. Nonoperative management was performed and successful recovery was observed at a 6-month follow-up.
CONCLUSIONS
Nonoperative management can be a better option for some variations of Maisonneuve fracture with a stable ankle joint. The selection of treatment options should be based on careful examination and radiological evaluation of the ankle.
PubMed: 36684214
DOI: 10.3389/fsurg.2022.959008