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In Vivo (Athens, Greece) 2020Isolated fractures of the lesser trochanter (LT) of adults are rare and most of them are pathologic fractures due to an underlying malignancy. The aim of our study was... (Review)
Review
BACKGROUND/AIM
Isolated fractures of the lesser trochanter (LT) of adults are rare and most of them are pathologic fractures due to an underlying malignancy. The aim of our study was to provide comprehensive information on the epidemiology, etiology, diagnostic approach, and treatment algorithm of adult LT fractures.
PATIENTS AND METHODS
We present the cases of six patients who were treated for isolated LT fractures between November 2010 and May 2019. A literature review was performed to identify adult LT fracture cases in previous studies.
RESULTS
In two patients, the LT fracture was the first manifestation of the underlying tumors. Through a literature review, we identified 32 adults with isolated LT fractures. Among these, 27 were pathologic fractures. In 11 pathologic fractures, LT avulsion was the first manifestation of malignancy.
CONCLUSION
Metastasis and the first manifestation of an underlying malignancy should be suspected in adult patients with isolated LT fracture. A stepwise approach can prevent misdiagnosis and offer rational treatment modality.
Topics: Adult; Femur; Fractures, Avulsion; Hip Fractures; Humans
PubMed: 33144462
DOI: 10.21873/invivo.12193 -
Clinics in Sports Medicine Apr 2021Pelvic avulsion fractures are common in youth athletes; many of these injuries can be treated conservatively. This article reviews the etiology, presentation, and... (Review)
Review
Pelvic avulsion fractures are common in youth athletes; many of these injuries can be treated conservatively. This article reviews the etiology, presentation, and management of the more common pelvic avulsion fractures, including anterior superior iliac spine, anterior inferior iliac spine, ischial tuberosity, and iliac crest avulsions. Adolescent pelvic avulsion fractures rely on the amount of fracture displacement to guide treatment. Conservative management includes rest and avoiding use of the muscle(s) that attach to the avulsed fragment. Operative treatment is reserved for widely displaced fractures or symptomatic nonunions. With appropriate treatment, young athletes frequently return to their same level of sport.
Topics: Adolescent; Athletes; Athletic Injuries; Conservative Treatment; Fracture Fixation, Internal; Fractures, Avulsion; Fractures, Bone; Humans; Ilium; Ischium; Pelvis
PubMed: 33673893
DOI: 10.1016/j.csm.2020.12.002 -
The Journal of Foot and Ankle Surgery :... 2018Avulsion fractures of the calcaneal tuberosity are predominantly seen in patients with poor bone quality, the commonly used lag screw fixation might not be strong enough... (Review)
Review
Avulsion fractures of the calcaneal tuberosity are predominantly seen in patients with poor bone quality, the commonly used lag screw fixation might not be strong enough even with bony fragments of sufficient size. We present a case of a closed displaced avulsion fracture of the calcaneal tuberosity due to blunt trauma to the calf in a 74-year-old female. Open reduction and internal fixation with two 3.5-mm cannulated cortical screws with washers was performed, and anatomic reduction was achieved. Without further trauma, secondary displacement of the fracture occurred on day 3. Revision was performed with a single 3.5-mm cortical screw and transosseous fixation with 2 suture anchors, followed by partial weightbearing for 6 weeks. At 12 weeks postoperative, the fracture had completely healed, and she was doing well at 16 months after the revision surgery. Transosseous suture anchor fixation of an osteoporotic avulsion fracture of the calcaneal tuberosity seems to provide better and stronger fixation than that using lag screws.
Topics: Aged; Bone Screws; Calcaneus; Female; Follow-Up Studies; Fracture Dislocation; Fracture Fixation, Internal; Fracture Healing; Fractures, Avulsion; Humans; Postoperative Complications; Radiography; Reoperation; Suture Anchors; Treatment Outcome
PubMed: 29153287
DOI: 10.1053/j.jfas.2017.07.016 -
Medicina (Kaunas, Lithuania) Aug 2023Isolated tibial tuberosity avulsion fractures are exceptionally uncommon among adults, with limited instances documented in published literature. Here, we describe a... (Review)
Review
Isolated tibial tuberosity avulsion fractures are exceptionally uncommon among adults, with limited instances documented in published literature. Here, we describe a case of an isolated tibial tuberosity avulsion fracture in an adult that was treated successfully with the suture bridge repair technique. A 65-year-old female visited the outpatient department with left knee pain after a slip and fall. Lateral radiographs and sagittal MR images of the left knee revealed the tibial tuberosity avulsion fracture, but the fracture line did not extend into the knee joint space. Surgical intervention was performed on the patient's knee using an anterior midline approach, involving open reduction and internal fixation. The avulsed tendon was grasped and pulled, and an appropriate suture location was identified. Using a suture hook, the suture was guided through the patellar tendon as near to its uppermost point of the fragment as achievable, and tied over tendon. A single suture limb from each anchor was fastened over the tibial tuberosity to the distally positioned foot print anchor, effectively anchoring the tibial tuberosity using the suture bridge technique. The patient started walking on crutches after one week and was able to walk independently with a brace after two weeks from the operation day. After three months, the patient had regained her mobility to the level prior to the injury and exhibited painless active range of motion from 0 to 130 degrees. Hardware positioning and bony union were maintained at the one-year follow-up. In our case, the open suture bridge fixation method for tibial tuberosity avulsion fractures produced satisfactory results. Open suture bridge fixation may be considered for isolated tibial tuberosity avulsion fractures in adults, especially when the avulsion tip is too small for screw fixation.
Topics: Humans; Adult; Female; Aged; Fractures, Avulsion; Neurosurgical Procedures; Tibial Fractures; Lower Extremity; Sutures
PubMed: 37763684
DOI: 10.3390/medicina59091565 -
The Journal of Emergency Medicine Dec 2021
Topics: Fractures, Avulsion; Fractures, Bone; Humans; Ilium; Ligaments
PubMed: 34535305
DOI: 10.1016/j.jemermed.2021.07.059 -
The American Journal of Sports Medicine Aug 2017The Segond fracture was classically described as an avulsion fracture of the anterolateral capsule of the knee. Recently, some authors have attributed its pathogenesis...
BACKGROUND
The Segond fracture was classically described as an avulsion fracture of the anterolateral capsule of the knee. Recently, some authors have attributed its pathogenesis to the "anterolateral ligament" (ALL). Biomechanical studies that have attempted to reproduce this fracture in vitro have reported conflicting findings.
PURPOSE
To determine the anatomic characteristics of the Segond fracture on plain radiographs and magnetic resonance imaging (MRI), to compare this location with the location of the ALL described in prior radiographic and anatomic publications, and to determine the fracture's attachments to the soft tissue anterolateral structures of the knee.
STUDY DESIGN
Case series; Level of evidence, 4.
METHODS
A total of 36 anterior cruciate ligament-injured patients with Segond fractures (33 male, 3 female; mean age, 23.2 ± 8.4 years) were enrolled. MRI scans were reviewed to determine the anatomic characteristics of the Segond fracture, including the following: proximal-distal (PD) length, anterior-posterior (AP) width, medial-lateral (ML) width, PD distance to the lateral tibial plateau, AP distance to the Gerdy tubercle (GT), and AP distance from the GT to the posterior aspect of the fibular head. The attachment of the anterolateral structures to the Segond fragment was then categorized as the iliotibial band (ITB) or anterolateral capsule. Interrater reliability of the measurements was determined by calculating the Spearman rank correlation coefficient. MEDLINE, Web of Science, and the Cochrane Library were searched from inception to May 2016 for the following keywords: (1) "Segond fracture," (2) "anterolateral ligament," (3) "knee avulsion," (4) "lateral tibia avulsion," and (5) "tibial plateau avulsion." All studies describing the anatomic location of the Segond fracture and the ALL were included in the systematic review.
RESULTS
On plain radiographs, the mean distance of the midpoint of the fracture to the lateral tibial plateau was 4.6 ± 2.2 mm. The avulsed fracture had a mean PD length of 9.2 ± 2.5 mm and a mean ML width of 2.4 ± 1.4 mm. On MRI, the mean distance of the proximal fracture to the tibial plateau was 3.4 ± 1.6 mm. The mean PD length was 8.7 ± 2.2 mm, while the mean AP width was 11.1 ± 2.2 mm. The mean distance between the GT and the center of the fracture was 26.9 ± 3.3 mm, while the mean distance between the GT and the posterior fibular head was 53.9 ± 4.4 mm. The mean distance of the midpoint of the fracture to the tibial plateau was 7.8 ± 2.7 mm, while the center of the fracture was 49.9% of the distance between the GT and the posterior aspect of the fibular head. Analysis of soft tissue structures attached to the fragment revealed that the ITB attached in 34 of 36 patients and the capsule attached in 34 of 36 patients. One patient had only the capsule attached, another had only the ITB attached, and the last showed neither clearly attached. A literature review of 20 included studies revealed no difference between the previously described Segond fracture location and the tibial insertion of the ALL.
CONCLUSION
The results of this study confirmed that while the Segond fracture occurs at the location of the tibial insertion of the ALL, as reported in the literature, MRI was unable to identify any distinct ligamentous attachment. MRI analysis revealed that soft tissue attachments to the Segond fracture were the posterior fibers of the ITB and the lateral capsule in 94% of patients.
Topics: Adolescent; Adult; Anterior Cruciate Ligament; Female; Fractures, Avulsion; Humans; Knee Injuries; Magnetic Resonance Imaging; Male; Radiography; Tibial Fractures; Young Adult
PubMed: 28499093
DOI: 10.1177/0363546517704845 -
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 -
Orthopaedics & Traumatology, Surgery &... Dec 2016The treatment of elbow injuries can be challenging because of the complexity of both anatomy and pathology. We present a rare traumatic avulsion fracture of the... (Review)
Review
Avulsion fracture of the supinator crest as an indication for a sustained posterolateral (sub)luxation of the elbow. A case report, anatomical evaluation and review of the literature.
The treatment of elbow injuries can be challenging because of the complexity of both anatomy and pathology. We present a rare traumatic avulsion fracture of the supinator crest of the ulna in a 37-year-old patient. Conservative treatment in a long arm cast for four weeks led to satisfactory results. Reproduction of the fracture on a cadaveric elbow clarified that the avulsed fragment holds the insertion of the lateral ulnar collateral ligament (LUCL). The mechanism of trauma that causes this fracture is a posterolateral (sub) luxation of the elbow, which usually causes the LUCL to rupture, but in rare cases the insertion of this ligament can be avulsed. A posterolateral (sub) luxation of the elbow can lead to chronic posterolateral rotational instability and therefore the stability of the elbow should be taken into account in the treatment of patients with such a fracture. A review of the literature concluded that this fracture often is associated with other injuries to the elbow and that it is easily missed on conventional AP and lateral radiographs. CT or MRI imaging and a radial head-capitellum view radiograph can be beneficial. Both conservative and operative treatments have been described with good clinical results.
Topics: Adult; Cadaver; Casts, Surgical; Collateral Ligaments; Elbow; Elbow Joint; Fractures, Avulsion; Humans; Joint Dislocations; Magnetic Resonance Imaging; Male; Ulna Fractures
PubMed: 27825706
DOI: 10.1016/j.otsr.2016.09.016 -
Fukuoka Igaku Zasshi = Hukuoka Acta... Jun 2015Avulsion fractures of the tibial tuberosity are uncommon injuries. A 16-year-old male sustained injuries to his right knee joint after jumping from stairs and landed on... (Review)
Review
Avulsion fractures of the tibial tuberosity are uncommon injuries. A 16-year-old male sustained injuries to his right knee joint after jumping from stairs and landed on his feet with his right knee forced into flexion. X-ray photographs showed a type III avulsion fracture of the tibial tuberosity. On the next day of the injury, open reduction and internal fixation, followed by arthroscopy was performed. The fracture fragment was fixed with three 5.0mm cannulated cancellous screws. The torn anterior portion of medial meniscus was repaired with 3-0 Polydioxanone (PDS) using outside-in sutures and the torn midportion of medial meniscus was repaired using the FasT-Fix meniscal repair system. Eight months after the injury, removal of the screws and arthroscopy were undertaken. The medial meniscus was completely healed. The range of motion was full at the knee joint. Meniscal suture should be strongly considered for type III avulsion fractures of the tibial tuberosity in adolescents.
Topics: Adolescent; Bone Screws; Fracture Fixation, Internal; Humans; Magnetic Resonance Imaging; Male; Menisci, Tibial; Tibial Fractures; Treatment Outcome
PubMed: 26306386
DOI: No ID Found