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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 -
Knee Surgery, Sports Traumatology,... Jun 2021To compare outcome of operative and non-operative treatment of avulsion fractures of the hamstring origin, with minor (< 1.5 cm) and major (≥ 1.5 cm)...
Satisfactory clinical outcome of operative and non-operative treatment of avulsion fracture of the hamstring origin with treatment selection based on extent of displacement: a systematic review.
PURPOSE
To compare outcome of operative and non-operative treatment of avulsion fractures of the hamstring origin, with minor (< 1.5 cm) and major (≥ 1.5 cm) displacement, and early (≤ 4 weeks) and delayed (> 4 weeks) surgery.
METHODS
A systematic literature search was performed using PubMed, Cochrane, Embase, CINAHL and SPORTDiscus. A quality assessment was performed using the Physiotherapy Evidence Database (PEDro) scale.
RESULTS
Eight studies with 90 patients (mean age: 16 years) were included. All studies had low methodological quality (PEDro score ≤ 5). Operative treatment yielded a return to preinjury activity rate (RTPA) of 87% (95% CI: 68-95), return to sports (RTS) rate of 100% (95% CI: 82-100), Harris hip score (HHS) of 99 (range 96-100) and a University of California Los Angeles activity scale (UCLA) score of 100%. Non-operative treatment yielded a RTPA rate of 100% (95% CI:68-100), RTS rate of 86% (95% CI: 69-94), HHS score of 99 (range 96-100), and non-union rate of 18% (95% CI: 9-34). All patients with minor displacement were treated non-operatively (RTPA: 100% [95% CI: 21-100], RTS: 100% [95% CI: 51-100]). For major displacement, operative treatment led to RTPA and RTS rates of 86% (95% CI: 65-95) and 100% (95% CI: 84-100), and 0% (0/1, 95% CI: 0-79) and 100% (95% CI: 51-100) for non-operative treatment. Early surgery yielded RTPA and RTS rates of 100% (95% CI: 34-100 & 57-100) compared to 100 (95% CI: 72-100) and 90% (95% CI: 60-98) for delayed repair.
CONCLUSION
All included studies have high risk of bias. There is only low level of evidence with a limited number of included patients to compare outcome of operative and non-operative treatment. Overall outcome was satisfactory. There is a treatment selection phenomenon based on displacement, with acceptable outcome in both groups. There is insufficient data to draw conclusions regarding timing of surgery.
LEVEL OF EVIDENCE
IV.
Topics: Adolescent; Adult; Athletic Injuries; Female; Fractures, Avulsion; Hamstring Muscles; Humans; Lysholm Knee Score; Male; Orthopedic Procedures; Return to Sport; Treatment Outcome; Young Adult
PubMed: 32809117
DOI: 10.1007/s00167-020-06222-y -
Plastic and Reconstructive Surgery.... Jan 2020Nail bed and fingertip injuries are the commonest hand injuries in children and can lead to profound functional and cosmetic impairments if not appropriately managed.... (Review)
Review
UNLABELLED
Nail bed and fingertip injuries are the commonest hand injuries in children and can lead to profound functional and cosmetic impairments if not appropriately managed. Fingertip injuries can present with subungual hematomas, simple or stellate lacerations, crush, or avulsion injuries, often with associated fractures or tip amputations. The fundamentals of managing nail bed injuries concern restoring the form and function of a painless fingertip. However, there are controversies surrounding the optimal management of each of these injuries, which has led to nonuniformity of clinical practice.
METHODS
The PubMed database was searched from March 2001 to March 2019, using a combination of MeSH terms and keywords. Studies evaluating children (<18 years of age) and the fingertip (defined as distal to the distal interphalangeal joint) were included following screening by the authors.
RESULTS AND CONCLUSION
The evidence base for the diverse clinical management strategies currently employed for fingertip injuries in the pediatric population is limited. Further studies yielding level I data in this field are warranted.
PubMed: 32095403
DOI: 10.1097/GOX.0000000000002595 -
Foot and Ankle Surgery : Official... Dec 2020The first descriptions on medial talar tubercle fractures are attributed to Cedell. He described avulsion fractures of the insertion of the posterior talotibial...
PURPOSE
The first descriptions on medial talar tubercle fractures are attributed to Cedell. He described avulsion fractures of the insertion of the posterior talotibial ligament. However the true etiology has not been established. Since little is known about these fractures, they are easily misdiagnosed as simple ankle sprains. Untreated, these fractures may lead to chronic ankle pain. To improve the understanding of the etiology and outcome of these fractures a systematic review was conducted of all cases of isolated fractures of the medial tubercle of the posterior talar process. In addition we present the first series of competitive athletes treated by means of the two-portal hindfoot approach for isolated medial talar tubercle fractures.
METHODS
A systematic search was performed to identify all cases of medial tubercle fractures. Data on trauma mechanism, clinical presentation, imaging and treatment were extracted. In addition we retrospectively report on the results of endoscopically treated patients in our institution over the last fifteen years. Of all patients Numeric Rating Scores (NRS) for Satisfaction, Pain and Function, Foot Ankle Outcome Scores (FAOS), return to sport and complications were reported.
RESULTS
Eightteen articles were included reporting on 33 patients with an isolated fracture or avulsion of the posteromedial talar process. Most of the fractures occurred during sport activities (58%), followed by motor vehicle accidents (21%) and fall from height (12%). Of the activities during sport, 73% resulted following an ankle sprain. Reasonable to good outcomes are described in cases treated with immobilization, open reduction internal fixation or open excision. Of the nine patients treated in our institution, five were male and the median age was 29. All were participating in sports at a competitive level, with four of them being a professional athlete. In most patients the diagnosis was made more than a year after initial trauma. Ankle sprain was most common trauma mechanism. In some patients it was evident the avulsion was part or the deep portion of the deltoid ligament, however in two cases it was more likely an avulsion of the flexor hallucis longus (FHL) retinaculum. The median follow-up was 69 months (IQR 12.0-94.3). At final follow-up patients had little pain, NRS 1. Median NRS for satisfaction and function were 7 and 8, respectively. All patients did resume sport activities, however only four reached the preinjury level. Of the five patients that did not return to their pre-injury level of activity, two were professional athletes at the end of their career, and retired not due to ankle complaints. One complication was reported.
CONCLUSION
Fractures of the medial tubercle are rare and based on the available literature there is not one distinct trauma mechanism. Based on literature no recommendation for treatment can be made. Our results show endoscopic excision of the fragment as a save alternative for open surgical treatment.
Topics: Adolescent; Adult; Ankle Injuries; Athletic Injuries; Endoscopy; Female; Fracture Fixation, Internal; Humans; Intra-Articular Fractures; Male; Middle Aged; Retrospective Studies; Talus; Treatment Outcome; Young Adult
PubMed: 31926849
DOI: 10.1016/j.fas.2019.12.003 -
Journal of the American Dental... Aug 2019Dental trauma injuries are frequent in children and adolescents and can result in a sequela of future complications. Lateral luxation injuries are diagnosed when a tooth...
BACKGROUND
Dental trauma injuries are frequent in children and adolescents and can result in a sequela of future complications. Lateral luxation injuries are diagnosed when a tooth becomes displaced in a position other than axial and is often associated with alveolar bone fracture. Although the tooth is not immediately lost, pulp canal obliteration or pulpal necrosis can occur. The objective of this systematic review was to gather existing data on lateral luxation injuries to mature teeth to evaluate their overall prognosis and reported complications.
TYPES OF STUDIES REVIEWED
The authors conducted a systematic search of the literature using MEDLINE, PubMed, Embase, and Cochrane databases in February 2019. They hand searched reference lists to identify additional literature. The authors included prospective and retrospective observational studies in the search. They screened a total of 291 articles, downloaded 28 articles, and included 4 articles in the study.
RESULTS
The most frequent complication reported for mature teeth with lateral luxation was pulpal necrosis (44.2%). Less frequent findings included surface resorption (14.0%), inflammatory resorption (8.5%), pulp canal obliteration (8.1%), and replacement resorption (0.9%). The included studies were cohort studies, which resulted in great heterogeneity, and the authors could not attempt a meta-analysis.
CONCLUSIONS AND PRACTICAL IMPLICATIONS
A large number of permanent teeth that experience lateral luxation are at risk of developing pulpal necrosis and other complications. Careful follow-up is required for these patients to treat complications as early as possible. Furthermore, the authors of this systematic review emphasize the importance of consistent reporting of dental trauma outcomes.
Topics: Adolescent; Child; Dental Pulp Necrosis; Humans; Prognosis; Prospective Studies; Retrospective Studies; Tooth Avulsion
PubMed: 31176453
DOI: 10.1016/j.adaj.2019.03.001 -
Acta Bio-medica : Atenei Parmensis Oct 2018ring avulsion are relatively common hand lesions and are associated with significant disability, especially in hand-workers. The treatment choice is still debatable. We...
BACKGROUND AND AIM OF THE WORK
ring avulsion are relatively common hand lesions and are associated with significant disability, especially in hand-workers. The treatment choice is still debatable. We sought to conduct a detailed systematic review in attempt to collate evidence on functional, cosmetic and patient-reported outcomes (PROs) following ray amputation for the management of traumatic hand injury and ring avulsion injury.
METHODS
using the PubMed database we made a systematic search for articles regarding single ray amputation after traumatic hand lesion. Nine articles met our including criteria and were analysed.
RESULTS
most of the included studies suggest that for those worse cases ray amputation still represent a good option. Indeed ray resection can eliminate the gap, remove a cumbersome or painful digit and guarantes better cosmesis but reduces grip and pinch strength (from 15% to 30%) and decreased palm width.
CONCLUSIONS
different surgical techniques are available, almost all of them results in a loss of strength but ensure good both functional and cosmetic results.
Topics: Amputation, Surgical; Amputation, Traumatic; Degloving Injuries; Finger Injuries; Finger Phalanges; Fingers; Fractures, Bone; Hand Bones; Hand Injuries; Hand Strength; Humans; Ischemia; Jewelry; Recovery of Function
PubMed: 30714994
DOI: 10.23750/abm.v90i1-S.7677 -
Knee Surgery & Related Research Dec 2018To compare the clinical outcomes between the open posterior approach and arthroscopic suture fixation for displaced posterior cruciate ligament (PCL) avulsion fractures. (Review)
Review
PURPOSE
To compare the clinical outcomes between the open posterior approach and arthroscopic suture fixation for displaced posterior cruciate ligament (PCL) avulsion fractures.
METHODS
A literature search was performed on MEDLINE, EMBASE, and the Cochrane Library databases. The inclusion criteria were as follows: papers written in English on displaced PCL avulsion fractures, clinical trial(s) with clear description of surgical technique, adult subjects, a follow-up longer than 12 months and modified Coleman methodology score (CMS) more than 60 points.
RESULTS
Twelve studies were included with a mean CMS value of 72.4 (standard deviation, 7.6). Overall, 134 patients underwent the open posterior approach with a minimum 12-month follow-up, and 174 patients underwent arthroscopic suture fixation. At final follow-up, the range of Lysholm score was 85-100 for the open approach and 80-100 for the arthroscopic approach. Patients who were rated as normal or nearly normal in the International Knee Documentation Committee subjective knee assessment were 92%-100% for the open approach and 90%-100% for the arthroscopic approach. The range of side-to-side difference was 0-5 mm for both approaches.
CONCLUSIONS
Both arthroscopic and open methods for the treatment of PCL tibial-side avulsion injuries resulted in comparably good clinical outcomes, radiological healing, and stable knees.
PubMed: 30466249
DOI: 10.5792/ksrr.17.073 -
Journal of Investigative Surgery : the... Feb 2020The aim of this research is to perform a literature review of the treatments available for the anterior iliac spines avulsion fracture on the young subjects. : We...
The aim of this research is to perform a literature review of the treatments available for the anterior iliac spines avulsion fracture on the young subjects. : We performed a systematic literature search for studies on spines avulsion fractures in young subjects from January 1, 2013, to February 2018; abstracts were screened by a single reviewer. For those studies meeting the eligibility criteria, full-text articles were obtained. : From 112 studies found only six articles were included in this systematic review. All the studies belonged to level IV of scientific evidence. 64 patients suffered an anterior inferior iliac spine fracture while patients 36% patients suffered an anterior superior iliac spine fracture. 93.2% underwent conservative treatment and 6.8% underwent surgery. : The anterior iliac spine avulsions fractures are rare injuries that occur in young male athletes and the conservative option is the most selected treatment modality.
Topics: Adolescent; Age Factors; Athletes; Child; Conservative Treatment; Female; Fracture Fixation, Internal; Fractures, Avulsion; Humans; Ilium; Incidence; Male; Risk Factors; Sex Factors; Spinal Fractures; Treatment Outcome; Young Adult
PubMed: 30212230
DOI: 10.1080/08941939.2018.1483447 -
The Physician and Sportsmedicine Sep 2018to identify all studies of Karate injuries and assess injury rates, types, location, and causes.
OBJECTIVES
to identify all studies of Karate injuries and assess injury rates, types, location, and causes.
METHODS
Six electronic and four grey literature databases were searched. Two reviewers independently assessed titles/abstracts, abstracted data and assessed risk-of-bias with the Newcastle-Ottawa scale. Average injury rates/1000AE (AE = athletic-encounter) and/1000minutesAE, injury location and type weighted by study size were calculated.
RESULTS
In competitions rates of injury/1000AE and/1000 minutesAE were similar for males (111.4/1000AE, 75.4/1000 minAE) and females (105.8/1000AE, 72.8/1000 minAE). Location of injury rates/1000AE for males were 44.0 for head/neck, 11.9 lower extremities, 8.1 torso and 5.4 upper extremities and were similar for females: 41.2 head/neck, 12.4 lower extremities, 9.1 torso and 6.3 upper extremities. Injury rates varied widely by study. Rates/1000AE for type of injury were contusions/abrasions/lacerations/bruises/tooth avulsion for males (68.1) and females (30.4); hematomas/bleeding/epistaxis males (11.4) and females (12.1); strains/sprains males (3.5) and females (0.1); dislocations males (2.9) and females (0.9); concussions males (2.5) and females (3.9); and fractures males (2.9) and females (1.4). Punches were a more common mechanism of injury for males (59.8) than females (40.8) and kicks similar (males 19.7, females 21.7). Weighted averages were not calculated for weight class or belt colour because there were too few studies. Nineteen injury surveys reported annual injury rates from 30% to rates ten times higher but used different reporting methods. Studies provided no data to explain wide rate ranges.
CONCLUSIONS
Studies need to adopt one injury definition, one data-collection form, and collect comprehensive data for each study for both training and competitions. More data are needed to measure the effect of weight, age and experience on injuries, rates and types of injury during training, and for competitors with high injury rates. RCTs are needed of interventions such as training and feedback of performance data to reduce injury rates.
Topics: Athletic Injuries; Brain Concussion; Female; Fractures, Bone; Humans; Joint Dislocations; Lower Extremity; Male; Martial Arts; Risk Factors; Sprains and Strains; Upper Extremity
PubMed: 29737221
DOI: 10.1080/00913847.2018.1472510 -
Hand (New York, N.Y.) Sep 2017Triceps tendon ruptures (TTR) are an uncommon injury. The aim of this systematic review was to classify diagnostic signs, report outcomes and rerupture rates, and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Triceps tendon ruptures (TTR) are an uncommon injury. The aim of this systematic review was to classify diagnostic signs, report outcomes and rerupture rates, and identify potential predisposing risk factors in all reported cases of surgical treated TTR.
METHODS
A literature search collecting surgical treated cases of TTR was performed, identifying 175 articles, 40 of which met inclusion criteria, accounting for 262 patients. Data were pooled and analyzed focusing on medical comorbidities, presence of a fleck fracture on the preoperative lateral elbow x-ray film (Dunn-Kusnezov Sign [DKS]), outcomes, and rerupture rates.
RESULTS
The average age of injury was 45.6 years. The average time from injury to day of surgery was 24 days while 10 patients had a delay in diagnosis of more than 1 month. Renal disease (10%) and anabolic steroid use (7%) were the 2 most common medical comorbidities. The DKS was present in 61% to 88% of cases on the lateral x-ray film. Postoperatively, 89% of patients returned to preinjury level of activity, and there was a 6% rerupture rate at an average follow-up of 34.6 months. The vast majority (81%) of the patients in this review underwent repair via suture fixation.
CONCLUSIONS
TTR is an uncommon injury. Risks factors for rupture include renal disease and anabolic steroid use. Lateral elbow radiographs should be scrutinized for the DKS in patients with extension weakness. Outcomes are excellent following repair, and rates of rerupture are low.
Topics: Comorbidity; Delayed Diagnosis; Humans; Kidney Diseases; Recovery of Function; Recurrence; Rupture; Suture Anchors; Sutures; Tendon Injuries; Testosterone Congeners; Time-to-Treatment; Upper Extremity
PubMed: 28832209
DOI: 10.1177/1558944716677338