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Acute Medicine & Surgery 2024Traumatic pneumocephalus is commonly encountered after basal skull fractures and rarely associated with blunt chest trauma. Here, we report a case of pneumocephalus...
BACKGROUND
Traumatic pneumocephalus is commonly encountered after basal skull fractures and rarely associated with blunt chest trauma. Here, we report a case of pneumocephalus caused by traumatic pneumothorax and brachial plexus avulsion.
CASE PRESENTATION
A 20-year-old male was admitted to our hospital following a motorcycle accident with complete paralysis of the right upper limb. 2 days later, follow-up computed tomography revealed a slight right pneumothorax, pneumomediastinum around the neck, and intracranial air without skull fracture. Air migrates into the subarachnoid space through a dural tear caused by a brachial plexus avulsion. The pneumocephalus immediately improved after the insertion of a chest drain.
CONCLUSION
Pneumothorax combined with brachial plexus avulsion could lead to pneumocephalus. Immediate chest drainage might be the best way to stop the migration of air; however, care should be taken to not worsen cerebrospinal fluid leakage.
PubMed: 38765777
DOI: 10.1002/ams2.956 -
Cureus Apr 2024A Segond fracture is a specific type of avulsion fracture involving the lateral aspect of the proximal tibia adjacent to the tibial plateau. Segond fractures are...
A Segond fracture is a specific type of avulsion fracture involving the lateral aspect of the proximal tibia adjacent to the tibial plateau. Segond fractures are indicative of ligamentous injury in the knee. In this case report, a 29-year-old male delivery driver presented to the ED with acute onset right knee pain after losing control of his motorbike at low speed. Examination revealed significant effusion and medial and lateral joint line tenderness. An anterior-posterior radiograph of the knee showed a Segond fracture. Subsequent MRI confirmed a full-thickness anterior cruciate ligament (ACL) rupture and medial collateral ligament (MCL) tear. Despite surgical reconstruction options, the patient chose conservative management. At eight-week follow-up, he demonstrated satisfactory progress. This case highlights the diagnostic significance of Segond fractures in identifying ligamentous damage in the knee without the availability of MRI. It also highlights the feasibility of non-operative management in some instances.
PubMed: 38765369
DOI: 10.7759/cureus.58588 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... May 2024To explore the mechanism, surgical method, and effectiveness of proximal phalangeal bone avulsion fracture caused by A2 circular trochlea injury of the flexor digitorum...
OBJECTIVE
To explore the mechanism, surgical method, and effectiveness of proximal phalangeal bone avulsion fracture caused by A2 circular trochlea injury of the flexor digitorum tendon.
METHODS
A retrospective analysis was conducted on the clinical data of 4 patients with proximal phalangeal bone avulsion fracture caused by A2 circular trochlea injury of flexor digitorum tendon admitted between May 2018 and September 2022. The patients were all male, the age ranged from 26 to 52 years, with an average of 33 years. The injured fingers included 1 case of middle finger and 3 cases of ring finger. The causes of injury were rock climbing of 2 cases and carrying heavy objects of 2 cases. Preoperative anteroposterior and lateral X-ray films and CT examination of the fingers showed a lateral avulsion fracture of the proximal phalanx, with a fracture block length of 15-22 mm and a width of 3-5 mm. The total active range of motion (TAM) of the injured finger before operation was (148.75±10.11)°. The grip strength of the middle and ring fingers was (15.50±2.88) kg, which was significantly lower than that of the healthy side (50.50±7.93) kg ( =-8.280, <0.001). The time from injury to operation was 2-7 days, with an average of 3.5 days. One Kirschner wire with a diameter of 1.0 mm was used for direct fixation through the fracture block, while two Kirschner wires with a diameter of 1.0 mm were used for compression fixation against the fracture block. The fracture healing was observed, and the TAM of the injured finger and the grip strength of the middle and ring fingers were measured. The finger function was evaluated according to the upper limb functional assessment trial standards of the Chinese Medical Association Hand Surgery Society.
RESULTS
The incisions all healed by first intention after operation. All patients were followed up 6-28 months, with an average of 19 months. X-ray films showed that all avulsion fractures of proximal phalanx reached bony union, and the healing time ranged from 4 to 8 weeks, with an average of 4.6 weeks. At last follow-up, the grip strength of the middle and ring fingers was (50.50±7.76) kg, which significantly improved when compared with preoperative one ( =-8.440, <0.001). The TAM of the injured finger reached (265.50±2.08)°, and there was a significant difference when compared with preoperative one ( =-21.235, <0.001). According to the upper limb functional assessment trial standards of the Chinese Medical Association Hand Surgery Society, the finger function was all evaluated as excellent in 4 cases.
CONCLUSION
Using Kirschner wire fixation through bone blocks and external compression fixation of bone blocks for treating proximal phalangeal bone avulsion fracture caused by A2 circular trochlear injury of the flexor digitorum tendon can achieve good effectiveness.
Topics: Humans; Male; Adult; Fracture Fixation, Internal; Bone Wires; Fractures, Avulsion; Finger Phalanges; Middle Aged; Tendon Injuries; Finger Injuries; Hand Strength; Treatment Outcome; Range of Motion, Articular; Fractures, Bone
PubMed: 38752245
DOI: 10.7507/1002-1892.202402073 -
Cureus Apr 2024A calcaneal tuberosity avulsion fracture occurring simultaneously with a rupture of the Achilles tendon, although occurring through similar mechanisms, is a rare injury...
A calcaneal tuberosity avulsion fracture occurring simultaneously with a rupture of the Achilles tendon, although occurring through similar mechanisms, is a rare injury pattern to see in combination and presents a unique challenge to the surgeon. The patient we present was initially found to have a type II fracture of the calcaneal tuberosity. However, during surgical fixation of the fracture, a complete rupture of the Achilles tendon was noticed. The technique used in this case was the fixation of the fracture fragment with two 5 mm fully threaded screws. The tendon was then reattached to the calcaneus using two Mitek anchors (DePuy Mitek Inc., MA, USA) with a modified Bunnell technique. There are a number of techniques suggested in the literature, including, among others, K-wires (DePuy Mitek Inc., MA, USA) and screw fixation. Our patient recovered well and has now been discharged from further orthopaedic follow-up.
PubMed: 38725765
DOI: 10.7759/cureus.57914 -
JSES International May 2024Treatment of displaced distal clavicle fractures with bony avulsion of the coracoclavicular (CC) ligaments often warrants surgical fixation, yet a gold standard surgical...
Biomechanical evaluation of fixation of the coracoclavicular stand-alone cow-hitch suture reconstruction in comparison to two established techniques for highly unstable distal clavicle fractures (Neer type V).
BACKGROUND
Treatment of displaced distal clavicle fractures with bony avulsion of the coracoclavicular (CC) ligaments often warrants surgical fixation, yet a gold standard surgical technique is to be defined. The purpose of this study was to compare the biomechanical fixation strength of a new fixation technique, the CC stand-alone cow-hitch suture reconstruction, and to compare this technique with a clavicle hook plate and a lateral locking plate with CC suture reconstruction.
METHODS
Simulated Neer type V distal clavicle fractures of the clavicle were created in 18 cadaveric shoulders, which were matched by age and gender in 3 groups: (1) clavicle hook plate (group HP), (2) lateral locking plate fixation with CC suture reconstruction (group LPCC), and (3) CC stand-alone suture reconstruction using the cow-hitch technique (group CH). After preconditioning with 25 N for 10 cycles, the specimens were cycled in the coronal plane for 500 cycles from 10N to 70N. Displacement and ultimate load to failure were documented and analyzed with the data acquisition system.
RESULTS
There was a significant difference in the fracture displacement during cyclic loading between the LPCC group and the HP group (0.6 vs. 1.7 mm; = .02) and between the CH and HP groups (0.5 vs. 1.7 mm; = .004). Fracture displacement was not different between the LPCC and the CH groups ( = .544). The CH group and the LPCC group showed a significantly higher stiffness compared to the HP group ( < .001 and = .003, respectively). The CH group showed a significantly higher ultimate load to failure compared with the HP group (429 vs. 172 N; = .005) and showed a tendency toward higher ultimate load to failure when compared with the LPCC group (429 vs. 258 N; = .071).
CONCLUSION
The CC stand-alone cow-hitch suture reconstruction and the locking plate with CC reconstruction showed higher fixation strength compared with the hook plate for simulated Neer type V distal clavicle fractures. There was a tendency of higher ultimate load to failure with the cow-hitch technique compared with the lateral locking plate with CC suture reconstruction, and given the potential advantages of less soft tissue stripping, metal-free fixation, low costs, and simple surgical technique, clinical application of the all-suture CC reconstruction using the cow-hitch for Neer type V distal clavicle fractures appears warranted.
PubMed: 38707556
DOI: 10.1016/j.jseint.2023.11.022 -
JSES International May 2024Avulsion of the greater tuberosity (GT) due to traumatic anterior shoulder dislocation (ASD) is a commonly observed fracture pattern. After closed reduction of the...
BACKGROUND
Avulsion of the greater tuberosity (GT) due to traumatic anterior shoulder dislocation (ASD) is a commonly observed fracture pattern. After closed reduction of the dislocated humerus, the GT typically reduces itself into its anatomic position enabling the patient to undergo conservative treatment. The aim of this study was to retrospectively review a consecutive series of patients with conservatively treated GT avulsion fractures after closed reduction of an ASD and analyze radiographic outcome, shoulder function and glenohumeral stability and the conversion rate to surgical treatment.
METHODS
All patients who underwent closed reduction of a GT avulsion fracture after ASD with the primary intention of conservative treatment between 2017 and 2022 were included. Complications (i.e. conversion to surgical treatment), shoulder function assessed with the American Shoulder and Elbow Surgeons score and subjective shoulder value, instability assessed with the Western Ontario Shoulder Instability score, radiological impingement (greater tuberosity index = GTI and impingement index = II) and GT fracture pattern were assessed as outcome measurements.
RESULTS
A total of 29 patients (mean age 44 years, 27% female) with a mean follow-up of 32.6 (range, 8-96) months were enrolled. Seven patients (24%) underwent surgery due to secondary displacement (n = 4, 14%) or impingement symptoms (n = 3, 10%). All patients who underwent secondary surgery showed a multifragmentary fracture pattern of the GT. Shoulder stiffness (n = 7) and neuropraxia of the axillary nerve (n = 3) were observed temporarily and resolved during the follow-up period. The American Shoulder and Elbow Surgeons and subjective shoulder value of the conservatively treated patients at the last follow-up was 89.2 ± 19.1 respectively 86 ± 18.2%. No recurrent glenohumeral dislocation was documented. The mean Western Ontario Shoulder Instability score at last follow-up was 8(0-71). The mean GTI decreased from 1.2 ± 0.1 after ASD to 1.1 ± 0.1 at the last follow-up ( = .002). The mean II decreased from 0.6 ± 0.5 after ASD to 0.4 ± 0.3 at the last follow-up ( = .110).
CONCLUSION
The GT avulsion fragment reduces typically into a close to anatomic position after closed reduction and the GTI even improves with further conservative treatment over time. Close radiological follow-up is necessary to rule out secondary displacement which occurs typically in a multifragmentary fracture pattern. Patients without the need for surgery showed good clinical outcomes without recurrence of glenohumeral instability.
PubMed: 38707548
DOI: 10.1016/j.jseint.2023.12.008 -
A New Entity of Ramp Lesion Combined with Posterior Root Tear of the Medial Meniscus: A Case Report.JBJS Case Connector Apr 2024This report describes a new pattern of meniscal tear in an 18-year-old man after a knee sprain; he had undergone anterior cruciate ligament revision (ACL-R) 3 years...
CASE
This report describes a new pattern of meniscal tear in an 18-year-old man after a knee sprain; he had undergone anterior cruciate ligament revision (ACL-R) 3 years earlier. He was diagnosed with an anterior cruciate ligament (ACL) graft rupture, a ramp lesion (Thaunat type 4), and a posterior root avulsion fracture of the medial meniscus (MM) (LaPrade type 5). He was treated successfully with an all-inside repair of the ramp lesion, a transtibial pull-out repair of the root tear, and ACL graft revision and anterolateral stabilization.
CONCLUSION
This specific meniscal injury pattern should be recognized and documented, potentially warranting consideration as a new addition to Thaunat and LaPrade classifications as type 6.
Topics: Humans; Male; Adolescent; Tibial Meniscus Injuries; Knee Injuries; Menisci, Tibial; Anterior Cruciate Ligament Reconstruction; Anterior Cruciate Ligament Injuries
PubMed: 38704648
DOI: 10.2106/JBJS.CC.23.00439 -
Journal of Orthopaedic Case Reports Apr 2024Tibial eminence fractures resulting from the avulsion of the anterior cruciate ligament (ACL) insertion are a common knee injury in the pediatric population. This injury...
INTRODUCTION
Tibial eminence fractures resulting from the avulsion of the anterior cruciate ligament (ACL) insertion are a common knee injury in the pediatric population. This injury is traditionally corrected through internal fixation using a guide pin and a cannulated screw. Due to the reported consequences of cannulated screws impinging on the joint space, we explored an alternative procedure to address this injury without the use of cannulated screws. We believe this is the first report of an alternate and improved procedure for repairing a tibial eminence fracture caused by ACL avulsion using non-absorbable sutures to secure the bony fragment back onto the tibial eminence.
CASE REPORT
We report the diagnosis, treatment, and follow-up of a 15-year-old Caucasian male who suffered a tibial eminence fracture associated with an ACL avulsion following a tackle football injury. We utilized a new all-arthroscopic procedure that involved securing the bony fragment of the tibial eminence using sutures that were passed through the ACL and proximal tibial using interosseous bone tunnels.
CONCLUSION
This novel procedure successfully eliminates the need for intra-articular screws in the adolescent knee while treating tibial avulsion fractures - as supported by the patient's marked radiographical and symptomatic improvement at the 2, 6, and 12-week follow-up visits.
PubMed: 38681939
DOI: 10.13107/jocr.2024.v14.i04.4370 -
Journal of Orthopaedic Case Reports Apr 2024A prospective case series study to analyze the outcome of arthroscopic fixation of posterior cruciate ligament (PCL) avulsion fracture using a single tibial tunnel and...
Outcome Analysis of Arthroscopic Fixation of Posterior Cruciate Ligament Avulsion Fracture Using a Single Tibial Tunnel and Suture Loop with Button Configuration - A Case Series Study.
INTRODUCTION
A prospective case series study to analyze the outcome of arthroscopic fixation of posterior cruciate ligament (PCL) avulsion fracture using a single tibial tunnel and suture loop with button configuration technique. PCL avulsion fracture injury requires surgical treatment to restore PCL function and stability of the knee joint. Several open and arthroscopic procedures require a steep learning curve are followed to treat these injuries; yet, our technique is a simpler technique with desirable outcomes and does not require a long learning curve. Hence, it is reported.
CASE SERIES
Ten patients with the same ethnic background having avulsed PCL injury since 2015 underwent arthroscopic fixation of avulsed PCL with single tibial tunnel and suture loop with button configuration within 3 months of injury are studied prospectively till date. All patients are clinically and radiologically evaluated with varied parameters. Postoperatively structured rehabilitation protocol is followed for all the patients. Post-operative clinical and radiological assessments are done and analyzed in 6 weeks, 3 months, 6 months, 1 year, 2 years, and 3 years.
DISCUSSION
Ten patients were available for follow-up for a period of 6 months-3 years. Outcome analysis at the end of 3 years for all patients showed definitive improvement in the function of the knee statistically and functionally.
CONCLUSION
For patients with PCL avulsion fracture, arthroscopic fixation of PCL with a single tibial tunnel and suture loop with Endobutton configuration gives definitive results. Medium-term follow-up analysis shows no failure in the outcome.
PubMed: 38681923
DOI: 10.13107/jocr.2024.v14.i04.4400 -
The Journal of International Medical... Apr 2024Tibial tubercle avulsion fractures (TTAFs) are rare but typical in children and adolescents and Osgood-Schlatter disease (OSD) may be involved in their pathogenesis....
Tibial tubercle avulsion fractures (TTAFs) are rare but typical in children and adolescents and Osgood-Schlatter disease (OSD) may be involved in their pathogenesis. However, few publications have reported the relationship between OSD and TTAF. A 16-year-old healthy male adolescent presented with pain, swelling and limited range of motion of the right knee following sudden acceleration while running. Based on the radiographic evidence, the patient was diagnosed with an avulsion fracture of the right tibial tubercle and OSD. Open reduction and internal fixation were performed using two cannulated screws and two Kirschner wires. The patient returned to preinjury activity levels at the 12-month follow-up postoperatively. This case report aimed to highlight this unique injury pattern. For patients with TTAFs, not only should the fracture be treated, but the cause of the fracture, such as OSD, should also be given appropriate treatment.
Topics: Humans; Adolescent; Male; Tibial Fractures; Fractures, Avulsion; Osteochondrosis; Fracture Fixation, Internal; Tibia; Bone Screws
PubMed: 38676540
DOI: 10.1177/03000605241247683