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Cureus Jan 2024Ischial tuberosity avulsion fractures areĀ overall uncommon but are known injuries in the adolescent population. They are the result of sudden, forceful contraction of...
Ischial tuberosity avulsion fractures areĀ overall uncommon but are known injuries in the adolescent population. They are the result of sudden, forceful contraction of the hamstring muscle groups. The characteristic radiographic appearance of an ischial tuberosity avulsion fracture is of an irregular ischial margin and a nearby avulsed bone fragment. Callous formation may ensue and appears as a calcific density in the region of injury. Awareness of the spectrum of radiographic presentations can help ensure correct diagnosis and minimize concern for alternative underlying diagnoses. This case report describes a 14-year-old boy with a chronic ischial tuberosity avulsion fracture which demonstrated an unusual presentation on radiographs and required MRI to confirm the diagnosis and rule out other potentially ominous pathology.
PubMed: 38420073
DOI: 10.7759/cureus.53165 -
Cureus Jan 2024Traumatic globe luxation associated with optic nerve avulsion is rare. We describe a case of a 42-year-old Indian gentleman who was involved in a motor vehicle accident...
Traumatic globe luxation associated with optic nerve avulsion is rare. We describe a case of a 42-year-old Indian gentleman who was involved in a motor vehicle accident (MVA). He sustained a deep laceration wound from the right side of the nose extending to the left medial canthal region and left eyelid. The left globe was not visualized, and only the left optic nerve stump was seen. A computerized tomography (CT) scan showed a left globe dislocated inferotemporal with discontinuity of the left optic nerve, inferior rectus, and lateral rectus muscle. There were also comminuted fractures at the floor and lateral wall of the left orbit with significant lateral displacement of the bone fragments. He underwent left eye enucleation, toilet, and suturing of the laceration wounds and open reduction internal fixation (ORIF) of the fractures. We report this case as it is not commonly seen in Malaysia.
PubMed: 38420068
DOI: 10.7759/cureus.53150 -
SAGE Open Medical Case Reports 2024Paraganglioma is derived from the paraganglia tissue in the neck, along the sympathetic trunk, and in the pelvis. Paraganglioma has malignant potential and can...
Paraganglioma is derived from the paraganglia tissue in the neck, along the sympathetic trunk, and in the pelvis. Paraganglioma has malignant potential and can metastasize to remote organs such as the liver, lungs, and bones. Most metachronous metastases occur within several years after the initial diagnosis of paraganglioma. Here, we report the case of a 71-year-old male patient who developed bony metastasis 52 years after the resection of a large paraganglioma at the aortic bifurcation. The biopsy-proven paraganglioma metastasis to the lesser trochanter of left femur presented as an avulsion fracture. His normetanephrine level was elevated. DOTATATE PET (positron emission tomography) did not find any other metastatic lesions. The bony metastasis was treated with radiation therapy. We believe that the patient had one of the longest gaps ever reported, 52 years, between the initial diagnosis and metastasis of paraganglioma. This case highlights the importance of long-term surveillance of patients with paraganglioma for metastasis.
PubMed: 38333518
DOI: 10.1177/2050313X241229853 -
Frontiers in Surgery 2024Avulsion fracture of the anterior superior iliac crest (ASIC) following autogenous bone grafting for anterior lumbar fusion (ALF) is an extremely rare complication. We...
Avulsion fracture of the anterior superior iliac crest (ASIC) following autogenous bone grafting for anterior lumbar fusion (ALF) is an extremely rare complication. We describe a very rare case of avulsion fracture of the ASIC following autograft for ALF in a revision surgery for treating lumbar tuberculosis. A 68-year-old woman with lumbar tuberculosis underwent posterior debridement and posterior iliac crest bone graft fusion; however, her lumbar tuberculosis recurred 9 months after surgery. She then underwent a lumbar revision surgery, including removal of the posterior instrumentation and debridement, followed by anterior L2 corpectomy, debridement, anterior left iliac crest bone graft fusion, and internal fixation. When walking for the first time on postoperative day 3, she experienced a sharp, sudden-onset pain in the anterior iliac crest harvest area. X-ray revealed an avulsion fracture of the ASIC. Considering her failure to respond to conservative treatment for one week and large displacement of the fracture ends, an open reduction and internal fixation surgery was scheduled. Her pain symptoms were significantly relieved after the operation. Although rare, fracture of the ASIC following autograft for ALF should not be ignored. Fracture of the ASIC is usually treated conservatively. Additional surgical treatment is required only when intractable pain fails to respond to conservative treatment or when there is a large displacement of fracture ends that are not expected to heal spontaneously.
PubMed: 38327545
DOI: 10.3389/fsurg.2024.1327028 -
Cureus Jan 2024Pectoralis major (PM) tendon ruptures are rare. Typically, they are caused by eccentric contractions from weight lifting. Due to the rarity of pectoralis major tendon...
Pectoralis major (PM) tendon ruptures are rare. Typically, they are caused by eccentric contractions from weight lifting. Due to the rarity of pectoralis major tendon ruptures, clinicians might misdiagnose this condition. We report a 16-year-old male with a right pectoralis major tendon rupture and an avulsion fracture after falling on a grass field playing soccer. He was initially misdiagnosed with biceps tendonitis, which highlights the importance of including pectoralis major tendon ruptures in one's differential diagnoses.
PubMed: 38313965
DOI: 10.7759/cureus.51616 -
Arthroscopy Techniques Jan 2024Posterior cruciate ligament (PCL) avulsion fractures at the tibial attachment site are managed using various techniques. Some surgeries involve internal fixation with an...
Posterior cruciate ligament (PCL) avulsion fractures at the tibial attachment site are managed using various techniques. Some surgeries involve internal fixation with an adjustable double-loop plate, anterior-to-posterior suture suspension fixation, hollow lag screw fixation, and steel wire fixation. In this case, an X-shaped knot and double posteromedial portals are used to retain the posterior septum for fixation. In this technique, we describe double posteromedial portals are used in this method. The internal joint is fixed with an X-shaped knot, and the external joint is fixed with SwiveLock, which puts the wire belt binding PCL compression bone block in a perfect tension state. This surgical technique can achieve a sound functional reduction.
PubMed: 38312887
DOI: 10.1016/j.eats.2023.08.019 -
Arthroscopy Techniques Jan 2024Various surgical management techniques have been introduced to treat anterior cruciate ligament avulsion fractures. There is disagreement among orthopedic surgeons about...
Various surgical management techniques have been introduced to treat anterior cruciate ligament avulsion fractures. There is disagreement among orthopedic surgeons about which fixation device to use during arthroscopy. Recently, there has been an increase in the use of arthroscopic techniques for fixation, and different devices such as sutures, screws, and fiber wires are being considered. The development of fiber wires has made it possible to use them in comminuted avulsions with satisfactory stability, whereas screws cannot be used in such cases. Sutures do not provide adequate stability for early range of motion compared to other methods. The article then goes on to describe a specific arthroscopic fixation technique that uses an adjustable loop cortical button to manage the avulsed fragment and provide stability.
PubMed: 38312862
DOI: 10.1016/j.eats.2023.08.020 -
Medicine Feb 2024Extremity injuries resulting from motor vehicle collisions, especially those leading to bone-exposed wounds, present challenges for achieving effective wound coverage.... (Review)
Review
RATIONALE
Extremity injuries resulting from motor vehicle collisions, especially those leading to bone-exposed wounds, present challenges for achieving effective wound coverage. Such injuries are susceptible to complications including infections, osteomyelitis, and unexpected amputations due to inadequate blood supply. Severe traumatic degloving injuries often entail damage to the surrounding blood vessels, making local or free flaps impractical choices in many cases. Consequently, treatment options may vary based on distinct clinical scenarios, with no standardized guidelines available. Our study introduces an integrated approach utilizing dermal substitutes and skin grafts as a safer treatment modality for managing large-area tibial exposure resulting from traffic accidents.
PATIENT CONCERNS
A 66-year-old male with a compromised nutritional status was struck by a car while riding a motorcycle. Previous attempts using double-layer Integra and negative pressure wound therapy (NPWT) for two-stage reconstruction have been unsuccessful.
DIAGNOSES
Computed tomography imaging studies revealed multiple comminuted and displaced fractures involving the left femoral shaft, left proximal tibia, left patella, and proximal fibula, as well as a fracture of the right fibular shaft and an avulsion fracture of the right distal medial femur. The patient's condition corresponded to Type 3B in the Gustilo classification for open fractures, and the patient had an Injury Severity Score of 25.
INTERVENTIONS
We applied a one-stage reconstruction involving single-layer Integra, split-thickness skin grafts, NPWT, and nutritional supplements containing various amino acids.
OUTCOMES
By implementing an integrated treatment approach and providing diligent wound care over a total of 2 months, the patient achieved successful healing and expressed satisfaction with the postoperative results.
LESSONS
This study offers insights into the effectiveness of employing one-stage reconstruction for traumatic injuries with extensive exposed tibias. In addition, it underscores the impact of a patient's nutritional status on wound healing and introduces a potential solution for similar challenging cases.
Topics: Male; Humans; Aged; Tibia; Tibial Fractures; Treatment Outcome; Wound Healing; Skin Transplantation
PubMed: 38306507
DOI: 10.1097/MD.0000000000037098 -
World Journal of Orthopedics Jan 2024Avulsion fracture of the ischial tuberosity is a relatively clinically rare type of trauma that is mainly incurred by adolescents during competitive sports activities....
BACKGROUND
Avulsion fracture of the ischial tuberosity is a relatively clinically rare type of trauma that is mainly incurred by adolescents during competitive sports activities. According to previous literature, the most commonly involved sports are soccer, sprinting, and gymnastics, in descending order. Dance-induced avulsion fracture of the ischial tuberosity and ischial ramus is extremely clinically rare.
CASE SUMMARY
A case of a neglected avulsion fracture of the ischial tuberosity and ischial ramus was diagnosed in a young female dancer who complained of pain and restricted movement of her right hip. She stated that she had suffered the injury while performing a split leap during a dance performance 9 mo prior. Eventually, she underwent surgery and obtained satisfactory treatment results.
CONCLUSION
Early diagnosis of these fractures is important to ensuring early proper treatment towards a quicker recovery. For old fractures with nonunion and chronic buttock pain, surgery is a preferred therapeutic choice with good treatment outcomes.
PubMed: 38293263
DOI: 10.5312/wjo.v15.i1.94 -
Journal of Orthopaedic Case Reports Jan 2024Avulsion fractures of the extensor carpi ulnaris (ECU) from its insertion are rare injuries that are rarely reported in the literature. Most of the case reports detailed...
INTRODUCTION
Avulsion fractures of the extensor carpi ulnaris (ECU) from its insertion are rare injuries that are rarely reported in the literature. Most of the case reports detailed closed ruptures. We present avulsion fractures of the bilateral ECU from the base of the 5th metacarpal. Not much of the literature has been published in this regard.
CASE REPORT
A 33 year old male presented with pain around both wrists and hands following a fall from a bike. Following evaluation and radiological investigation, he was found to have a volar Barton fracture with an undisplaced avulsed 5th metacarpal base fracture on the right side and a displaced avulsed fracture of the left 5th metacarpal base. Internal fixation of the volar Barton fracture and mini open fixation of the left 5th metacarpal were done with a wire. The wires were removed at 6 weeks and rehabilitation started. At 3 months, the patient returned to activity with full wrist and hand function.
CONCLUSION
Bilateral avulsion fractures of the ECU from its insertion are a rare injury. Displaced fractures might benefit from surgical intervention. Early diagnosis and treatment are essential for a good functional outcome.
PubMed: 38292090
DOI: 10.13107/jocr.2024.v14.i01.4186