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Journal of Orthopaedic Case Reports 2018Simultaneous avulsion fractures of the insertion of both cruciate ligaments of the knee are extremely uncommon lesions and their treatment remains difficult. The purpose...
INTRODUCTION
Simultaneous avulsion fractures of the insertion of both cruciate ligaments of the knee are extremely uncommon lesions and their treatment remains difficult. The purpose of this paper is to show an arthroscopic repair technique of simultaneous tibial avulsion fracture of both cruciate ligaments of the knee such by using an adjustable length suspension device.
CASE REPORT
A 25-year-oldmale patient was treated by arthroscopic reduction and fixation of both bony avulsion of cruciate ligaments of the knee with a sliding and adjustable length suspension device (ZipTight, Biomet, Warsaw, IN, USA). There were no post-operative complications appeared. At 18-month follow-up, the patient was conducting normal life, free of symptoms. At clinical examination, Lachman, anterior drawer, pivot shift, posterior drawer, and reverse pivot shift tests were negative. Range of motion was 130° flexion, presenting a slight 5° of extension deficit. The International Knee Documentation Committee score was 83.80 points. Lysholm scale was 85 points.
CONCLUSION
The described repair technique is able to provide stable fixation of bone fragments in the face of early fracture consolidation, as well as minimizing potential complications and surgical time.
PubMed: 30167421
DOI: 10.13107/jocr.2250-0685.1062 -
World Journal of Clinical Cases Apr 2022Independent avulsion fractures with anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) attachment are relatively common among tibial intercondylar...
BACKGROUND
Independent avulsion fractures with anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) attachment are relatively common among tibial intercondylar eminence fractures, and their postoperative outcomes are generally favorable. Conversely, huge avulsion fractures of the intercondylar eminence containing the attachment site of both the ACL and the PCL are extremely rare, and the reported clinical outcomes are poor.
CASE SUMMARY
We describe a 30-year-old Japanese male's huge avulsion fracture of the intercondylar eminence of a tibia containing the attachment site of both the ACL and PCL, together with a complete tear of the medial collateral ligament and a partial tear of both the medial and lateral menisci caused by a fall from a high place. All of these injuries were treated surgically, with anatomical reduction and stable fixation. The limb function at 1 year post-surgery was excellent (Lysholm score: 100 points).
CONCLUSION
Although this patient's complete surgical repair was complex, it should be performed in similar cases for an excellent final clinical outcome.
PubMed: 35647157
DOI: 10.12998/wjcc.v10.i12.3879 -
CMAJ : Canadian Medical Association... Nov 2018
Topics: Aged; Calcaneus; Female; Foot Injuries; Fracture Fixation, Internal; Fractures, Avulsion; Humans
PubMed: 30420390
DOI: 10.1503/cmaj.180248 -
World Journal of Clinical Cases Sep 2022The tibial stop of anterior cruciate ligament (ACL) is fan-shaped and attached to the medial groove in front of the intercondylar spine, which is located between the...
BACKGROUND
The tibial stop of anterior cruciate ligament (ACL) is fan-shaped and attached to the medial groove in front of the intercondylar spine, which is located between the anterior horn of the medial and lateral meniscus. The incidence of this fracture is low previously reported, which is common in children and adolescents. With the increase of sports injury and traffic injury and the deepening of under-standing, it is found that the incidence of the disease is high at present.
AIM
To explore the difference between open reduction and internal fixation with small incision and high-intensity non-absorbable suture under arthroscopy in the treatment of tibial avulsion fracture of ACL.
METHODS
Seventy-six patients with tibial avulsion fracture of anterior cruciate ligament diagnosed and treated in Guanyun County People's Hospital from April 2018 to June 2020 were retrospectively analyzed. According to the surgical methods, they were divided into group A (40 cases) and group B (36 cases). Patients in group A were treated with arthroscopic high-strength non-absorbable suture, and patients in group B were treated with small incision open reduction and internal fixation. The operation time, fracture healing time, knee joint activity and functional score before and after operation, and surgical complications of the two groups were compared.
RESULTS
The operation time of group A was higher than that of group B, and the difference was statistically significant ( < 0.05); the fracture healing time of group A was compared with that of group B, and the difference was not statistically significant ( > 0.05); The knee joint function activity was compared between two groups before operation, 3 mo and 6 mo after operation, and the difference was not statistically significant ( > 0.05); the knee joint function activity of group A and group B at 3 mo and 6 mo after operation was significantly higher than that before operation ( < 0.05); the limp, support, lock, instability, swelling, upstairs, squatting, pain and Lysholm score were compared between the two groups before and 6 mo after operation, and the difference was not statistically significant ( > 0.05); the scores of limp, support, lock, instability, swelling, upstairs, squatting, pain and Lysholm in group A and group B at 6 mo after operation were significantly higher than those before operation ( > 0.05); the surgical complication rate of group A was 2.63%, which was lower than 18.42% of group B, and the difference was statistically significant ( > 0.05).
CONCLUSION
Both small incision open reduction and internal fixation and arthroscopic high-strength non-absorbable sutures can achieve good results in the treatment of anterior cruciate ligament tibial avulsion fractures. The operation time of arthroscopic high-strength non-absorbable sutures is slightly longer, but the complication rate is lower.
PubMed: 36186203
DOI: 10.12998/wjcc.v10.i27.9641 -
Journal of Clinical Orthopaedics and... Jan 2021Surgical treatment for avulsion injuries of the proximal hamstrings has gained increasing popularity over the past decade. Despite good outcomes, early failures have...
Chemoprotection with botulinum toxin following proximal hamstring-Ischial tuberosity avulsion fracture repair: Running title: Chemoprotection for hamstring avulsion fractures.
INTRODUCTION
Surgical treatment for avulsion injuries of the proximal hamstrings has gained increasing popularity over the past decade. Despite good outcomes, early failures have been noted and have been attributed to slipping and falling, postoperative muscle spasm, or early mobilization. In a recent review of hamstring repair rehabilitation protocols, it was shown that there is marked variability in post-operative management. Post-operative bracing with limiting knee extension and hip flexion is the standard of care in most early rehabilitation protocols. Braces with limitation of hip flexion and knee locked in 90 flexion can be awkward, cumbersome and create fall risk.Chemoprotection has more recently been proposed to be an alternative approach to prevent tendon repair failure and controlled mobilization which has been shown to be superior to complete immobilization. We present the first case series of the use of botulinum toxin for chemo-protection of the proximal hamstring ischial avulsion repair, demonstrating its safety and efficacy.
METHODS
Retrospective case series at a tertiary children's hospital which included patients <18 years of age who underwent interventional treatment for proximal hamstring avulsion injuries of the ischium utilizing botulinum toxin as a chemoprotective agent. Data collected included demographic data, injury and treatment details, imaging, post-operative rehabilitation and return to activity. Descriptive statistical analysis was conducted.
RESULTS
Five male patients with mean age 14 years (12-17) were included in the study. All were sports related non-contact injuries. Radiographs showed displaced avulsion fractures in all 5 patients. All patients had failed conservative management initially; mean time to surgery from initial injury was 34.4 weeks. 4 patients underwent open reduction and internal fixation (ORIF), 1 patient with less displacement had bone marrow aspirate (BMA) injection; all had chemoprotection using botulinum toxin injected in the hamstrings. No patient required hip immobilization or knee immobilization locked to 90°. We elected to use a brace locked at 20° knee flexion in 2/5 patients. All patients underwent supervised physical therapy and achieved symmetric knee range of motion (ROM). Post-operative radiographs confirmed healing of the avulsion fracture in all 5 patients and they all returned to previous level of activity at mean 32 weeks (21-43) from surgery. None of the patients had a hamstring re-injury at mean follow up of 27 months (11-42).
CONCLUSION
Our case series is the first in literature that shows the safety and efficacy of chemoprotection with botulinum toxin for the post-operative management of avulsion injuries of proximal hamstrings, by minimizing the need for cumbersome bracing and allowing controlled motion during physical therapy.
PubMed: 33716443
DOI: 10.1016/j.jcot.2020.06.030 -
Skeletal Radiology Sep 2019The aims of this work are to determine how frequently medial tibial plateau fractures are accompanied by fibular head avulsion fractures and evaluate the sensitivity of...
OBJECTIVE
The aims of this work are to determine how frequently medial tibial plateau fractures are accompanied by fibular head avulsion fractures and evaluate the sensitivity of radiographs detecting them, and also to assess if the presence of fibular fracture is correlated with long-term functional outcome and peroneal nerve damage.
MATERIALS AND METHODS
A retrospective chart review of operated patients with medial tibial plateau fractures at level I trauma center during 2002-2008 was performed. From 63 patients imaged preoperatively, 59 had CT and radiographs, three had only CT, and one only radiograph. The presence and fragment size of fibular fracture were retrospectively evaluated. Body mass index (BMI) and functional outcome measurements (the Modified Lysholm knee score and WOMAC) were available for 46 patients.
RESULTS
Fourteen out of 63 patients (22.2%) had fibular fractures. Of the 59 patients with both CT and radiographs, 12 had fibular fractures, and of these, nine were seen with both modalities and three only in CT. Functional scores were available for ten patients with fibular fracture. Patients with fibular fracture seen on radiographs had a significantly higher score on WOMAC function (26 vs. 7; p = 0.027). The patients with fibular fractures had also higher BMI (p = 0.035). Of the six patients with peroneal nerve damage, 50% had fibular fracture.
CONCLUSIONS
In patients with operatively treated medial tibial plateau fracture, the fibular fractures are relatively common. Detecting it is important, as it may be associated with worse functional scores and peroneal nerve paresis. Some fibular fractures may remain undetected on radiographs, hence preoperative CT is recommended.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Body Mass Index; Female; Fibula; Fracture Fixation, Internal; Fracture Healing; Fractures, Avulsion; Humans; Male; Middle Aged; Radiography; Retrospective Studies; Tibial Fractures; Tomography, X-Ray Computed; Young Adult
PubMed: 30834953
DOI: 10.1007/s00256-019-03191-3 -
Orthopaedic Journal of Sports Medicine Jan 2020Lesser trochanter avulsions are rare injuries in adolescents. Severe cases with relevant fragment displacement can be treated surgically. However, no standard approach...
BACKGROUND
Lesser trochanter avulsions are rare injuries in adolescents. Severe cases with relevant fragment displacement can be treated surgically. However, no standard approach is available in the literature. Operative techniques are presently limited to anterograde fixations. A new retrograde approach to reduce operative difficulty and postoperative morbidity has been proposed. So far, no biomechanical comparison of these techniques is available.
HYPOTHESIS
Retrograde repair of the lesser trochanter with a titanium cortical button will produce superior stability under load to failure and similar displacement under cyclic loading compared with anterograde fixation with titanium suture anchors.
STUDY DESIGN
Controlled laboratory study.
METHODS
Sixteen paired hemipelvic cadaveric specimens (mean age, 62.5 ± 10.7 years) were dissected to isolate the lesser trochanter and iliopsoas muscle. After repair of a simulated lesser trochanter avulsion, specimens were tested under cyclic loading between 10 and 125 N at 1 Hz for 1500 cycles before finally being loaded to failure at a rate of 120 mm/min in a material testing machine. Motion tracking was used to assess displacement at the superior and inferior aspects of the iliopsoas tendon under cyclic loading.
RESULTS
Load to failure was significantly greater for the retrograde repair compared with the anterograde repair (1075.24 ± 179.39 vs 321.85 ± 62.45 N; = .012). Mean displacement at the superior repair aspect (retrograde vs anterograde: 3.29 ± 1.84 vs 4.39 ± 4.50 mm; = .779) and mean displacement at the inferior aspect (3.54 ± 2.13 vs 4.22 ± 4.48 mm; = .779) of the iliopsoas tendon did not significantly differ by the type of repair. Mode of failure was tendon tearing by the sutures for each retrograde repair and anchor pullout for each anterograde repair.
CONCLUSION
Surgical repair of lesser trochanter avulsion fractures with retrograde fixation using a titanium cortical button demonstrated superior load to failure and similar displacement under cyclic loading compared with anterograde fixation using suture anchors.
CLINICAL RELEVANCE
The retrograde approach provides a biomechanically validated alternative to other surgical techniques for this injury.
PubMed: 32010731
DOI: 10.1177/2325967119892281 -
Cureus Apr 2023Fifth metatarsal fractures are common foot injuries that involve the long bone on the outer side of the foot, and avulsion fractures involving the short bone and the...
Fifth metatarsal fractures are common foot injuries that involve the long bone on the outer side of the foot, and avulsion fractures involving the short bone and the fifth distal phalanx of the foot have never been reported. A 25-year-old female marathon runner sustained an avulsion fracture of the distal lateral phalanges of the fifth metatarsal. The patient's high functional demands necessitated a conservative approach to minimize complications and facilitate efficient fracture healing. The patient underwent a comprehensive chiropractic rehabilitation program that focused on progressive weight-bearing exercises, range-of-motion activities, strengthening exercises, instrument-assisted soft tissue mobilization (IASTM), therapeutic ultrasound, and laser therapy to stimulate the speed of healing. The patient's progression was closely monitored throughout the rehabilitation process. Because of the nonoperative management and chiropractic rehabilitation, the patient successfully returned to her running activities within a six-week duration. This case demonstrates the effectiveness of nonoperative management and chiropractic rehabilitation in promoting the healing of avulsion fractures of the fifth metatarsal in high-level athletes. This conservative approach can facilitate a safe and efficient return to running activities while minimizing complications and reinjury risks.
PubMed: 37056221
DOI: 10.7759/cureus.37468 -
Arthroscopy Techniques Sep 2018Although some literature may suggest that acute nondisplaced lesser tuberosity fractures should undergo nonoperative management, there is a body of evidence that...
Although some literature may suggest that acute nondisplaced lesser tuberosity fractures should undergo nonoperative management, there is a body of evidence that supports surgical stabilization of these injuries due to concern for fracture displacement, nonunion and malunion, anteromedial impingement, and possible biceps tendon subluxation or dislocation. In this Technical Note, we introduce a novel technique for arthroscopic fixation of lesser tuberosity avulsion fractures using a knotless repair. In the lateral decubitus position using standard arthroscopic portals, with the addition of the biceps accessory portal, 2 ULTRATAPE sutures are fixed to the avulsed fragment in luggage-tag fashion to create a secure, knotless fixation. These are used to mobilize and anatomically approximate the lesser tuberosity to the avulsion bed and are held in place with suture anchors placed immediately adjacent to the fracture bed. This technique provides good anatomic reduction with maximal surface area for bone-to-bone healing.
PubMed: 30258770
DOI: 10.1016/j.eats.2018.04.015 -
Acta Orthopaedica Et Traumatologica... Oct 2016Reverse Segond fracture is originally described as an indirect radiographic clue for a specific injury complex of the knee joint that includes posterior cruciate... (Review)
Review
Reverse Segond fracture is originally described as an indirect radiographic clue for a specific injury complex of the knee joint that includes posterior cruciate ligament (PCL) rupture and medial meniscal tear. Herein, we describe a case with reverse Segond fracture associated with PCL avulsion fracture instead of PCL rupture. According to current literature review, reverse Segond fracture is not only associated with PCL and medial meniscal injuries, but also frequently associated with anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injuries. Furthermore, medial meniscus and PCL may remain intact.
Topics: Anterior Cruciate Ligament Injuries; Female; Humans; Knee Injuries; Knee Joint; Magnetic Resonance Imaging; Tibial Fractures; Tibial Meniscus Injuries; Young Adult
PubMed: 27726919
DOI: 10.1016/j.aott.2016.08.017