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Orthopaedic Journal of Sports Medicine Jun 2021Sternal fractures are rare, and they can be treated nonoperatively. Vertical sternal fractures have rarely been reported.
BACKGROUND
Sternal fractures are rare, and they can be treated nonoperatively. Vertical sternal fractures have rarely been reported.
PURPOSE
To describe the management and surgical treatment of a series of elite-level athletes who presented with symptomatic nonunions of a vertical sternal fracture.
STUDY DESIGN
Case series; Level of evidence, 4.
METHODS
Patients with an established symptomatic nonunion of a vertical sternal fracture, as diagnosed by computed tomography (CT) or magnetic resonance imaging (MRI), underwent open reduction and internal fixation using autologous bone graft and cannulated lag screws. The patients were assessed preoperatively and at the final follow-up using the Rockwood sternoclavicular joint (SCJ) score; Constant score; and shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores. Bony union was confirmed on postoperative CT scan.
RESULTS
Five patients (4 men and 1 woman) were included; all were national- or international-level athletes (rugby, judo, show-jumping, and MotoGP). The mean age at surgery was 23.4 years (range, 19-27 years), the mean time from injury to referral was 13.6 months (range, 10-17 months), and the mean time from injury to surgery was 15.8 months (range, 11-20 months). The mean follow-up was 99.4 months (range, 25-168 months). There was a significant improvement after surgery in the mean Rockwood SCJ score (from 12.6 to 14.8 [ < .05]), Constant score (from 84 to 96.4 [ < .05]; 80% met the minimal clinically important difference [MCID] of 10.4 points), and QuickDASH (from 6.8 to 0.98 [ < .05]; 0% met the MCID of 15.9 points). Four of the patients were able to return to sport at their preinjury level, and 1 patient retired for nonmedical reasons. All of the fractures had united on the postoperative CT scan. There were no postoperative complications.
CONCLUSION
Vertical fractures of the sternum are very rare and tend to behave clinically like an avulsion fracture injury to the capsuloligamentous structure of the inferior SCJ. The requirement of advanced imaging to diagnose this injury means that the actual incidence and natural history are not known. For high-demand athletes, early identification, surgical reduction, and fixation are likely to achieve the best outcome.
PubMed: 34250172
DOI: 10.1177/23259671211010804 -
Journal of Orthopaedic Case Reports Dec 2022This study highlights the case of a 75-year-old female patient with a history of bilateral knee replacements who presented with a subacute patellar tendon rupture that...
INTRODUCTION
This study highlights the case of a 75-year-old female patient with a history of bilateral knee replacements who presented with a subacute patellar tendon rupture that occurred after falling on her left knee.
CASE REPORT
The patient had a left total knee replacement one year previously and came in for her one-year follow-up. She presented 3 weeks after her injury with a high-riding patella and a small tibial tubercle avulsion fracture on X-ray, yet she did not experience much pain nor any loss of active extension of her left knee. Despite the severity and subacute presentation of the patient's patellar tendon injury, conservative measures that included physical and occupational therapy was recommended instead of surgery due to her paradoxical retention in gross function of her left knee.
CONCLUSION
Showcasing this patient's case may provide further understanding of patellar tendon ruptures and tibial avulsion fractures, specifically factors that allow the patient to retain strength and extensor function in her knee to curb the need for surgery.
PubMed: 37056583
DOI: 10.13107/jocr.2022.v12.i12.3446 -
Medicine Sep 2022The anterior cruciate ligament (ACL) is relatively rarely injured in children and adolescents, accounting for just 0.5% of all ACL rips that occur. Avulsion fractures...
RATIONALE
The anterior cruciate ligament (ACL) is relatively rarely injured in children and adolescents, accounting for just 0.5% of all ACL rips that occur. Avulsion fractures are more common in youngsters because their ligamentous structures are known to be stronger than their physical insertion sites. Tibial eminences have been reported to be the sites of most ACL avulsions, and both cartilaginous and osteochondral avulsion fractures have been observed, whereas the latter occurs more commonly. On the other hand, femoral osteochondral avulsion fractures of the ACL in children are uncommon, as only a few studies describe their occurrence in immature patients.
PATIENT CONCERNS
In this case report, we present an 11-year-old girl who suffered an ACL femoral attachment avulsion fracture after pivoting her knee during riding. A comprehensive formal evaluation of the knee was impractical due to the persistence of pain and tight haemarthrosis.
DIAGNOSES
Femoral anterior cruciate ligament osteochondral avulsion fracture.
INTERVENTIONS
We used Two No.2Ethibond sutures to pick up the osteochondral fragment and passed across the lateral femoral condyle to come out laterally and fixed with a tie proximally, and we recommended the patient perform reasonable functional exercises postoperatively.
OUTCOMES
The patient had no pain, instability, or activity limitations after 24 months of surgery. Physical examination of the patient revealed full and symmetric ROM, and normal Lachman and pivot shift test performance.
LESSONS
ACL avulsion fractures can be accurately treated with arthroscopic reduction and sutures via an inside-out technique, which can reduce the risk of persistent ligamentous laxity and reduce open surgery-related morbidity.
Topics: Adolescent; Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Arthroscopy; Child; Female; Femoral Fractures; Fractures, Avulsion; Humans; Intra-Articular Fractures
PubMed: 36107596
DOI: 10.1097/MD.0000000000030321 -
International Journal of Surgery Case... Jul 2024Avulsion fractures of the calcaneal tuberosity with significant displacement can cause soft tissue complications in the heel. However, a treatment strategy for calcaneal...
INTRODUCTION
Avulsion fractures of the calcaneal tuberosity with significant displacement can cause soft tissue complications in the heel. However, a treatment strategy for calcaneal tuberosity fractures with poor heel-skin condition is yet to be established. Here, we report a case involving avulsion fracture of the calcaneal tuberosity presenting with superficial skin necrosis that was treated with a plate lacking the anterior component and screws inserted percutaneously.
PRESENTATION OF CASE
A 74-year-old woman presented with progressive right heel pain following an injury to her heel sustained approximately six weeks previously. She had experienced difficulty walking due to heel pain and superficial necrosis was observed on the posterior surface of the heel. Radiography and computed tomography revealed an avulsion fracture of the calcaneal tuberosity with superior displacement. Open reduction was performed using a lateral L-shaped incision. After inserting two cancellous screws percutaneously into the calcaneal tuberosity, we fixed a plate lacking the anterior component to the lateral surface of the calcaneus. The superficial necrosis healed gradually post-operatively. Bone union was confirmed using radiography six months post-operatively.
DISCUSSION
We developed a novel surgical procedure to treat avulsion fractures of the calcaneal tuberosity with poor skin condition. The combination of a plate lacking the anterior component and the percutaneous insertion of canulated cancellous screws can reduce the risk of post-operative soft tissue complications while maintaining fixation of the fractured fragment.
CONCLUSION
Our findings provide a novel surgical method for the treatment of avulsion fractures of the calcaneal tuberosity with soft tissue complications.
PubMed: 38830333
DOI: 10.1016/j.ijscr.2024.109848 -
Journal of Orthopaedic Case Reports Jan 2024Acute avulsion of the tibial tubercle is an uncommon fracture, with reported incidence rates of 0.4-2.7% of all epiphyseal injuries and <1% of all physeal injuries....
INTRODUCTION
Acute avulsion of the tibial tubercle is an uncommon fracture, with reported incidence rates of 0.4-2.7% of all epiphyseal injuries and <1% of all physeal injuries. Typically, these fractures present with marked displacement of the entire proximal apophysis, with or without intra-articular extension, and variable associated soft-tissue injury. The Ogden classification has historically directed both non-operative and operative treatment of this injury. The overarching objective of several fracture fixation techniques has been outlined as being to restore the joint surface and the extensor mechanism.
CASE REPORT
This case report describes the management of a 14-year-old male who sustained a rare avulsion fracture of the left tibial tuberosity with epiphyseal injury during a soccer game. The fracture was classified as Ogden Type III-B, indicating an intra-articular extension. The patient underwent open reduction and internal fixation with three cannulated screws and tension band wiring.
CONCLUSION
The fracture united with no residual deformity and return of full range of motion. Tension band wiring provides stable reduction; hence, prompt diagnosis and appropriate surgical intervention in similar cases is important to optimize outcomes.
PubMed: 38292087
DOI: 10.13107/jocr.2024.v14.i01.4150 -
Medicine Aug 2019Tibial tubercle avulsion fracture caused by knee extensor is very rare; furthermore, non-traumatic fractures during running or bilateral fractures have been reported.... (Observational Study)
Observational Study
Tibial tubercle avulsion fracture caused by knee extensor is very rare; furthermore, non-traumatic fractures during running or bilateral fractures have been reported. The purpose of this study was to evaluate any differences according to the mechanisms of injury in adolescents with tibial tubercle avulsion fracture.Thirty patients with tibial tubercle avulsion fractures were reviewed and the average age was 13 years 1 month. Seven patients (low-stress group) had a spontaneous fracture during running without definite trauma. Twenty-three patients (high-stress group) experienced pain during jumping and landing, or definite trauma. The mechanisms of injury, age, height, weight, body mass index (BMI), BMI percentile, fracture type, as well as any complication, such as limitation of motion and deformity related to the physeal arrest, were compared between groups.There was no definite difference in age, fracture type, and surgical outcomes between groups. There was no patient with significant early physeal arrest in both groups. The weight (P = .02), BMI (P = .03) and BMI percentile (P = .01) in low-stress group were higher than those in high-stress group. In low-stress group, 6 patients' BMIs were in the 97th percentile, and 1 patient's BMI was in the 5th percentile.Extreme BMI may be a risk factor for tibial tubercle avulsion fractures in adolescents during running without definite trauma. However, there was no difference in the final outcome according to injury mechanisms.
Topics: Adolescent; Athletic Injuries; Body Mass Index; Child; Female; Fracture Fixation, Internal; Fractures, Avulsion; Humans; Male; Radiography; Retrospective Studies; Risk Factors; Tibial Fractures
PubMed: 31393372
DOI: 10.1097/MD.0000000000016700 -
Journal of Wrist Surgery Dec 2019Using three-dimensional (3D) computed tomography models of acute scaphoid fractures, we looked for differences between volumetric size of the fracture fragments,...
Using three-dimensional (3D) computed tomography models of acute scaphoid fractures, we looked for differences between volumetric size of the fracture fragments, recognizable groups, or a shared common fracture area. We studied 51 patients with an adequate computed tomography scan of an acute scaphoid fracture using 3D modeling. Fracture surfaces were identified and fragment volumetric size of the fracture fragments was measured. A principal component analysis was used to find groups. Density mapping was used to image probable common fracture areas in the scaphoid. Forty-nine of 51 fractures had a similar pattern. It was not possible to identify subgroups based on fracture pattern. The mean volumetric size of the fracture fragments of the proximal (1.45 cm ± 0.49 cm standard deviation [SD]) and distal fracture fragments (1.53 cm ± 0.48 cm SD) was similar. There was a single common fracture area in the middle third of the bone. In the distal third, there were no horizontal fractures through-but only directly proximal to-the tubercle suggesting that these would be best classified as distal waist fractures. Acute scaphoid fractures mainly occur in the middle third of the bone and tend to divide the scaphoid in half by volumetric size of the fracture fragments. There were two distinct grouping patterns: fractures through the proximal and middle third were horizontal oblique, whereas fractures of the distal third were vertical oblique. It seems that scaphoid fractures might be classified into proximal pole fractures, a range of waist fractures, and tubercle avulsion fractures. This is a Level IV study.
PubMed: 31815056
DOI: 10.1055/s-0039-1693050 -
The Journal of International Medical... Feb 2020In acute trauma, posterior cruciate ligament (PCL) injury may occur concomitantly with a bony fracture and be easily overlooked. A popliteal artery injury associated...
In acute trauma, posterior cruciate ligament (PCL) injury may occur concomitantly with a bony fracture and be easily overlooked. A popliteal artery injury associated with a tibial plateau fracture and PCL avulsion fracture is rare. Missed or delayed diagnosis of this condition leads to a high amputation rate. Therefore, close attention is required with this type of injury. The limb can be saved though early detection and immediate reconstruction of the injured artery, followed by fasciotomy. We report here a rare case of popliteal artery occlusion proximal to the surgical zone, which was diagnosed after fixation of a medial tibial plateau fracture and posterior cruciate avulsion injury. In dashboard injuries without knee dislocation, the arterial intima may be injured and become vulnerable, even with an initial ankle brachial index greater than 0.9. This can cause concomitant occlusion of the popliteal artery due to iatrogenic retraction during surgery. Therefore, a neurovascular examination should be repeated to prevent delayed-onset thrombosis. To the best of our knowledge, this is the first case of popliteal artery injury concomitant with a tibial plateau fracture and PCL avulsion owing to initial dashboard injury-related arterial intima injury, which can present with a normal ankle brachial index.
Topics: Fractures, Avulsion; Humans; Knee Joint; Popliteal Artery; Posterior Cruciate Ligament; Tibial Fractures
PubMed: 31510833
DOI: 10.1177/0300060519869073 -
World Journal of Orthopedics Dec 2020Few cases of avulsion fractures of the tibial tuberosity with simultaneous rupture of the patellar tendon have been reported in the literature. Therefore, its mechanism...
BACKGROUND
Few cases of avulsion fractures of the tibial tuberosity with simultaneous rupture of the patellar tendon have been reported in the literature. Therefore, its mechanism and incidence have not been determined conclusively. This type of fracture is considered a serious injury that requires prompt diagnosis and early surgical repair. There is no therapeutic algorithm or standard method of treatment due to the infrequency of the injury. In this case report, we conducted an exhaustive review and synthesis of the existing literature including all previously reported cases.
CASE SUMMARY
We present a 16-year-old male soccer player with a case of a tibial tuberosity fracture with distal avulsion of the patellar tendon 5 d prior to surgical treatment. The patient presented with a loss of the extensor mechanism of the knee, edema, the inability to walk, and pain. X-rays showed a high patella and a 180-degree avulsion of the tibial tuberosity. The diagnosis was confirmed by magnetic resonance imaging and computed tomography. The patient underwent open reduction and internal fixation of the fracture with a cannulated screw and washer as well as patellar tendon repair with two metallic anchors. The rehabilitation protocol consisted of initial immobilization in extension followed by passive mobility and muscle strengthening exercises. The patient demonstrated excellent postoperative outcomes and returned to regular activity without complications.
CONCLUSION
This case presentation and literature review comprise the most relevant clinical, radiographic, and treatment details described in the international literature to date, providing the reader with an overview of this rare condition.
PubMed: 33362997
DOI: 10.5312/wjo.v11.i12.615 -
Journal of Orthopaedic Case Reports Dec 2021Lesser tuberosity avulsion fractures are rare and often missed. Patients often complain only of heaviness around the shoulder and some loss in range of motion.
INTRODUCTION
Lesser tuberosity avulsion fractures are rare and often missed. Patients often complain only of heaviness around the shoulder and some loss in range of motion.
CASE REPORT
This is a rare case of a lesser tuberosity avulsion fracture with displacement. The patient was a 29-year-old male who suffered an injury to the right shoulder due to a fall. Post-fall, the patient developed typical heaviness and restrictions in the range of motion of his right shoulder. Radiographs initially taken were not true anteroposterior (AP) views. The fracture was primarily missed by another surgeon, after which on opting for a true AP radiographs, the fracture was diagnosed. The fracture was managed by an open deltopectoral approach. Fracture fragment was reduced to its footprint and was fixed using 2 × 4.0 mm cancellous screws. Post-surgery, the patient was advised 3 weeks of immobilization after which mobilization was started. By monitored physiotherapy, consistent results can be obtained without loss of reduction. In this case too, full ranges with strength were achieved by 3 months postoperatively.
CONCLUSION
Such fractures often missed may cause loss of external rotation movements in the patient and eventually malunion of the fragment if displaced. Watchfulness and timely management of the fractures can give excellent results. This case report aims at increasing the awareness among the budding shoulder surgeons in identifying such injuries at the earliest, and the means of managing them.
PubMed: 35415148
DOI: 10.13107/jocr.2021.v11.i12.2544