A comparative study of absorbable screw fixation and absorbable screw combined with suture anchor fixation in treatment of avulsion fracture of posterior cruciate ligament at tibial insertion of knee joint / 中国修复重建外科杂志

OBJECTIVE@#To compare the effectiveness of open reduction of posterior cruciate ligament (PCL) avulsion fracture at tibial insertion of knee joint with absorbable screws fixation and absorbable screw combined with suture anchor fixation.@*METHODS@#The clinical data of 26 patients with PCL avulsion fracture at tibial insertion who met the selection criteria between March 2015 and October 2021 were retrospectively analyzed. Among them, 14 patients were fixed with simple absorbable screw (group A), and 12 patients were fixed with absorbable screw combined with suture anchors (group B). All patients were confirmed by X-ray film, CT, or MRI preoperatively, and got positive results in preoperative posterior drawer tests. There was no significant difference in gender, age, side of affected limb, time from injury to operation, comorbidities, and preoperative Meyers & McKeever classification, Lysholm score, and International Knee Documentation Committee (IKDC) score between the two groups ( P>0.05). The operation time and postoperative complications were recorded and compared between the two groups. At last follow-up, Lysholm score and IKDC score were used to evaluate the improvement of knee function.@*RESULTS@#There was no significant difference in operation time between the two groups ( P>0.05). All incisions healed by first intention, and no complication such as vascular and nerve injury or venous thrombosis occurred. All 26 patients were followed up 9-89 months, with an average of 55.3 months. The follow-up time of group A and group B was (55.7±23.2) and (56.8±29.3) months, respectively, with no significant difference ( t=-0.106, P=0.916). Radiographs showed bone healing in both groups at 3 months after operation, and no complication such as infection and traumatic arthritis occurred. At last follow-up, the posterior drawer test was negative in both groups, and the Lysholm score and IKDC score significantly improved when compared with the pre-operative values ( P<0.05). However, there was no significant difference in the improvement value between the two groups ( P>0.05).@*CONCLUSION@#For PCL avulsion fracture at tibial insertion of the knee joint, the open reduction and absorbable screw combined with suture anchor fixation can achieve reliable fracture reduction and fixation, which is conducive to the early rehabilitation and functional exercise, and the postoperative functional recovery of the knee joint is satisfactory.

Radiographic diagnosis of distal fibula avulsion fractures: Comparison of ankle X-ray and three-dimensional reconstruction of CT / 北京大学学报(医学版)

OBJECTIVE@#To investigate the difference in sensitivity between X-ray and three-dimensional reconstruction of computed tomography (3D-CT) for the diagnosis of distal fibular avulsion fracture, and the radiographic presentation of the ossicle.@*METHODS@#From January to October 2018, 92 patients with distal fibular avulsion fracture were visited for surgical treatment in Department of Sports Medicine, Peking University Third Hospital, and 60 cases were finally enrolled according to the inclusion and exclusion criteria. Intraoperative detection was regarded as the gold standard, and the diagnostic sensitivity of preoperative ankle X-ray and 3D-CT for the distal fibular avulsion fractures was statistically determined. The ossicle maximum diameter as well as the degree of its displacement were also measured. On 3D-CT, the distance from the ossicle center point to the anterior fibular tuberosity (a), the distance to the fibular tip (b), and the a/b value was used to present the ossicle displacement.@*RESULTS@#Among the 60 patients, 36 and the 52 patients were correctly detected by X-ray and 3D-CT, respectively, and the sensitivities was 60.0% and 86.7%, respectively (P=0.004). The mean diameter of the ossicle on X-ray and 3D-CT was (9.2±3.9) mm and (10.5±3.2) mm, respectively. The mean distance from the ossicle center to the anterior fibular tuberosity (a) was (17.5±3.6) mm and the mean distance to the fibular tip (b) was (17.4±4.8) mm, with mean a/b values of 1.1±0.7. The intraclass correlation coefficients (ICC) for each measurement ranged from 0.891-0.998 with a high degree of consistency.@*CONCLUSION@#Compared with X-ray, 3D-CT has higher sensitivity in diagnosing distal fibular avulsion fractures, can help clinicians evaluate ossicle's location and choose surgical methods, and is recommended to be performed in patients with suspected distal fibula avulsion fractures in clinical practice.

Arthroscopic fixation of chronic bicruciate tibial avulsion fractures: A case report / 中华创伤杂志(英文版)

A cruciate ligament avulsion is a much less common form of injury than a cruciate ligament tear. Simultaneous tibial avulsion fractures of both cruciate ligaments occur even more rarely. Over the last decades, many studies have described arthroscopic fixation of acute cruciate tibial avulsion fractures, but arthroscopic treatment in a late presenting patient has not been reported in the literature. This case report presents a 32-year-old female with a chronic tibial avulsion fracture of both anterior cruciate ligament and posterior cruciate ligament. Simultaneous fixation of both fractures was performed arthroscopically at week four post-injury. At one year of follow-up, the patient had demonstrated full knee range of motion and stable knee with no complaints, and achieved excellent clinical outcomes. Radiographs showed union of both fractures, and the patient had resumed high-impact exercises.

Bilateral Tibial Tuberosity Periosteal Sleeve Fracture in an Adolescent: A Case Report

@#Tibial tuberosity avulsion fracture is a rare injury, and bilateral occurrence is more uncommon. Periosteal sleeve fracture is a unique fracture pattern which was first described in the lower pole of patella in children. We are reporting a rare case of bilateral tibial tuberosity sleeve fracture in a teenage boy which occurred while sprinting. The patient underwent open reduction, pull through suture fixation of the bilateral tibial tuberosity and screw fixation of left tibial tuberosity. Post-operative rehabilitation included gradual increment of range of motion with hinged brace and quadriceps muscle strengthening. Close follow-up was done to monitor the progression of his recovery. At six months follow-up, the patient recovered well. Both knees had full range of motion with an intact extensor mechanism.

Fracturas avulsivas tibiales del ligamento cruzado posterior fijadas con tornillos: un estudio clínico y radiológico / Screw fixation of posterior cruciate ligament tibial avulsion fractures: a clinical and radiographic study

OBJETIVO: Realizar la evaluación clínica, imagenológica y funcional de pacientes con fracturas avulsivas tibiales del ligamento cruzado posterior (FTALCPs) fijadas con tornillos canulados con técnica abierta. MÉTODOS: Los pacientes con FTALCP operados entre 2010 y 2017 fueron revisados retrospectivamente. Criterios de inclusión: fracturas agudas, desplazadas, test de cajón posterior grado III, lesiones combinadas de rodilla, seguimiento > 12 meses. Se excluyeron pacientes > 65 años, con FTALCPs bilaterales, lesiones del ligamento cruzado posterior (LCP) intrasustancia, test de cajón posterior grados I-II, fracturas expuestas, lesiones neurovasculares, y seguimientos < 12 meses. Objetivo primario: medir la estabilidad clínica mediante test de cajón posterior y radiografía de estrés arrodillada comparativa. Objetivos secundarios: nvaluar la consolidación en radiografías, complicaciones y funcionalidad con las escalas de Lysholm y Tegner. Resultados Se incluyeron 20 pacientes, con edad media de 41 años (rango: 32 a 61 años). El seguimiento promedio fue de 33,9 meses (rango: 12 a 82 meses). La estabilidad clínica mejoró en 93% (cajón posterior postoperatorio grados 0 y I) de los pacientes. La radiografía de estrés arrodillada mostró una diferencia promedio de 2,6 mm (rango: 0,1 mm a 6,8 mm) de traslación posterior al comparar con el lado sano. Todas las fracturas consolidaron. Siete pacientes presentaron complicaciones. El puntaje promedio de la escala de Lysholm al final del seguimiento fue de 85,17. El promedio preoperatorio del puntaje en la escala de Tegner no varió significativamente en comparación con el postoperatorio. CONCLUSIONES: La fijación de fracturas avulsivas tibiales del LCP con tornillos canulados con técnica abierta es efectiva en restaurar la estabilidad posterior y lograr la consolidación ósea. La funcionalidad clínica a mediano plazo es buena, a pesar del alto número de complicaciones y lesiones concomitantes. NIVEL DE EVIDENCIA: tipo IV.

OBJECTIVE: To report mid-term clinical, radiographic, and functional outcomes following open reduction and fixation of posterior cruciate ligament tibial avulsion fractures (PCLTAFs) with cannulated screws. METHODS: This is a retrospective analysis of patients with PCLTAF operated on from August 2010 to April 2017. Patients with acute fractures, with more than 2 mm of displacement and grade III on the posterior drawer test, combined or not to knee injuries, were included. Patients older than 65 years of age, with bilateral avulsion fractures, intrasubstance posterior cruciate ligament (PCL) lesions, stable grade-I to -II on the posterior drawer test, concomitant neurovascular injuries, mid-substance tears, open fractures, and less than 12 months of follow-up were excluded. Primary outcomes: the clinical stability was assessed using the posterior drawer test and a single comparative knee stress radiograph. Secondary outcomes: radiographic consolidation, complications, Lysholm score, and Tegner activity score. RESULTS: In total, 20 patients with a mean age of 41 years (range: 32 to 61 years) were included. The mean follow-up was of 33.9 months (range: 12 to 82 months). Clinical stability (grade 0 or I on the posterior drawer test) was observed in 93% of the patients. The mean difference in contralateral posterior displacement was of 2.6 mm (range: 0.1 mm to 6.8 mm) on a single comparative knee stress radiograph. All fractures presented radiological consolidation. Seven patients developed complications. The mean Lysholm score at the last follow-up visit was of 85.17. The postoperative Tegner activity scores did no vary significantly compared to the preinjury scores. CONCLUSIONS: Cannulated screw fixation of a displaced PCLTAF through a posterior approach restores clinical and radiographic stability and has excellent union rates. The mid-term functional outcomes are good despite the high rates of combined knee lesions and postoperative complications. LEVEL OF EVIDENCE: IV.

Arthroscopic treatment of tibial avulsion fracture of posterior cruciate ligament with a knot-free anchor and Endobuton titanium plate / 中国骨伤

OBJECTIVE@#To investigate the clinical effect of arthroscopic fixation of tibial avulsion fracture of posterior cruciate ligament with a knot-free anchor and Endobuton titanium plate.@*METHODS@#From October 2019 to October 2020, 12 patients with tibial avulsion fracture of posterior cruciate ligament were treated with the arthroscopic knot-free anchor and Endobuton titanium plate, including 9 males and 3 females. The age ranged from 23 to 58 years old. The time from injury to operation ranged from 2 to 9 days. There were 2 cases of Meyers typeⅡand 10 cases of Meyers type Ⅲ. There were 2 cases of meniscus injury and 1 case of partial injury of medial collateral ligament. The fracture healing and knee range of motion were evaluated after operation, and the clinicalefficacy was evaluated by Lysholm function score.@*RESULTS@#All patients were followed up for 12 months. All patients healed within 6 months, and there were no complications such as incision infection, lower extremity deep venous thrombosis and internal fixation falling off. The knee flexion range of motion recovered from 50°-90° before operation to 115°-130° 6 months after operation, and no patient had straightening disorder. Lysholm functional score recovered from preoperative 29-54 scores to 86-100 scores 12 months after operation.@*CONCLUSION@#Arthroscopic reduction and fixation of tibial avulsion fracture of posterior cruciate ligament with the knot-free anchor and Endobuton titanium plate has less complications, high fracture healing rate, good extension and flexion angle and early function recovery of knee joint.

Functional Outcome of Isolated Posterior Cruciate Ligament Avulsion Fractures Treated by Open Reduction and Internal Fixation

Isolated Posterior cruciate ligament (PCL) avulsion fractures are uncommon, but are complicated intra-articular fractures.1 In India due to high prevalence of motorcycle transportation, the cause of PCL avulsion fractures was predominantly motorcycle accidents, though sports accidents still remain the most common cause in world over. These injuries are quite often missed in the emergency department and are often neglected. In the long run they cause severe functional disability of the knee joint. There is no consensus concerning the optimal surgical treatment approach for these injuries. Hence, we aimed to study the functional and clinical outcome of isolated PCL avulsion fractures with open reduction and internal fixation.METHODSThis is a prospective study of 28 cases of isolated PCL tibial avulsion fractures, in patients aged between 22-38 years during the period 2014 - 2018 in our hospital. All were treated with open reduction and internal fixation with 4 mm cannulated cancellous screw and washer. Postoperatively, patient leg was immobilized in posterior POP slab for 2 weeks, allowing toe touch weight bearing. All patients were regularly followed-up at 2, 4, 6, 8, 10, and 12 weeks. The functional outcome is assessed by Lyndholm scoring at the end of 12 weeks.RESULTS98% of the cases have shown excellent results with good range of movement in the knee without pain and without knee instability. The other 2% of cases had mild knee arthrofibrosis and pain.CONCLUSIONSPCL Avulsion fractures are rarity but yet need to be managed surgically. Open reduction and internal fixation by Burks and Schaffer approach has resulted in excellent results and good functional outcome.

Early effectiveness of minimally invasive open reduction and internal fixation versus arthroscopic double-tunnel suture fixation for tibial avulsion fracture of posterior cruciate ligament / 中国修复重建外科杂志

Objective: To compare the early effectiveness of minimally invasive open reduction and internal fixation via posterior median approach versus arthroscopic double-tunnel suture fixation in treatment of tibial avulsion fracture of the posterior cruciate ligament (PCL). Methods: A clinical data of 31 patients with the tibial avulsion fracture of the PCL and met the criteria between January 2015 and January 2019 was retrospectively analyzed. Nineteen patients (group A) were treated with open reduction and internal fixation with cannulated screw via posterior median approach. The other 12 patients (group B) were treated with arthroscopic double-tunnel suture fixation technique. There was no significant difference between the two groups ( P>0.05) in the gender, age, side of effected limb, the injury cause, the time from injury to operation, the combined meniscus injury, Meyers & McKeever classification and preoperative Lysholm score, Tegner score, International Knee Documentation Committee (IKDC) score, and the difference of tibial posterior displacement between bilateral knees. The operation time, postoperative complications, fracture healing, and the difference of tibial posterior displacement between bilateral knees, Lysholm score, Tegner score, and IKDC score were recorded. Results: Group B spent significantly longer operation time than group A ( t=7.347, P=0.000). No postoperative complication occurred in group B, and 1 patient in group A had a screw breakage. All patients were followed up 6-36 months (mean, 22 months). X-ray films showed that all fractures healed at 3 months after operation. At last follow-up, there was no significant difference in the patients with normal knee range of motion between the two groups ( P=0.510). At last follow-up, the difference of tibial posterior displacement between bilateral knees, Lysholm score, Tegner score, and IKDC score in the two groups were superior to those before operation ( P0.05). Conclusion: For the tibial avulsion fracture of PCL, the minimally invasive open reduction and internal fixation and arthroscopic double-tunnel suture fixation can obtain similar early effectiveness. However, arthroscopic surgery has the advantages of being able to simultaneously deal with intra-articular combined injuries, avoiding internal fixator complications, and eliminating the need for secondary operation.

Arthroscopic technique with fiber tape circular fixation for treating avulsion fracture of tibial insertion of anterior cruciate ligament / 中国组织工程研究

BACKGROUND: The avulsion fracture of tibial Insertion of anterior cruciate ligament needs to be operated and fixed as early as possible. At present, the open reduction (absorbable screw, hollow screw, steel wire, and titanium cable) Is commonly used in the clinical treatment plan for internal fixation, which is more traumatic and has many postoperative complications. Arthroscopic reduction and elastic (suture) Internal fixation of anterior cruciate ligament fracture has the advantages of minimally invasive, clear surgical field, high fixation accuracy, few complications, good fracture reduction and healing, meeting the biomechanical requirements, and allowing rapid recovery of joint function, but also has the disadvantages of Insufficient strength, and osteotomy. OBJECTIVE: To compare the treatment efficacy of arthroscopic technique with Fiber Tape circular fixation and open reduction and fixation for the avulsion fracture of tibial Insertion of anterior cruciate ligament. METHODS: Thirty-two patients with tibial eminence fracture at Department of Orthopedics of Shanghai China Metallurgical Hospital from January 2017 to December 2018 were enrolled. All patients signed the informed consents and the study was approved by the Ethics Committee. The patients were divided into two groups based on surgical methods: Minimally Invasive group (n=17, arthroscopic reduction and Fiber Tape circular fixation) and open group (n=15, open reduction and hollow tension screw fixation). The operation time, blood loss, and postoperative complications were recorded. The range of motion of knee joint, Lysholm score, and International Knee Documenting Committee score before operation, 1 and 6 months after surgery were recorded. X-ray film was used to evaluate fracture healing. RESULTS AND CONCLUSION: (1) All patients were followed up for 6-13 months. (2) There were no significant differences in age composition, fracture type, cause of injury or preoperative score between two groups. (3) X-ray film showed satisfactory fracture reduction after operation. There were no neurological, vascular injury or fracture displacement after surgery. The fractures healed well after 6 months. (4) There was no significant difference In the operation time and postoperative complications between two groups. The blood loss showed significant difference between two groups (P=0.036). (5) The range of motion of knee joint at postoperative 1 month In both groups was significantly larger than that at baseline (P < 0.05). The range of motion of knee joint at postoperative 6 months was significantly larger than that at postoperative 1 month (P < 0.05). The range of motion of knee joint at postoperative 1 and 6 months in the minimally invasive group was significantly larger than that in the open group (P < 0.05). (6) The Lysholm and International Knee Documenting Committee scores at postoperative 1 month in both groups were significantly higher than those at baseline (P < 0.05). The scores at postoperative 6 months were significantly higher than those at postoperative 1 month (P < 0.05). The scores at postoperative 1 and 6 months in the minimally invasive group were significantly higher than those in the open group (P < 0.05). (7) These findings suggest that the patients in both groups after undergoing surgical methods had restored motion of range with time going. Compared with open fixation, arthroscopic reduction and Fiber Tape circular fixation for treating tibial eminence fracture has less blood loss, less trauma, shorter recovery time and higher functional recovery.

Irreducible Elbow Dislocation Associated with Hill-Sachs-like Lesion over the Capitellum

Irreducible dislocation of the elbow is an uncommon event. We present the case of a posterolateral elbow dislocation after a fall injury in a 67-year-old woman. A closed reduction performed in the emergency department was unsuccessful since the limited passive range of motion resulted in difficulty to perform longitudinal traction and flexion. Computed tomography images showed that the posterolateral aspect of the capitellum was impacted by the tip of the coronoid process, thus appearing similar to the Hill-Sachs lesion in the humeral head. Subsequent open reduction of the elbow revealed the dislocation to be irreducible since the tip of the coronoid process had wedged into a triangular Hill-Sachs-like lesion in the capitellum. The joint was reduced by providing distal traction on the forearm, and main fragments were disengaged using digital pressure. At the 3-month follow-up, the patient reported no dislocations, and had an acceptable range of motion. Thus, we propose that to avoid iatrogenic injury to the joint or other nearby structures, irreducible dislocations should not be subjected to repeated manipulation.

Comparison of notch width indexes between tibial intercondylar eminence avulsion fracture and anterior cruciate ligament injury / 中华创伤骨科杂志

Objective To find out if there is any difference in intercondylar fossa width and notch width index (NWI) between tibial intercondylar eminence avulsion fracture and anterior cruciate ligament (ACL) injury.Methods A retrospective study was conducted of the patients who had sought medical attention at Department of Sports Medicine and Adult Reconstructive Surgery,Drum Tower Hospital from June 2014 to May 2018.There were 10 patients with tibial intercondylar eminence avulsion fracture (4 males and 6 females with an average age of 32.7 ± 9.2 years),13 patients with ACL injury (8 males and 5 females with an average age of 31.8 ± 10.9 years) and 22 patients with simple meniscus injury as controls (13 males and 9 females with an average age of 30.9 ± 10.6 years).They all had MRI examination of the knee before surgery.The width of intercondylar fossa and the width and height of bilateral femoral condyles were measured on high resolution images of MRI axial view.NWI was calculated.The 3 groups were compared in intercondylar fossa width and NWI.Results The 3 groups of patients were comparable because there were no significant differences in gender,age,height,weight or BMI between them (P ＞ 0.05).The intercondylar fossa width in the ACL injury group (17.4 ± 3.5 mm) was significantly smaller than that in the avulsion fracture group (20.8 ± 1.1 mm) or in the control group (20.2 ±2.6 mm) (P ＜ 0.05),but no significant difference was detected between the avulsion fracture group and the control group (P ＞ 0.05).NWI in the avulsion fracture group (0.301 ±0.011) was similar to that in the control group (0.280 ±0.039) (P ＞ 0.05) but significantly higher than that in the ACL injury group (0.25 ± 0.05) (P ＜ 0.05).NWI in the ACL injury group was significantly lower than that in the control group (P ＜ 0.05).Conclusions Intercondylar notch stenosis may be a risk factor for ACL injury but may not be associated with tibial intercondylar eminence avulsion fracture.The difference in pathogenesis between tibial intercondylar eminence avulsion fracture and ACL injury may be associated with their difference in NWI.

Arthroscopic double-row bridging suture versus minimally invasive locking plate system in treatment of avulsion fracture of humeral greater tuberosity / 中华创伤骨科杂志

Objective To compare arthroscopic double-row bridging suture and minimally invasive locking plate system in the treatment of simple avulsion fracture of humeral greater tuberosity.Methods A retrospective study was conducted of the 93 patients with avulsion fracture of humeral greater tuberosity who had been treated at Orthopaedic Center,Beijing Luhe Hospital from January 2012 to December 2016.Of them,38 were treated by arthroscopic double-row bridging suture (ADRB) and 55 by open reduction and internal fixation with minimally invasive locking plate system (MIPS).Regular X-ray follow-ups were carried out at 3,6 and 12 months postoperatively and every 6 months afterwards.Surgical time,range of motion (ROM) of the shoulder,American Shoulder and Elbow Surgeons (ASES) score,Visual Analogue Scale (VAS) and complications were recorded preoperatively and at the last follow-up.Results The patients of the arthroscopy and plate groups were comparable because there were no significant differences in the preoperative general data between them (P ＞ 0.05).The average follow-up time for the 93 patients was 35.9months (from 12 to 60 months).The operation time for the arthroscopy group (97.0 ± 20.1 min) was significantly longer than that for the plate group (67.5 ± 19.0 min) (P ＜ 0.05).At the last follow-up,anteflexion lift (152.6° ± 12.9°),abduction lift (154.0° ± 13.5°) and internal rotation angle at 90° (57.7° ±12.2°) in the arthroscopy group were significantly better than those in the plate group (134.9° ± 17.8°,129.5° ± 18.6° and 50.8° ± 12.9°,respectively) (P ＜ 0.05).At the last follow-up,the ASES scores for the arthroscopy and plate groups were 88.5 ± 7.6 and 85.1 ± 11.3,respectively,showing no statistically significant difference (P ＞ 0.05);the VAS scores for the 2 groups were 1.5 ± 1.2 and 2.2 ± 1.5 respectively,showing a statistically significant difference between the 2 groups (P ＜ 0.05).There was no significant difference between the2 groups in improvement of ASES scores (P ＞ 0.05).Ninety fractures healed after 3 months while 3 fractures in the arthroscopy group did after 6 months.In the plate group,7 patients developed shoulder stiffness 3 to 6 months after surgery and 3 ones reported pain during abduction.Conclusions Both ADRB and MIPS are an effective treatment for simple avulsion fracture of humeral greater tuberosity.MIPS fixation needs shorter surgical time while ADRB leads to better postoperative shoulder ROM.

Arthroscopic treatment of avulsion fracture of tibial origin with Ⅰ degree supination and external rotation injury / 中华外科杂志

Objective@#To analyze the clinical effects of all-inside arthroscopic treatment for the patients of avulsion fracture of tibial origin withⅠdegree supination and external rotation injury according to the Lauge-Hansen classification.@*Methods@#A retrospective analysis of 34 patients (34 feet) who had underwent all-inside arthroscopic for avulsion fracture of tibial origin with Ⅰ degree supination and external rotation injury from September 2015 to September 2017 in Department of Hand and Foot Microsurgery, Xuzhou Central Hospital. There were 20 males and 14 females, aged (24.7±11.3)years (range:14-43 years). The duration from injury to operation was (4.3±2.5) d (range: 6 h-7 d). The pro-operation visual analogue scale(VAS) of pain was 6.8±1.4(range: 4-8). All the patients were treated with the all-inside arthroscopic procedure by using the anterolateral and near-anterolateral portals and the fractures were fixed with cannulated screws. Main outcome measures included the pain, foot appearance, and patients were scored using the American Orthopaedic Foot & Ankle Society Lesser Toe Metatarsophalangeal-Interphalangeal Scale(AOFAS).@*Results@#Primarily healing of the wound was achieved in all cases without postoperative complications of nerve, vessel and tendon injury. The follow-up period was (16.9±6.6)months(range: 8-24 months). Postoperatively X-ray films showed complete fracture healing at (11.2±2.1)weeks after surgery.At the last follow-up, the ankle movement and appearance were good, and no ankle joint traumatic arthritis were found. The VAS and AOFAS was 0 and 95.7±9.4 respectively.@*Conclusion@#The all-inside arthroscopic treatment of Lauge-Hansen type avulsion fracture of tibial origin with Ⅰ degree supination and external rotation injury is an effective and precise method, with accurately outcomes, precise reduction and minimally postoperative complications.

Early effectiveness of arthroscopic three-point suture technique in treatment of anterior cruciate ligament tibial eminence avulsion fracture / 中国修复重建外科杂志

Objective: To investigate the early effectiveness of three-point suture technique in treatment of anterior cruciate ligament (ACL) tibial eminence avulsion fracture by arthroscopy. Methods: Between January 2016 and December 2017, 12 patients with ACL tibial eminence avulsion fractures underwent arthroscopic fixation of avulsion fractures with Ethibon suture using three-point suture technique. There were 9 males and 3 females, with an average of 36.4 years (range, 18-50 years). The fracture caused by traffic accident in 10 cases and sports in 2 cases. Among them, 1 patient was old fracture and 11 was fresh fracture. According to the modified Meyers-McKeever classification criteria, the fractures were rated as type Ⅲ in 7 cases and type Ⅳ in 5 cases. There were 2 cases of medial collateral ligament injury and medial meniscus injury. The preoperative International Knee Documentation Committee (IKDC) score was 37.9±4.7 and Lysholm score was 46.0±3.7. Results: All operations completed smoothly. The operation time was 45-70 minutes (mean, 61.3 minutes). The incisions healed by first intention in all patients. The hospitalization stays ranged from 4 to 9 days (mean, 5 days). All patients were followed up 3-20 months (mean, 9.3 months). The anterior drawer test, Lachman test, and axis shift test in all patients were negative after operation. At last follow-up, the IKDC score was 89.7±2.5 and Lysholm score was 90.2±1.9, which were significantly higher than those before operation ( t=-30.94, P=0.00; t=-33.03, P=0.00). At last follow-up, the X-ray films showed 9 cases of fracture anatomical reduction and 3 cases of almost anatomical reduction, and 12 cases of fracture healing. Conclusion: For ACL tibial eminence avulsion fracture, arthroscopic three-point suture technique can effectively restore the stability of knee joint and obtain satisfactory early effectiveness.

Study on development and biomechanics test of plastic rod-hook plate / 中国修复重建外科杂志

Objective: To develop a new type of internal fixation device which can be used to treat the minor avulsion fracture of the medial malleolus, lateral malleolus, the base of the fifth metatarsal, and the ulnar styloid process, and investigate the reliability and effectiveness of the device through biomechanical test. Methods: Eighty human's bone specimens with complete medial malleolus, lateral malleolus, the base of the fifth metatarsal, and the ulnar styloid process were selected and measured the anatomic indexes (the height, width, and thickness of medial malleolus, lateral malleolus, the base of the fifth metatarsal, and the ulnar styloid process). The CT three-dimensional reconstruction data of 200 healthy adults which including medial malleolus, lateral malleolus, the base of the fifth metatarsal, and the ulnar styloid process was also selected and measured the anatomic indexes by Mimics software. The plastic rod-hook plate was designed according to the measured results and prepared. Forty fresh porcine lower limb specimens were randomly divided into groups A and B (20 in each group), and 8 adult lower limb specimens including 4 left and 4 right were also randomly divided into groups A and B (4 in each group). All specimens were prepared for avulsion fracture of medial malleolus. Then, the fractures were fixed with plastic rod-hook plate in group A and wire anchor in group B. The load and axial torsion test of ankle joint were carried out by universal biomechanical testing machine. Results: According to the anatomical characteristics, a plastic rod-hook plate was designed successfully. The biomechanical test results between animal and human specimens were consistent. There was a linear relationship between load and displacement in the ankle distal load test. The displacement when loaded to the maximum load was significantly lower in group A than in group B ( P0.05). Conclusion: The biomechanical properties of plastic rod-hook plate is obviously better than wire anchor, and the fixation of avulsion fracture with plastic rod-hook plate is easy to operate, which is expected to be used in the clinical treatment of minor avulsion fractures such as medial malleolus, lateral malleolus, base of the fifth metatarsal, and ulna styloid process.

Open reduction and fixation with cannulated screws via the modified Burks-Schaffer approach versus arthroscopic EndoButton plating for avulsion fracture of the tibial attachment of the posterior cruciate ligament / 中华创伤骨科杂志

Objective To compare the clinical outcomes between open reduction and fixation with cannulated screws via the modified Burks-Schaffer approach versus arthroscopic EndoButton plating for avulsion fracture of the tibial attachment of the posterior cruciate ligament(PCL).Methods From February 2013 to August 2017,41 patients with acute displaced avulsion fracture of the tibial PCL attachment were treated operatively at Department of Trauma Surgery,The Affiliated Hospital to Qingdao University.They were 24 men and 17 women,aged from 18 to 65 years (average,39 years).The lefi knee was injured in 22cases and the right knee in 19.They were divided into 2 groups according to their different fixation methods.The open reduction and fixation group (23 cases) received open reduction and fixation with cannulated screws via the modified Burks-Schaffer approach while the arthroscopic group (18 cases) arthroscopic Endobutton plating.The 2 groups were compared in terms of operation time,bleeding,objective knee scores and knee range of motion (ROM) after operation.Results All the 41 patients were followed up from 23 to 40months (average,27.2 months).Their follow-up revealed no incision infection,malunion,nonunion or loosening of the implants.Their knee X-ray films at the final follow-ups showed bony union of all the avulsion fractures.There were significant differences between the open reduction and fixation group and the arthroscopic group in operation time (52.6±7.3 min versus 86.8±9.2 min) and bleeding (63.9±12.7 mL versus 19.7 ± 10.2 mL) (P ＜ 0.05).There was no significant difference in the objective knee scores or knee ROM between the 2 groups (P ＞ 0.05).Conclusions Both open reduction and cannulated screw fixation via the modified Burks-Schaffer approach and arthroscopic EndoButton plating can achieve satisfactory clinical outcomes in the treatment of avulsion fracture of the tibial PCL attachment.Although the 2 methods make no significant differences in stability of the knee joint or in clinical scores,the latter leads to less bleeding and the former shorter operation time.

Avulsion Fracture of the Posterior Cruciate Ligament from Femoral Insertion Occurred in a Patient with Residual Poliomyelitis: A Case Report

Avulsion fracture of the posterior cruciate ligament from its femoral insertion is quite rare, particularly in adults, and the treatment guidelines have not been established. A 68-year-old female patient with residual poliomyelitis presented with an avulsion fracture of the femoral insertion of the posterior cruciate ligament after a falling accident and was treated with arthroscopic headless compression screw fixation and pull-out suture of the avulsed ligament. We report this case with a relevant discussion of this type of injury.

Arthroscopic treatment of anterior cruciate ligament tibial eminence avulsion fracture with double heads compressive cannulated screw fixation in adolescents / 中国修复重建外科杂志

Objective: To discuss the effectiveness of arthroscopic treatment of anterior cruciate ligament (ACL) tibial eminence avulsion fracture in adolescents by using double heads compressive cannulated screw fixation. Methods: Twenty-four patients with ACL tibial eminence avulsion fractures were treated by arthroscopic reduction and internal fixation with double heads compressive cannulated screw fixation between June 2014 and June 2017. There were 15 males and 9 females with an average age of 12.3 years (range, 5-18 years). The body mass index was 19.3-26.4 kg/m 2 (mean, 23.3 kg/m 2). The injury causes included traffic accident injury in 10 cases, sports injury in 8 cases, and falling injury in 6 cases. According to the Meyers-McKeever classification, there were 19 cases of type Ⅱ and 5 cases of type Ⅲa. All patients’ drawer test and pivot shift test were positive. The interval between injury and operation was 3-14 days (mean, 6.2 days). During the follow-up period, the fracture healing condition of patients were determined by X-ray examination; Lysholm score, International Knee literature Committee (IKDC) score, and Tegner score were used to evaluate the knee function. Results: Primary healing of incision was obtained in all patients after operation. All the 24 patients were followed up 6-32 months (mean, 16.4 months). At 6 weeks after operation, 3 patients had difficulty in knee flexion. After the release of the knee joint by manipulation, the knee joint function recovered normally at 6 months after operation. At last follow-up, the X-ray films showed that all the fractures healed and no epiphyseal dysplasia, knee joint deformity, or leg length discrepancy occurred. The Lysholm score, IKDC score, and Tegner score were improved from preoperative 44.3±5.4, 43.7±4.4, and 3.0±1.3 to postoperative 93.1±4.3, 94.6±3.3, and 8.1±1.2, the differences were all significant ( t=25.152, P=0.000; t=28.634, P=0.000; t=13.226, P=0.000). Conclusion: The arthroscopic reduction and internal fixation with double heads compressive cannulated screw in treatment of ACL tibial avulsion fracture (Meyers-McKeever type Ⅱ and Ⅲ) in adolescents has so many advantages, such as minimal trauma, simple operation, firm fixation, little effect on the epiphyseal plate, and has a good joint function recovery.

Suture-bridge fixation under arthroscopy in treatment of tibial eminence avulsion fracture of anterior cruciate ligament in adolescents / 中国修复重建外科杂志

Objective: To explore effectiveness of suture-bridge fixation under arthroscopy in treatment of tibial eminence avulsion fracture of anterior cruciate ligament in adolescents. Methods: Between June 2013 and October 2016, 18 adolescent patients suffered tibial eminence avulsion fracture of anterior cruciate ligament were treated by suture-bridge fixation under arthroscopy. There were 11 males and 7 females with an average age of 12.5 years (range, 5-17 years). The injury caused by bruise in 6 cases, by sprain in 4 cases, and by sport injury in 8 cases. The interval between injury and admission ranged from 2 hours to 10 months (mean, 2 months). The results of preoperative Lachman and anterior drawer tests were positive. There were 10 cases of knee pain, 4 cases of knee extension limitation, and 4 cases of knee extension without strength. According to the Meyer-McKeever classification criteria, 12 cases were type Ⅱ and 6 cases were type Ⅲ. Results: All incisions healed by first intention. All 18 patients were followed up 10-18 months after operation, with an average of 12 months. Postoperative X-ray films showed that all fractures healed after 6-12 weeks (mean, 8 weeks). The results of postoperative Lachman and anterior drawer tests were negative. At last follow-up, the Lysholm knee score was 90.1±5.0 and 93.1±6.2 for affected and unaffected sides, respectively, showing no significant difference between affected and unaffected sides( t=0.669, P=3.184［?］). There was no premature closure of skeleton or leg length discrepancy and deformity. Conclusion: For tibial eminence avulsion fracture of anterior cruciate ligament in adolescents, the suture-bridge fixation under arthroscopy is an effective method with many advantages, such as minimal invasion, reliable fixation, good fracture healing, and no need for second operation to remove implants.

Clinical comparative study of two kinds of fixation methods by arthroscopy in treatment of ACL tibial avulsion fracture / 中国内镜杂志

Objective To investigate the clinical effects' differences of screw and suture fixation by arthroscopy in treatment of patients with ACL tibial avulsion fracture. Methods 80 patients with ACL tibial avulsion fracture were chosen and randomly divided into both groups including A group (40 patients) with suture fixation by arthroscopy and B group (40 patients) with screw fixation by arthroscopy; and the operation time, the Lysholm knee score, the IKDC knee function subjective scale score, the difference of uninjured and injured side displacement, and the incidence of flexion contracture of both groups were compared. Results The operation time of B group were significantly shorter than A group (P < 0.05). There was no significant difference in the Lysholm knee score, the IKDC knee function subjective scale score and the difference of uninjured and injured side displacement between the two groups (P > 0.05). There was no significant difference in the incidence of flexion contracture between the two groups (P > 0.05). Conclusion Screw and suture fixation by arthroscopy in treatment of patients with ACL tibial avulsion fracture possess the same clinical effects to higher the stability of reduction and improve the joint motion function; but screw fixation by arthroscopy application can efficiently shorten the operation time and reduce the operation difficulty.