Tibial tubercle fracture associated with distal rupture of the patellar tendon: case report / Fratura da tuberosidade anterior da tíbia associada à ruptura distal do tendão patelar: relato de caso

ABSTRACT Avulsion of the tibial tubercle is an uncommon injury that occurs in the young athlete, resulting from an eccentric contraction of the extensor mechanism with the leg fixed to the ground. Concomitant injuries to the patellar tendon are very rare, with few cases reported in the literature. The authors present a case of a 15-year-old basketball player who suffered an avulsion of the tibial tubercle associated with complete distal rupture of the patellar tendon while training. It was treated with open reduction of the tibial fragment and reconstruction of the patellar tendon with mini-anchors and cannulated screws, as well as hamstring autograft tendon reinforcement. The patient showed excellent results and returned to sports after 12 months of follow-up.

RESUMO A fratura-avulsão da tuberosidade anterior da tíbia é uma lesão incomum que ocorre no jovem atleta, resultado de uma contração excêntrica do mecanismo extensor do joelho com o membro inferior fixo ao solo. Lesões concomitantes ao tendão patelar são muito raras, com poucos casos relatados na literatura. Os autores apresentam o caso de um atleta de basquete de 15 anos que sofreu uma fratura-avulsão da tuberosidade anterior da tíbia associada à ruptura completa distal do tendão patelar durante movimento de arremesso no treino esportivo. O paciente foi tratado com redução aberta da fratura e reparo do tendão patelar com miniâncoras e parafuso poste com reforço tendinoso com enxerto autólogo de semitendíneo. O paciente apresentou ótimos resultados e retornou ao esporte após 12 meses de acompanhamento.

Calcaneal Apophyseal Avulsion Fractures with Achilles Tendon Rupture in a 10-Year-Old Patient: A Case Report / 대한족부족관절학회지

Calcaneal apophysitis is a relatively common disease in young athletes. On the other hand, if not treated properly, it can lead to apophyseal avulsion fracture in rare cases. In the case of apophyseal avulsion fractures, it is often necessary to remove or preserve the bone fragment, which often requires a suture of the Achilles tendon. A 10-year-old badminton athlete visited the outpatients' clinic with pain in both heels from 10 months ago without any trauma history. After conservative therapy, the pain in the left heel was relived but the right heel pain persisted. After 10 months of conservative therapy, the patient visited the outpatients' clinic showing a calcaneal apophyseal avulsion fracture with a total rupture of the Achilles tendon. In the operation room, a bone fragment needed to be removed because of its poor viability and the fragment was too thin for fixation. After removing the bone fragment, the ruptured Achilles tendon was fixed with an anchor system.

Outcome of Isolated PCL Avulsion Fractures Treated with Cancellous Screw Fixation.

Background: Isolated PCL avulsion fractures are uncommon. The road traffic accidents (RTA), sports injuries are common causes along with domestic trauma. Methods: We conducted a prospective study with sample size of 34 patients to evaluate the outcome of isolated PCL avulsion fractures treated with cancellous cannulated screws over washers. Results: Our study included 47.06% RTA, 26.47% sports trauma and 26.47% domestic injuries. Standard Burks schaffers approach was used in all 34 cases. Delayed union was found in 5.88 % beyond 16 weeks although none needed revision or reconstruction. The delayed union was obvious in patients with comminuted fractures, which were fixed with washers on screws along with pull through sutures. All the cases were evaluated using Lysholm, IKDC and objective PDT manual examination. Conclusion: The isolated PCL avulsion fractures treated with fixation have good Lysholm and IKDC scores, although objective laxity is present in significant number of cases without subjective disability. The isolated PCL injuries have good results if managed surgically.

Lesiones deportivas en niños y adolescentes / Pediatric and adolescent sports injuries

El aumento en la actividad deportiva de niños y adolescentes ha derivado en un aumento de las lesiones esqueléticas atribuidas a la actividad física. El aparato locomotor infantil presenta particularidades que hacen que los patrones de lesión difieran a lo que ocurre en los adultos. Se producen lesiones agudas y de sobrecarga que se presentan en edades y sitios específicos. Debido a la alta frecuencia de aparición de ellas, es necesario que los médicos que atienden niños estén familiarizados con los cuadros más frecuentes. En este artículo se revisan los aspectos más importantes de las principales lesiones deportivas en niños y adolescentes resumiendo las principales consideraciones diagnósticas, terapéuticas y pronósticas.

The increase in sport activity of children and adolescents has led to an increase in skeletal lesions attributed to physical activity. The children’s musculoskeletal system presents particularities that make injury patterns defer to those that occur in adults. Acute and overluse injuries are produced, which occur in specific locations and ages. Due to the high frequency of their occurrence, it is necessary that physicians who treat children are familiar with the most frequent conditions. In this article the most important aspects of major sports injuries in children and adolescents are reviewed by summarizing the main diagnostic, therapeutic and prognostic considerations.

Intra-articular Avulsion Fractures of the Malleolus in Chronic Ankle Pain / 대한족부족관절학회지

PURPOSE: We report our results of arthroscopic treatment of symptomatic avulsion fracture of the malleolus in chronic ankle pain, and also analyzed the clinical and radiological features for evaluating the good candidate for arthroscopic treatment. MATERIALS AND METHODS: Fourteen patients who were diagnosed with intra-articular avulsion fractures of the malleolus received arthroscopic surgery and were followed up for at least a year. The clinical and radiological characters including MRI and arthroscopic findings were reviewed. Clinical assessments were done according to the AOFAS score system. RESULTS: There was a history of inversion type of the injury in most cases and local tenderness of lesion site was a unique. MRI study showed thickened anterior talofibular ligament (ATFL) in 8 cases (57%) and discontinued ATFL in 3 cases (21%). Enhanced signal surrounding soft tissue corresponding to synovial inflammation and impingement was found in 12 cases (86%). Preoperative score of all patients were 74.0+/-5.5, which improved to 89.3+/-6.7 at the follow-up after the treatment (P<0.001). CONCLUSION: Most patients had history of injury and localized tenderness in the area coinciding with radiological findings. Thickened ATFL and contrast enhancement around the ossicle were frequently found. Symptomatic avulsion fractures of the malleolus associated with the clinical and radiological findings above could be a good candidate for arthroscopic treatment.

Intra-articular Avulsion Fractures of the Malleolus in Chronic Ankle Pain / 대한족부족관절학회지

PURPOSE: We report our results of arthroscopic treatment of symptomatic avulsion fracture of the malleolus in chronic ankle pain, and also analyzed the clinical and radiological features for evaluating the good candidate for arthroscopic treatment. MATERIALS AND METHODS: Fourteen patients who were diagnosed with intra-articular avulsion fractures of the malleolus received arthroscopic surgery and were followed up for at least a year. The clinical and radiological characters including MRI and arthroscopic findings were reviewed. Clinical assessments were done according to the AOFAS score system. RESULTS: There was a history of inversion type of the injury in most cases and local tenderness of lesion site was a unique. MRI study showed thickened anterior talofibular ligament (ATFL) in 8 cases (57%) and discontinued ATFL in 3 cases (21%). Enhanced signal surrounding soft tissue corresponding to synovial inflammation and impingement was found in 12 cases (86%). Preoperative score of all patients were 74.0+/-5.5, which improved to 89.3+/-6.7 at the follow-up after the treatment (P<0.001). CONCLUSION: Most patients had history of injury and localized tenderness in the area coinciding with radiological findings. Thickened ATFL and contrast enhancement around the ossicle were frequently found. Symptomatic avulsion fractures of the malleolus associated with the clinical and radiological findings above could be a good candidate for arthroscopic treatment.