Acute tibial tubercle avulsion fractures in children: selective use of the closed reduction and internal fixation method

The Bosworth ankle fracture-dislocation is a rare injury and is often irreducible because of an entrapped proximal fragment of the fibula behind the posterior tibial tubercle. Repeated closed reduction or delayed open reduction may result in several complications. Thus, early open reduction and internal fixation enable a better outcome by minimizing soft-tissue damage. We report on a 27-year-old man who underwent open reduction and internal fixation after multiple attempts at failed closed reduction, complicated by severe soft-tissue swelling, rhabdomyolysis, and delayed peroneal nerve palsy around the ankle.

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Short-term Outcomes of Herbert Screw Fixation for Isolated Olecranon Fractures in Children: a Single-institution Retrospective Study

10.21203/rs.3.rs-287204/v1 ◽

2021 ◽

Author(s):

Yang Li ◽

Kelai Wang ◽

Dong Sun ◽

Yakun Liu ◽

Jingwei Liu ◽

...

Keyword(s):

Clinical Outcomes ◽

Closed Reduction ◽

Screw Fixation ◽

Young Patients ◽

Ossification Center ◽

Fixation Method ◽

Short Version ◽

Herbert Screw ◽

Fractures In Children ◽

Olecranon Fractures

Abstract Background: Although various fixation methods can be used for the treatment of displaced olecranon fractures, there are no clear indications in the current literature regarding which surgical technique should be adopted. In this study, we evaluated the clinical and radiological outcomes of closed reduction with percutaneous Herbert screw fixation in children with isolated olecranon fractures.Methods: We retrospectively reviewed the records of children treated at our center for isolated olecranon fractures (Mayo type IIA) with closed reduction and percutaneous Herbert screw fixation between January 2016 and December 2018. Radiographic assessment of fracture healing was performed 6–8 months postoperatively and included assessment for loss of reduction and maximum length of the ulna. Clinical outcomes included elbow flexion and extension, forearm pronation and supination, short version of the Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, and complications. The Herbert screws were removed by a second operation.Results: A total of 14 patients with an average age at the time of injury of 11.36 (range, 10–14) years were included. All patients had good radiological and clinical outcomes at 6–8 months postoperatively; all had normal elbow ranges of motion and showed complete bone healing on radiographs. There were no cases of foreign body irritation, implant migration, or osteoarthritis. Premature epiphyseal closure was noted in six patients. The average QuickDASH score was 1.58. Conclusions: Fixation of olecranon fractures with Herbert screws is a safe and easy fixation method in young patients, leading to good functional and radiological results. Nonetheless, determination of the effects of this treatment method on the olecranon ossification center requires long-term follow-up.

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Closed reduction using the percutaneous leverage technique and internal fixation with K-wires to treat angulated radial neck fractures in children-case report

Medicine ◽

10.1097/md.0000000000005806 ◽

2017 ◽

Vol 96 (1) ◽

pp. e5806 ◽

Cited By ~ 1

Author(s):

Hai Jiang ◽

Yongtao Wu ◽

Youting Dang ◽

Yusheng Qiu

Keyword(s):

Case Report ◽

Internal Fixation ◽

Closed Reduction ◽

Radial Neck ◽

Fractures In Children ◽

Radial Neck Fractures ◽

K Wires

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Bilateral Tibial Tubercle Avulsion Fractures in Children – Clinical Results of a Rare Fracture

Zeitschrift für Orthopädie und Unfallchirurgie ◽

10.1055/a-0979-2384 ◽

2019 ◽

Vol 158 (05) ◽

pp. 466-474

Author(s):

Francisco Fernandez Fernandez ◽

Oliver Eberhardt ◽

Steffen Schröter ◽

Thomas Wirth ◽

Christoph Ihle

Keyword(s):

Clinical Results ◽

Tibial Tubercle ◽

Avulsion Fractures ◽

Type Iv ◽

Fractures In Children ◽

Activity Scale ◽

K Wires ◽

Type V ◽

Tegner Activity Scale

Abstract Background Tibial tubercle avulsion fractures are rare, they represent less than 1% of all physeal fractures. Compared to monolateral tibial tubercle avulsion fractures, bilateral occurrence is even rarer. The purpose of this study is to report about the so far largest group of bilateral avulsion fractures and to compare them to unilateral fractures as well as to current literature. Method All patients who suffered from bilateral tibial tubercle fractures between January 2009 and March 2019 were included. All medical records and radiographs were reviewed and a clinical follow-up was performed. The examined criteria were age, gender, mechanism of injury, classification, risk factors, complications, management and outcomes. Clinical outcome was measured using the well established Tegner activity scale and Lysholm-Gillquist score. The same criteria were analyzed in a literature review of bilateral tibial tubercle fractures to compare our results to available literature. Results We found four children with bilateral tibial tubercle avulsion fractures. All patients were male with a mean age of 14.5 ± 0.7 years (13 – 15). Mean follow-up examination was 13.6 ± 6.5 months (8 – 29) after surgery. The avulsions occurred during jumping activities in all cases. All children could no longer stand or move because of sudden pain in the knee. We found type IV fractures in three cases, type III fractures in four cases and one type V fracture according to the Ogden classification. All children were treated by open or closed reduction and stabilization with screws or K-wires. Follow-up showed complete fracture healing without complications in all patients. There were no changes in Tegner activity scale and Lysholm-Gillquist Score and knee function comparable to prior to the accident was achieved in all cases. Conclusion Good clinical results without restrictions regarding function of the knee joint can be achieved by direct operative treatment of bilateral tibial avulsion fractures. A reduction in sporting activity has not to be expected. There were no differences between bilateral or unilateral tibial tubercle avulsion fractures.

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Unicortical Fixation is Sufficient for Surgical Treatment of Tibial Tubercle Avulsion Fractures in Children

Journal of Pediatric Orthopaedics ◽

10.1097/bpo.0000000000001269 ◽

2019 ◽

Vol 39 (1) ◽

pp. e18-e22 ◽

Cited By ~ 7

Author(s):

Alexandre Arkader ◽

Mathew Schur ◽

Christian Refakis ◽

Anthony Capraro ◽

Regina Woon ◽

...

Keyword(s):

Surgical Treatment ◽

Tibial Tubercle ◽

Avulsion Fractures ◽

Fractures In Children

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Tibial tubercle avulsion fractures in children

Current Opinion in Pediatrics ◽

10.1097/mop.0000000000000870 ◽

2020 ◽

Vol 32 (1) ◽

pp. 86-92 ◽

Cited By ~ 1

Author(s):

Pia Franz ◽

Eva Luderowski ◽

María Tuca

Keyword(s):

Tibial Tubercle ◽

Avulsion Fractures ◽

Fractures In Children

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Modified Closed Reduction and Percutaneous Kirschner Wires Internal Fixation for Treatment of Supracondylar Humerus Fractures in Children

Current Medical Science ◽

10.1007/s11596-021-2396-0 ◽

2021 ◽

Vol 41 (4) ◽

pp. 777-781

Author(s):

Shu-bin Wang ◽

Bin-hui Lin ◽

Wei Liu ◽

Guo-jun Wei ◽

Zong-guang Li ◽

...

Keyword(s):

Internal Fixation ◽

Closed Reduction ◽

Kirschner Wires ◽

Fractures In Children ◽

Supracondylar Humerus Fractures ◽

Humerus Fractures

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Closed Reduction and Percutaneous Pinning Versus Open Reduction and Internal Fixation for Type II Lateral Condyle Humerus Fractures in Children Displaced >2 mm

Journal of Pediatric Orthopaedics ◽

10.1097/bpo.0000000000000570 ◽

2016 ◽

Vol 36 (8) ◽

pp. 780-786 ◽

Cited By ~ 21

Author(s):

Andrew T. Pennock ◽

Lissette Salgueiro ◽

Vidyadhar V. Upasani ◽

Tracey P. Bastrom ◽

Peter O. Newton ◽

...

Keyword(s):

Internal Fixation ◽

Closed Reduction ◽

Open Reduction ◽

Lateral Condyle ◽

Type Ii ◽

Percutaneous Pinning ◽

Fractures In Children ◽

Humerus Fractures

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Tibial Tubercle Avulsion Fractures in Adolescents: A Narrative Review & Case Report

Journal of Orthopedics and Orthopedic Surgery ◽

10.29245/2767-5130/2021/3.1149 ◽

2021 ◽

Vol 2 (3) ◽

pp. 12-18

Author(s):

Gregory W. Kunis ◽

Joshua A. Berko ◽

Jeffrey C. Shogan ◽

Joshua B. Sharan ◽

Derek Jones

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Avulsion Fracture ◽

Open Reduction Internal Fixation ◽

Fracture Pattern ◽

Tibial Tuberosity ◽

Tibial Tubercle ◽

Significant Past Medical History ◽

Anterior Portion ◽

Avulsion Fractures

Intro: Tibial tuberosity avulsion fractures are rare fracture patterns accounting for less than 1% of all pediatric fractures. These fractures occur when there is a sudden unbalancing of forces through the patellar tendon that separates the tibial tubercle from the anterior portion of the proximal tibia. These forces are commonly introduced in sporting activities and show a predominance for adolescent males. Treatment with open reduction internal fixation commonly results in favorable outcomes with minimal complications. In this presentation, we explore a case of a tibial tuberosity avulsion fracture and give an in-depth review of all aspects concerning this fracture pattern. Case Description: A 14-year-old male with no significant past medical history presented via emergency medical services after a ground level fall while playing basketball. Radiographs of the left knee and tibia revealed an Ogden Type III, distracted avulsion fracture of the tibial tuberosity with suprapatellar effusion. Surgical intervention was achieved through open reduction internal fixation of the left tibial tubercle. Discussion: Although a relatively rare fracture pattern, this case demonstrates a classic presentation and treatment of a tibial tuberosity avulsion fracture. This case serves as a reminder that despite the rarity of the injury, a clinician with an appropriate index of suspicion can accurately diagnose and treat this fracture and achieve positive outcomes in returning the patient to pre-injury activities. For those reasons, we provide a comprehensive overview of all aspects regarding this fracture pattern including the anatomy, embryology, mechanism of action, predisposing conditions, treatment considerations, complications and associated injuries.

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Comparative analysis of surgical outcome of treatment of supracondylar humerus fractures Gartland’s extension type III by using closed reduction and K –wire fixation versus open reduction and K –wire fixation method

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20170080 ◽

2017 ◽

Vol 3 (2) ◽

pp. 271

Author(s):

Nilesh Janardan Keche ◽

Abhijit Bhimrao Kale ◽

Binoti Arun Sheth ◽

Ashok Kumar Rathod

Keyword(s):

Internal Fixation ◽

Closed Reduction ◽

Open Reduction ◽

Fixation Method ◽

Elbow Fracture ◽

Supracondylar Humerus Fractures ◽

Wire Fixation ◽

Group 2 ◽

K Wires ◽

Group 1

Background: Supracondylar fractures of the humerus are the most common elbow fracture in children of the age group 4-12 years. The modern approach for its treatment includes closed reduction or open reduction and internal fixation with K wires. The aim of the present study was to evaluate the clinical and radiological results of children who were treated with the two surgical approaches.Methods: In our institute children who underwent surgical treatment for supracondylar humeral fractures by closed reduction or open reduction and internal fixation with K wires and whose data were available with regular follow-up of at least 1 year were included in the study. Each group included 25 children in each. Clinical and radiological outcomes were evaluated and compared among the study groups.Results: The mean age of the patients in both the groups were 6.84 and 6.64 in group 1 and group 2 respectively. Fractures were more in boys compared to girls in both the groups. Most of the fractures were seen on left side with posteromedial displacement of distal fragment in almost 80% in both the groups. Mean change in Baumann’s angle (BA), carrying angle and range of motion (ROM) as compared to normal side in both the groups after 3rd and 9th month of follow ups was found to be not statistically significant. Overall result according to Flynn’s criteria was 60% excellent in group 1 as compared to 52% in group 2. Mean satisfaction score was also more in group 1 children when compared to group 2. Conclusions: Closed reduction with internal fixation with K wires was found to be a better choice of treatment with good functional results.

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