Lesser Tuberosity Avulsion Fracture in an 11-Year-Old Baseball Player due to Batting

Case. We report an 11-year-old male who sustained a lesser tuberosity avulsion fracture of the proximal humerus upon making contact with a baseball during an at-bat. This injury was neglected for 14 months and was eventually detected by an axillary radiograph and subsequent MRI. He successfully underwent an open surgical repair and regained full range of motion and level of activity at 1-year follow-up. Conclusion. In pediatric baseball players, lesser tuberosity avulsion fractures may occur upon striking a baseball with a bat. Even after being neglected for several months, these injuries can be treated successfully with an open surgical repair.

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Arthroscopic Fixation of Avulsion Fractures of the Lesser Tuberosity of the Humerus: Clinical Outcomes With a Mean 3.5-Year Follow-up

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211029886 ◽

2021 ◽

Vol 9 (9) ◽

pp. 232596712110298

Author(s):

Lin Lin ◽

Jian Xiao ◽

Guoqing Cui ◽

Hui Yan

Keyword(s):

Los Angeles ◽

Clinical Outcomes ◽

Full Range ◽

Case Series ◽

Arthroscopic Repair ◽

Suture Anchors ◽

Avulsion Fractures ◽

Lesser Tuberosity ◽

Arthroscopic Fixation

Background: Avulsion fracture of the lesser tuberosity (AFLT) of the humerus has traditionally been treated with open reduction internal fixation using screw fixation. The clinical outcomes of arthroscopic repair with suture anchors remains unknown. Hypothesis: It was hypothesized that arthroscopic fixation with suture anchors would result in good clinical outcomes for the treatment of AFLT. Study Design: Case series; Level of evidence, 4. Methods: This study included 15 patients who underwent arthroscopic repair of AFLT of the humerus between January 2014 and October 2017. All patients had 3-dimensional computed tomography scans and magnetic resonance imaging to evaluate the avulsed fracture and concomitant injuries before surgery. The arthroscopic double-row and suture-bridge techniques were used based on the morphology of the avulsion fractures. Functional outcomes were assessed with range of motion, the visual analog scale (VAS) for pain, the Subjective Shoulder Value (SSV), the American Shoulder and Elbow Surgeons (ASES) score, and the University of California, Los Angeles (UCLA) shoulder score. The bear-hug test, liftoff test, and internal rotation resistance test at 90° abduction and external rotation (IRRT 90°) were used to evaluate subscapularis tendon integrity. Results: The mean follow-up time was 3.5 years (range, 3-5 years). Comminuted fractures with 1 large part and ≥1 small pieces were seen in 12 cases, partial tear of the supraspinatus in 2 cases, Bankart lesion in 2 cases, and superior labrum anterior to posterior injury in 2 cases. There was a statistically significant improvement from the baseline to the final follow-up in the VAS (from 6.9 ± 1.5 to 1.1 ± 1), SSV (from 30.7 ± 5.1 to 90.5 ± 11.6), ASES (from 28.5 ± 7.7 to 92.3 ± 4.5), and UCLA (from 29.5 ± 6.3 to 94.2 ± 8.3) scores ( P < .001 for all). All patients showed full range of shoulder motion and bilateral symmetric strength on physical examination with the bear-hug test, liftoff test, and IRRT 90° test. Conclusion: The arthroscopic repair of AFLT resulted in excellent reduction and healing of the displaced fragment. At the final follow-up, clinical and functional results were good. Associated injuries occurred in 40% of patients but did not affect outcomes.

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Avulsion fracture of tibial insertion of PCL - operative management and outcome

Pulse ◽

10.3329/pulse.v4i1.6957 ◽

2010 ◽

Vol 4 (1) ◽

pp. 14-15 ◽

Cited By ~ 2

Author(s):

M Ali ◽

P Agrawal ◽

N Katakdhond ◽

M Arshadullah

Keyword(s):

Surgical Management ◽

Avulsion Fracture ◽

Full Range ◽

Operative Management ◽

Study Group ◽

Range Of Movement ◽

Avulsion Fractures ◽

Tibial Insertion ◽

The Mean

There are controversies about the management of the PCL injuries among the Orthopaedic surgeons. We present our result of 14 cases that underwent surgical management for the avulsion fracture of the tibial insertion of the PCL. Open reduction and internal fixation of the avulsion fracture of the tibial insertion of the PCL were done and results were analyzed. The study group consisted of 13 males and 1 female; the mean age was 27 years. The avulsion fractures of more than 3 weeks old were excluded. The result showed that there were no instability in any of the patients and each patient obtained pain free, full range of movement for the affected knee within a mean follow-up period of 11 months. Therefore it is recommended to take up surgical management for avulsed PCL if presented within 3 weeks of injury.DOI: http://dx.doi.org/10.3329/pulse.v4i1.6957Pulse Vol.4 January 2010 p.14-15

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State-of-the-art aortic imaging: Part II - applications in transcatheter aortic valve replacement and endovascular aortic aneurysm repair

VASA ◽

10.1024/0301-1526/a000324 ◽

2014 ◽

Vol 43 (1) ◽

pp. 6-26 ◽

Cited By ~ 12

Author(s):

Fabian Rengier ◽

Philipp Geisbüsch ◽

Paul Schoenhagen ◽

Matthias Müller-Eschner ◽

Rolf Vosshenrich ◽

...

Keyword(s):

Aortic Valve ◽

Transcatheter Aortic Valve Replacement ◽

Surgical Repair ◽

Imaging Modality ◽

Open Surgical Repair ◽

Cross Sectional ◽

Transcatheter Aortic Valve ◽

Cross Sectional Imaging ◽

Sectional Imaging

Transcatheter aortic valve replacement (TAVR) as well as thoracic and abdominal endovascular aortic repair (TEVAR and EVAR) rely on accurate pre- and postprocedural imaging. This review article discusses the application of imaging, including preprocedural assessment and measurements as well as postprocedural imaging of complications. Furthermore, the exciting perspective of computational fluid dynamics (CFD) based on cross-sectional imaging is presented. TAVR is a minimally invasive alternative for treatment of aortic valve stenosis in patients with high age and multiple comorbidities who cannot undergo traditional open surgical repair. Given the lack of direct visualization during the procedure, pre- and peri-procedural imaging forms an essential part of the intervention. Computed tomography angiography (CTA) is the imaging modality of choice for preprocedural planning. Routine postprocedural follow-up is performed by echocardiography to confirm treatment success and detect complications. EVAR and TEVAR are minimally invasive alternatives to open surgical repair of aortic pathologies. CTA constitutes the preferred imaging modality for both preoperative planning and postoperative follow-up including detection of endoleaks. Magnetic resonance imaging is an excellent alternative to CT for postoperative follow-up, and is especially beneficial for younger patients given the lack of radiation. Ultrasound is applied in screening and postoperative follow-up of abdominal aortic aneurysms, but cross-sectional imaging is required once abnormalities are detected. Contrast-enhanced ultrasound may be as sensitive as CTA in detecting endoleaks.

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Treatment Outcomes of Lesser Tuberosity Osteotomy Nonunion After Total Shoulder Arthroplasty

Journal of Shoulder and Elbow Arthroplasty ◽

10.1177/2471549218807777 ◽

2018 ◽

Vol 2 ◽

pp. 247154921880777

Author(s):

Zachary J Bloom ◽

Cesar D Lopez, BA ◽

Stephen P Maier ◽

Brian B Shiu ◽

Djuro Petkovic ◽

...

Keyword(s):

Treatment Outcomes ◽

Shoulder Arthroplasty ◽

Surgical Repair ◽

Total Shoulder Arthroplasty ◽

Case Series ◽

Radiographic Evaluation ◽

Lesser Tuberosity ◽

Conservative Care ◽

Conservative Group

Introduction Lesser tuberosity osteotomy (LTO) during anatomic total shoulder arthroplasty has a 13% nonunion rate. Treatment for LTO nonunion is controversial and poorly described in the literature. The purpose of this study was to compare the surgical and nonsurgical treatment outcomes of LTO nonunion. Methods A retrospective case series of 9 consecutive patients with LTO nonunion after primary anatomic shoulder arthroplasty at 1 institution from 2010 to 2016 were studied. Outcomes measured were radiographic evaluation of LTO on axillary X-ray, clinical range of motion (ROM), subscapularis strength, and pain at the time of LTO nonunion diagnosis and after either conservative care or surgical repair of the LTO nonunion. Results LTO nonunion was treated surgically in 4 and conservatively in 5 patients with average follow-up of 30 and 22 months, respectively. There were no significant differences in age, sex, or smoking status between groups. Treatment decision was a shared model of surgeon and patient. Displaced LTO nonunion was treated surgically in 2 and conservatively in 3 patients. There were no differences in LTO union rate of 50% in the surgical versus 60% in the conservative group. Abdominal compression test was abnormal in 50% of surgical versus 40% of conservative groups. At follow-up, ROM was lower in the surgical group with 128° forward elevation (FE) and 33° external rotation (ER) compared to 148° FE and 62° ER. Only 1 patient with LTO nonunion required conversion to reverse replacement. Conclusion LTO nonunion after shoulder arthroplasty is rare. Surgical repair of LTO nonunion does not significantly improve clinical or radiographic outcomes compared to conservative care.

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Quadriceps reconstruction with suture anchor and Achilles allograft combination in quadriceps tendon re-rupture after primary surgical repair: A novel technique

Joint Diseases and Related Surgery ◽

10.52312/jdrs.2021.14 ◽

2021 ◽

Author(s):

Erhan Okay ◽

Mehmet Cenk Turgut ◽

Abbas Tokyay

Keyword(s):

Suture Anchor ◽

Surgical Repair ◽

Primary Repair ◽

Full Range ◽

Knee Extensor ◽

Quadriceps Tendon ◽

Extensor Mechanism ◽

Surgical Options ◽

Knee Extensor Mechanism

Quadriceps ruptures are one of the pathological conditions of the knee extensor mechanism, accounting for 3% of all tendon injuries. These injuries cause substantial disability of the extensor mechanism. Primary repair is the treatment of choice in acute presentation. In the setting of chronic conditions, the treatment becomes more challenging. Available surgical options include lengthening procedures, and reconstruction with auto graft or allografts. The traditional Scuderi and Codivilla techniques are challenging to perform in degenerative or traumatic retracted ruptures. There is no standard effective treatment in these patients, which yields the best clinical and biomechanical outcomes. An 18 - year-old male patient with quadriceps re-rupture after a primary repair was managed with allograft reconstruction using suture anchors. At six years of follow-up, the patient gained a full range of motion with excellent clinical outcomes. He returned to his previous work. In conclusion, quadriceps reconstruction using suture anchor and Achilles allograft combination is a feasible technique in neglected cases who present with quadriceps tendon re-rupture after primary surgical repair.

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VP021 A WAY TO TREAT SPIGELIAN HERNIA

British Journal of Surgery ◽

10.1093/bjs/znab395.157 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Bruno Barbosa ◽

Raquel Pereira ◽

Cesar Prudente ◽

Maria Joao Diogo ◽

Carlos Casimiro ◽

...

Keyword(s):

Hospital Stay ◽

Laparoscopic Repair ◽

Surgical Repair ◽

Laparoscopic Approach ◽

Spigelian Hernia ◽

Laparoscopic Technique ◽

Open Surgical Repair ◽

Intraperitoneal Route ◽

Abdominal Hernias

Abstract Aim “Spigelian hernia is uncommon and accounts for only 0.12–2% of all abdominal hernias. It is mandatory to perform surgical correction and in recent years the laparoscopic approach is gaining ground. The authors pretend to demonstrate a video of an outpatient laparoscopic repair of Spigelian hernia.” Material and Methods “53-year-old woman with a left Spigelian hernia referred to laparoscopic repair via intraperitoneal approach.” Results “The patient was submitted to laparoscopic correction with a Ventralex® mesh. The surgery went without any complication and under 30 minutes. A few hours after the surgery, the patient was discharged. In the follow-up appointment, the patient had no complaints or evidence of recurrence.” Conclusions “Spigelian hernias are rare and have a mandatory surgical indication. Traditionally, open surgical repair is most commonly used. However, laparoscopic approach is becoming increasingly popular since it allows faster recovery, shorter hospital stay, and less pain, with no commitment to recurrence. Currently, there are no studies that demonstrate the superiority of a laparoscopic technique (intraperitoneal, TAPP or TEP). The intraperitoneal route is a simple, faster, and easily reproducible approach.”

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Isolated PCL and ACL Avulsion Fractures of the Knee

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967114s00185 ◽

2014 ◽

Vol 2 (11_suppl3) ◽

pp. 2325967114S0018

Author(s):

Özgur Baysal ◽

Engin Ecevız ◽

Fevzi Saglam ◽

Nurzat Elmalı

Keyword(s):

Range Of Motion ◽

Avulsion Fracture ◽

Weight Bearing ◽

Full Range ◽

Imaging Modalities ◽

Advanced Imaging ◽

Avulsion Fractures ◽

Pull Out ◽

Partial Weight ◽

Acl Avulsion

Objectives: Isolated combined PCL and ACL avulsion fractures is a rare condition. A 40 year old woman had both PCL and ACL avulsion fracture due to a car accident. These fractures often have a subtle appearance at conventional radiography. Advanced imaging modalities, particularly CT and MRI are helpful to diagnose correctly and define the extent of damage. The aim of the study was point out this rare injury. We diagnosed this patient who had both PCL and ACL avulsion fractures. In the literature only a few case have been reported. We think that these fractures may be missed in the Emergency Department. If a patient is brought to the ED with high-velocity trauma, careful evaluation of bone and soft tissues followed by advanced imaging modalities should be performed. Methods: The PCL avulsion fracture was fixed with a cancellous screw via posterior approach and ACL avulsion fracture was fixed with arthroscopically assisted pull-out sutures 10 days after the traumatic event. The knee was immobilized in 20° flexion. Isometric knee, hip and ankle exercises were started immediately. Six weeks later after the operation active range of motion exercises and partial weight-bearing were allowed. In the third month full weight bearing was allowed and full range of motion was achieved. Results: Both PCL and ACL avulsion fractures healed uneventfully. Conclusion: Although knee injuries are frequent, simultaneous PCL and ACL avulsion fractures are rare . The clinician should have a high index of suspicion for these injuries. Careful physical examination and radiological imaging, especially magnetic resonance imagination is helpful in the diagnosis. Early surgical repair and appropriate rehabilitation are the keys to a good outcome in these injuries.

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Surgical Treatment for Avulsion Fractures of the Anterolateral Ligament Associated with Periarticular Fractures of the Knee

The Journal of Knee Surgery ◽

10.1055/s-0041-1735311 ◽

2021 ◽

Author(s):

Xuelei Wei ◽

Zengliang Wang ◽

Yandong Lu ◽

Jie Sun ◽

John Riehl

Keyword(s):

Avulsion Fracture ◽

Pivot Shift ◽

Anterolateral Ligament ◽

Lysholm Score ◽

Pivot Shift Test ◽

X Rays ◽

Avulsion Fractures ◽

Ikdc Score ◽

The Mean

AbstractThe existence and anatomy of the anterolateral ligament (ALL) of the knee are a somewhat controversial topic in orthopaedic surgery. The fixation of the avulsion fracture of the ALL (Segond fracture), associated with periarticular knee fractures, is rarely given much consideration while the major fracture fragments are reconstructed. This study aims to confirm the existence of ALL and evaluate the clinical outcomes of surgical management for avulsion fractures, involving its insertion, when associated with periarticular knee fractures. Twenty-three patients (16 males and 7 females) with avulsion fractures of the ALL associated with periarticular knee fractures were fixed with a spider plate, cannulated screw, or suture anchor. Eight patients were diagnosed with distal femoral fracture, 10 with tibial plateau fracture, and 5 with tibial eminence avulsion fracture. All patients underwent X-rays at follow-up. Clinical and functional outcomes were assessed with the pivot-shift test, objective and subjective International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner activity scale. The ALL was found and identified as a distinct ligamentous structure in all patients. Prior to Segond repair, patients had significantly more instability, as determined by pivot-shift test, than seen postoperatively (p < 0.0001). At final follow-up, the mean subjective IKDC score was 83.2 ± 10.3. Fourteen patients were graded A, 6 were graded B, and 3 was graded C on the IKDC objective score. The mean Lysholm score was 85.4 ± 12.2. The mean Tegner score was 7.5 ± 1.2. This study confirmed that the ALL is a distinct structure in the anterolateral portion of the knee. The fixation of the avulsion fracture of the ALL associated with periarticular knee fractures can be an effective procedure without specific complications. Long-term and comparative follow-up studies are necessary to confirm the effects.

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Treatment of subacute/chronic ECU tendinopathy using wrist arthroscopy and open surgical repair

Journal of Orthopaedic Surgery ◽

10.1177/23094990211067009 ◽

2022 ◽

Vol 30 (1) ◽

pp. 230949902110670

Author(s):

Young-Keun Lee

Keyword(s):

Surgical Repair ◽

Clinical Findings ◽

Wrist Arthroscopy ◽

Dash Score ◽

Open Surgical Repair ◽

Mri Findings ◽

Open Procedure ◽

Mayo Wrist Score ◽

Quick Dash

Purpose To report the arthroscopic and clinical findings of patients with extensor carpi ulnaris (ECU) tendinopathy treated with wrist arthroscopy and open surgical repair. Methods We retrospectively reviewed the medical records of seven patients with chronic ECU tendinopathy who were treated with diagnostic wrist arthroscopy and open surgical repair between 2010 and 2017. Seven cases diagnosed with ECU tendinopathy had undergone open procedure for the ECU tendinopathy, as well as wrist arthroscopy in the same session. Any pathology of the triangular fibrocartilage complex (TFCC) diagnosed by wrist arthroscopy were treated simultaneously with open procedure for the ECU tendinopathy. The functional outcome was evaluated by comparing the preoperative and final follow-up values of range of motion (ROM), grip strength, visual analog scale (VAS) for pain, modified Mayo wrist score and quick disabilities of the arm, shoulder, and hand (DASH) score. Results TFCC tears were identified in four patients of which repair was performed concomitantly. The average follow-up period was 39 months (range, 25–49 months). At the final follow-up, all the outcomes including average VAS score (6.4→1), the ROM (173→192°), quick DASH score (42.5→18.2), and modified Mayo wrist score (48.6→79.3) improved significantly. Conclusion When treating patients with ECU tendinopathy, the possibility of TFCC combined injury should always be considered. If surgical treatment is planned, we suggest a wrist arthroscopy for more accurate diagnosis an intra-articular pathology, particularly for patients whose MRI findings suggest a degenerative tear or degeneration at the periphery of the TFCC. Additionally, if ECU and DRUJ stability is obtained by repair or reconstruction of the concurrent pathologies in the ECU subsheath, TFCC and other intra-articular structures, the results will be favorable.

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Arthroscopic Two-Point Suture Bridge Fixation Technique for the Treatment of Anterior Cruciate Ligament Tibial Avulsion Fractures

Journal of Biomaterials and Tissue Engineering ◽

10.1166/jbt.2021.2776 ◽

2021 ◽

Vol 11 (10) ◽

pp. 1977-1982

Author(s):

Dong Zheng ◽

Jianjian Yin ◽

Long Han ◽

Jianchao Gui

Keyword(s):

Anterior Cruciate Ligament ◽

Avulsion Fracture ◽

Cruciate Ligament ◽

Suture Fixation ◽

Fixation Technique ◽

Avulsion Fractures ◽

Anterior Drawer ◽

Kt 1000 ◽

Anterior Cruciate

This study aimed to present and evaluate a new arthroscopic technique that uses two-point suture fixation for anterior cruciate ligament (ACL) tibial avulsion fractures. A total of 15 patients diagnosed with ACL tibial avulsion fracture underwent arthroscopic suture fixation from November 2018 to October 2019 and were treated using two-point suture fixation. The patients were followed up and evaluated according to Lysholm scores, International Knee Documentation Committee (IKDC) subjective scores, Tegner activity level scales, anterior drawer testing, and KT-1000 arthrometer testing. The mean follow-up period was 18 months (12 to 24). All patients had a negative Lachman test and anterior drawer test at final follow-up and showed the radiological union of avulsion fracture at 12-week postoperative radiograph. The Lysholm score improved significantly postoperatively with a mean score of 94.26±3.63 (87 to 98; p < 0.001). The Tegner score improved significantly postoperatively from 3.61 ±1.37 to 7.14±1.51 (P < 0.001). The KT-1000 measured value decreased significantly postoperatively from 7.3±1.5 to 1.4 ±1.2 (P < 0.001). The IKDC category was abnormal or severely abnormal preoperatively, and all patients improved to normal or nearly normal at final follow-up. Arthroscopic treatment using the two-point suture fixation technique is effective for ACL avulsion fracture and can restore the function and stability of the knee joint.

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