scholarly journals Isolated PCL and ACL Avulsion Fractures of the Knee

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.

scholarly journals Arthroscopic fixation of anterior cruciate ligament tibial avulsion fractures: the suture “bridge” pull out technique and evaluation of results

2017 ◽  
Vol 3 (5) ◽  
pp. 979
Author(s):  
Mihir R. Patel ◽  
Ushma K. Butala ◽  
Nirlepsinh S. Thakor ◽  
Raunik R. Bansod ◽  
Rohan A. Dhotre
Keyword(s):  
Range Of Motion ◽  
Cruciate Ligament ◽  
Avulsion Fractures ◽  
Suture Bridge ◽  
Pull Out ◽  
Arthroscopic Fixation ◽  
Anterior Cruciate ◽  
Acl Avulsion

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Tibial anterior cruciate ligament (ACL) avulsion fractures are a common injury in children and adolescents. Operative treatment is indicated for type 2, 3 and 4 fractures. Arthroscopic fixation is the preferred method and numerous fixation options are described. The purpose of this study is to evaluate the results of a new technique of arthroscopic fixation.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">A retrospective study was done involving twelve patients having displaced ACL tibial avulsion fractures. The arthroscopic suture “bridge” pull out technique was used to fix these fractures. Patient symptoms like knee pain, locking, clicking, sensation of giving way and clinical signs like tenderness, range of motion, Mc Murray’s test, stability test and Lysholm knee scores were evaluated pre operatively and post operatively at 3 months and 6 months. Patient satisfaction was noted at latest follow up</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">One patient had type 2, 7 patients had type 3 and 4 patients had type 4 tibial ACL avulsion fractures. All the fractures united and all patients achieved full knee range of motion by 2 months post-operative. The clinical symptoms and signs improved post operatively. The mean Lysholm knee score at 3 months follow up was 88.8 and at 6 months follow up were 98.8. At latest follow up, all the patients were satisfied with their knee function. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">The arthroscopic suture “bridge” pull out technique is an effective method for fixation of ACL tibial avulsion fractures with respect to knee stability, range of motion and resumption of pre injury activity level.</span></p>

scholarly journals Surgical Repair of Open Achilles Tendon Injuries Using No.1 Prolene to Pull Down the Proximal Tendon: A Safe Technique

1970 ◽  
Vol 21 (2) ◽  
pp. 132-134
Author(s):  
Sayed Ahmed ◽  
Debashis Roy ◽  
S Uddin Ahmed ◽  
M Enamul Haque ◽  
Moshidur Rahman
Keyword(s):  
Suture Material ◽  
Weight Bearing ◽  
Full Range ◽  
Neutral Position ◽  
Partial Weight Bearing ◽  
Active Flexion ◽  
Safe Technique ◽  
Partial Weight ◽  
Distal Tendon

From July 1998 to October 2004 forty-seven patients with open tendo-Achilles injuries were treated pull down the proximal tendon with no.1 prolene. In this surgical method no.1 prolene was threaded through the proximal tendon and the same suture material passed through the distal tendon and its bilateral ends were tightened over the rubber button either under the heel or by the sides of the heel. Box sutures apposed cut ends of the tendon. The ankle was placed in the cast in near neutral position. At six weeks the cast was removed and active flexion program was started. Partial weight bearing was allowed at seven weeks and full bearing was allowed at ten weeks after surgery. The average follow up period is 1.8 years. All the patients exhibited full range of motion at the final follow-up. doi: 10.3329/taj.v21i2.3792 TAJ 2008; 21(2): 132-134

scholarly journals Synovial Lipomatosis (Lipoma Arborescens) of the Knee

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0026
Author(s):  
Melih Malkoç ◽  
Ozgur Korkmaz ◽  
Ali Seker ◽  
Mehmet Isyar ◽  
Ismail Oltulu ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Knee Society Score ◽  
Weight Bearing ◽  
Full Range ◽  
Daily Activities ◽  
Full Weight Bearing ◽  
Female Group ◽  
Arthroscopic Synovectomy ◽  
Significant Difference ◽  
Synovial Lipomatosis

Objectives: The goals of this retrospective study are to emphasize that the patients who have non surgical treatments for several times due to the massive swelling in their knees should be considered the SL and this pathology is treatable by arthroscopic synovectomy Methods: Seventeen patients (four female and thirteen male), were evaluated retrospectively from May 2009 and April 2013. Mean age for female group was 34,75 (range between 32 to 41) and for male group was 34,23 (range between 26 to 46). Mean follow-up period was 14,76 months (range between 6 months and 38 months). Mean duration of compliance was 26,23 months (range between 9 to 96) months. All patients rated by Knee Society Score preoperatively and postoperatively arthroscopic synovectomy, performed by using radiofrequency ablation and arthroscopic shaver for treatment procedure. Patients were discharged at the end of the one day hospitalization. Postoperatively all patients were allowed to full range of motion and full weight-bearing within one day after surgery. Results: Patients were evaluated preoperatively and postoperatively using the Knee Society Score. The mean Knee Society Score was 67,82 preoperatively and 88,23 was postoperatively. There is significant difference between preoperative and postoperative Knee Society scores.(p <0.05) At the end of the three months, MRI studied and there was no clue of recurrence except two patients. All patients returned to their daily activities with full of range of motion and without swelling of the affected knee joints. At the microscopic histological studies were reported as synovial lipomatosis for all patients Conclusion: Arthroscopic synovectomy is the safe and dramatically effective method of treatment in synovial lipomatosis with less complication, curability and retrieving patients full range of motion with no limitation in their daily activities

Medial femoral condyle fracture during an Oxford unicompartmental knee replacement surgery: case report

2020 ◽  
pp. jisakos-2019-000311
Author(s):  
Rafael Calvo ◽  
David Figueroa ◽  
Zoy Anastasiadis ◽  
Gonzalo Espinoza ◽  
Daniel Sarango
Keyword(s):  
Range Of Motion ◽  
Rare Complication ◽  
Femoral Condyle ◽  
Intraoperative Complications ◽  
Weight Bearing ◽  
Full Range ◽  
Unicompartmental Knee Replacement ◽  
Medial Condyle ◽  
Unicompartmental Knee ◽  
Condyle Fracture

Oxford unicompartmental knee arthroplasty has been used as a good alternative for medial unicompartmental osteoarthritis due to its association with early rehabilitation and a low rate of intraoperative complications. This case describes a rare complication during the procedure of an intraoperative fracture of the medial condyle that was treated with osteosynthesis with 6.5 mm cannulated screws and a compression technique. The patient followed a non-weight-bearing protocol for 6 weeks and reached full range of motion at 3 months. Complete radiological fusion and good functional outcome were observed. Intraoperative fractures can benefit from stable osteosynthesis that allows free range of motion and does not jeopardise the final surgical result.

A SIMPLE METHOD OF OSTEOSYNTHESIS FOR AVULSION FRACTURES OF THE THUMB METACARPOPHALANGEAL JOINT

Hand Surgery ◽  
2005 ◽  
Vol 10 (02n03) ◽  
pp. 209-211
Author(s):  
Kentaro Watanabe
Keyword(s):  
Internal Fixation ◽  
Avulsion Fracture ◽  
Kirschner Wire ◽  
Metacarpophalangeal Joint ◽  
Tension Band ◽  
Tension Band Wiring ◽  
Simple Method ◽  
Avulsion Fractures ◽  
Pull Out ◽  
Thumb Metacarpophalangeal Joint

Five cases with an avulsion fracture of the thumb metacarpophalangeal joint treated by a simple method of internal fixation are described. This method is designed as a form of modified tension band wiring using the combination of a single Kirschner wire and a pull-out wire, and is technically easy.

scholarly journals Multi-Ligament Knee Injury with Concomitant Tibial Tubercle Fracture: A Challenging Case Report and Review of the Pertinent Literature

2021 ◽  
Author(s):  
Mohammad Tahami ◽  
Arash Sharafat Vaziri ◽  
Mohammad Naghi Tahmasebi ◽  
Fardis Vosoughi ◽  
Majid Khalilizad ◽  
...  
Keyword(s):  
Case Report ◽  
Knee Injury ◽  
Cruciate Ligament ◽  
Weight Bearing ◽  
Full Range ◽  
The Body ◽  
Tibial Tubercle ◽  
Partial Weight Bearing ◽  
Rehabilitation Protocol ◽  
Partial Weight

Background: Multi-ligament knee injury (MLKI) combined with a comminuted tibial tubercle avulsion fracture in the literature has been reported as a very rare condition. To the best of our knowledge, there was no case report of this condition associated with open proximal tibia fractures. Case Report: A 32-year-old man was referred to our center, with a comminuted tibial tubercle fracture, patella alta, fracture of the tibia at the proximal meta-diaphyseal junction, a Segond fracture, and proximal tibiofibular dislocation on X-ray images. Further assessment of intra-articular pathologies was performed during the operation and complete tear of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) tear were identified. Radial tear of the body and anterior root avulsion of medial meniscus were also noted. All of the extra-articular and intra-articular injuries were addressed surgically, except ACL and PCL tear, which were postponed to a second stage. Proximal tibiofibular dislocation was not approached surgically. The rehabilitation protocol included 6 weeks of non-weight-bearing followed by 6 weeks of crutch-assisted partial weight-bearing ambulation, and forbidden active knee extension during the first 6 weeks and allowing the patient to perform passive flexion of the knee to 90 degrees starting from the second week. Following the rehabilitation program, the patient achieved near-full range of motion (ROM) by the end of 6 months of clinical follow-up. Conclusion: By means of our specific surgical technique and post-operative rehabilitation protocol, we led the patient with this specific condition to have fracture union and near-normal ROM by the end of 6 months.

scholarly journals 90° Spinning of Polyethylene Inserts in Mobile Bearing Unicompartmental Knee Arthroplasty

2022 ◽  
pp. 1-6
Author(s):  
Connor Fitz-Gerald ◽  
David Kieser
Keyword(s):  
Range Of Motion ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Weight Bearing ◽  
Full Range ◽  
Mobile Bearing ◽  
Good Resolution ◽  
Polyethylene Insert ◽  
Medial Knee ◽  
Unicompartmental Knee

<b>Background</b> The objective of this article is to describe for the first time a case of 90<sup>°</sup> spin out of a mobile bearing unicompartmental knee arthroplasty (UKA) polyethylene insert. In this report, we present a 57-year-old gentleman with a medial compartment UKA for osteoarthritis in 2017 who developed dislodgement and 90<sup>°</sup> rotation subsequent to traumatic injury when he was involved in a bus crash and impacted the anterolateral knee sustaining a valgus type injury 1 week postoperatively. Following the injury, he reported medial knee pain and a sensation of something moving within the joint. He was initially managed conservatively and progressed to full weight bearing; however, he experienced intermittent symptoms of catching and blocking of the joint, as well as medial knee swelling, that inhibited his ability to perform activities involving walking, kneeling, or pivoting. Imaging taken in 2018 show a 90° rotation of the polyethylene insert. These images showed the longitudinal metallic marker on the insert facing in an anteroposterior direction as opposed to the normal medial-lateral orientation. Failing conservative management, he presented to our clinic in 2019 and proceeded for revision of his UKA. Intraoperatively, his insert was reviewed and seen to easily spin on axis. The liner was therefore removed and upsized from a size 5 medium to a size 7 medium insert which provided excellent stability and stopped any further spinning. He has done tremendously well since the operation and reports full range of motion and no concerns. In patients with a history of pain, swelling, or locking following a UKA, it would be prudent to consider insert spinning, as well as the more common dislocation, through confirming the orientation of the metallic insert marker. Revision surgery to correct the spinning defect has proven effective with good resolution of symptoms and return to full range of motion.

scholarly journals Proximal tibiofibular joint dislocation treated using flexible and permanent syndesmosis fixation

2018 ◽  
pp. bcr-2017-222843
Author(s):  
Antonio Carlos Moscon ◽  
Ana Luiza Cabrera Martimbianco ◽  
Aires Duarte Junior ◽  
Guilherme Conforto Gracitelli
Keyword(s):  
Internal Fixation ◽  
Range Of Motion ◽  
Weight Bearing ◽  
Gait Training ◽  
Left Knee ◽  
Postoperative Treatment ◽  
Full Weight Bearing ◽  
Proximal Tibiofibular Joint ◽  
Proximal Fibula ◽  
Partial Weight

We present the case of a 40-year-old man who suffered an isolated proximal tibiofibular dislocation of the left knee after a trauma during a soccer game. Physical examination and radiographic imaging revealed an anterolateral dislocation of the proximal fibula. The diagnosis was confirmed by MRI. The treatment choice was open reduction and internal fixation under direct visualisation using flexible and permanent internal fixation. Postoperative treatment includes knee immobilisation during the first week, and partial weight was allowed for 2 weeks progressing to full weight bearing over 4 weeks. The patient started a gradual and progressive physical therapy programme with range of motion exercises, muscle strengthening and gait training. Full knee range of motion was achieved after 4 weeks. No complaint of pain or hardware discomfort was reported, and the patient is back to daily life and sports activities after 6 months of surgical treatment.

scholarly journals Avulsion Fractures Osteosynthesis in Patients with Normal Bone Mineral Density and Osteoporosis

2018 ◽  
Vol 24 (4) ◽  
pp. 72-80
Author(s):  
L. B. Reznik ◽  
V. V. Guryev ◽  
M. A. Turushev ◽  
D. A. Negrov ◽  
R E. Il’in
Keyword(s):  
Bone Mineral Density ◽  
Bone Mineral ◽  
Avulsion Fracture ◽  
Bone Fragment ◽  
Mineral Density ◽  
Avulsion Fractures ◽  
Titanium Screw ◽  
Pull Out ◽  
Normal Bone Mineral Density ◽  
Titanium Screws

Objective:to compare the effectiveness of osteosynthesis for avulsion fractures using bioabsorbable versus titanium implants in patients differing in bone mineral density.Material and Methods.In the experimental phase of study, two groups of bone blocks were singled out from patients' femoral heads to assess the anchoring properties of the implant in osteoporotic and healthy bone. The first group included blocks of 31 patients with osteoporosis, the second one — 27 blocks of patients without osteoporosis. In the first group, cortical bioabsorbable Poly-L-Lactic/ co-glycolic acid (PLGA) screws were implanted into 13 bone blocks, titanium screws — into 10 bone blocks, and bioabsorbable pins (PLGA) — into 8 bone blocks. In the second group, 10 titanium screws, 10 bioabsorbable screws and 7 bioabsorbable pins were implanted. The anchorage of the implant in bone was evaluated by a pull-out test. Then, depending on the anchorage used, the studied bone blocks with osteoporosis, newly obtained from the first group, were divided into three groups for the purpose of evaluating the resistance to the damaging effects of the implant. In experiment, the osteosynthesis for avulsion fracture was simulated on these bone blocks. In the first group (11 bone blocks), the transosseous osteosynthesis of the bone fragment was carried out with a titanium screw, in the second group (9 bone blocks) with a bioabsobable screw, in the third group (11 bone blocks) with a bioabsorbable pin. The results of osteosynthesis were assessed based on how often a small bone fragment was damaged by an implant and on stability of the anchored implant. In the clinical phase of study, a comparative analysis of 65 surgical interventions (38 people with osteoporosis and 27 without osteoporosis) in patients with avulsion fractures was performed. In 24 cases, bioabsorbable screws were used for osteosynthesis, AO/ASIF titanium screws were used in 31 cases, and pins were used in 10 cases.Results.Experimental studies showed that the resistance to pull-out test of a bioabsorbable screw anchored in osteoporotic bone is 25.7% higher than a titanium screw. No statistically significant difference was found in bone without osteoporosis. Resistance to pull-out test of a bioabsorbable pin is 3% higher than a titanium screw. The model-based experiment with an avulsion fracture in osteoporotic bone using a titanium screw showed lower effectiveness of osteosynthesis: in 27.2% of cases the cortical titanium screw damaged a small bone fragment. Based on the clinical trial findings, no negative results were obtained using bioabsorbable anchorage. In 12.5% cases of osteosynthesis with a titanium screw, migration of a bone fragment was noted. The data obtained during the clinical study correlated with the experimental data. This makes the use of bioabsorbable implants advantageous.Conclusion.For avulsion fracture osteosynthesis in patients with normal bone mineral density, it is possible to use both titanium and biodegradable fixators with equivalent strength of fragment fixation. n osteosynthesis of fractures in patients with osteoporosis it is preferable to use bioabsorbable implants

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