Surgical treatment of an old avulsion fracture of the ischial tuberosity and ischial ramus: A case report

BACKGROUND Avulsion fracture of the ischial tuberosity is a relatively clinically rare type of trauma that is mainly incurred by adolescents during competitive sports activities.According to previous literature,the most commonly involved sports are soccer,sprinting,and gymnastics,in descending order.Dance-induced avulsion fracture of the ischial tuberosity and ischial ramus is extremely clinically rare.CASE SUMMARY A case of a neglected avulsion fracture of the ischial tuberosity and ischial ramus was diagnosed in a young female dancer who complained of pain and restricted movement of her right hip.She stated that she had suffered the injury while performing a split leap during a dance performance 9 mo prior.Eventually,she underwent surgery and obtained satisfactory treatment results.CONCLUSION Early diagnosis of these fractures is important to ensuring early proper treatment towards a quicker recovery.For old fractures with nonunion and chronic buttock pain,surgery is a preferred therapeutic choice with good treatment outcomes.

Arthroscopic M-shaped suture fixation for tibia avulsion fracture of posterior cruciate ligament:A modified technique and case series

BACKGROUND Tibial avulsion fractures of the posterior cruciate ligament(PCL)are challenging to treat and compromise knee stability and function.Traditional open surgery often requires extensive soft tissue dissection,which may increase the risk of morbidity.In response to these concerns,arthroscopic techniques have been evolving.The aim of this study was to introduce a modified arthroscopic tech-nique utilizing an M-shaped suture fixation method for the treatment of tibial avulsion fractures of the PCL and to evaluate its outcomes through a case series.AIM To evaluate the effects of arthroscopic M-shaped suture fixation on treating tibia avulsion fractures of the PCL.METHODS We developed a modified arthroscopic M-shaped suture fixation technique for tibia avulsion fractures of the PCL.This case series included 18 patients who underwent the procedure between January 2021 and December 2022.The patients were assessed for range of motion(ROM),Lysholm score and International knee documentation committee(IKDC)score.Postoperative complications were also recorded.RESULTS The patients were followed for a mean of 13.83±2.33 months.All patients showed radiographic union.At the final follow-up,all patients had full ROM and a negative posterior drawer test.The mean Lysholm score significantly improved from 45.28±8.92 preoperatively to 91.83±4.18 at the final follow-up(P<0.001),and the mean IKDC score improved from 41.98±6.06 preoperatively to 90.89±5.32 at the final follow-up(P<0.001).CONCLUSION The modified arthroscopic M-shaped suture fixation technique is a reliable and effective treatment for tibia avulsion fractures of the PCL,with excellent fracture healing and functional recovery.

Therapeutic effect of two methods on avulsion fracture of tibial insertion of anterior cruciate ligament

BACKGROUND The tibial stop of anterior cruciate ligament(ACL) is fan-shaped and attached to the medial groove in front of the intercondylar spine,which is located between the anterior horn of the medial and lateral meniscus.The incidence of this fracture is low previously reported,which is common in children and adolescents.With the increase of sports injury and traffic injury and the deepening of understanding,it is found that the incidence of the disease is high at present.AIM To explore the difference between open reduction and internal fixation with small incision and high-intensity non-absorbable suture under arthroscopy in the treatment of tibial avulsion fracture of ACL.METHODS Seventy-six patients with tibial avulsion fracture of anterior cruciate ligament diagnosed and treated in Guanyun County People’s Hospital from April 2018 to June 2020 were retrospectively analyzed.According to the surgical methods,they were divided into group A(40 cases) and group B(36 cases).Patients in group A were treated with arthroscopic high-strength non-absorbable suture,and patients in group B were treated with small incision open reduction and internal fixation.The operation time,fracture healing time,knee joint activity and functional score before and after operation,and surgical complications of the two groups were compared.RESULTS The operation time of group A was higher than that of group B,and the difference was statistically significant(P < 0.05);the fracture healing time of group A was compared with that of group B,and the difference was not statistically significant(P > 0.05);The knee joint function activity was compared between two groups before operation,3 mo and 6 mo after operation,and the difference was not statistically significant(P > 0.05);the knee joint function activity of group A and group B at 3 mo and 6 mo after operation was significantly higher than that before operation(P < 0.05);the limp,support,lock,instability,swelling,upstairs,squatting,pain and Lysholm score were compared between the two groups before and 6 mo after operation,and the difference was not statistically significant(P > 0.05);the scores of limp,support,lock,instability,swelling,upstairs,squatting,pain and Lysholm in group A and group B at 6 mo after operation were significantly higher than those before operation(P > 0.05);the surgical complication rate of group A was 2.63%,which was lower than 18.42% of group B,and the difference was statistically significant(P > 0.05).CONCLUSION Both small incision open reduction and internal fixation and arthroscopic high-strength nonabsorbable sutures can achieve good results in the treatment of anterior cruciate ligament tibial avulsion fractures.The operation time of arthroscopic high-strength non-absorbable sutures is slightly longer,but the complication rate is lower.

Surgical treatment for a combined anterior cruciate ligament and posterior cruciate ligament avulsion fracture: A case report

BACKGROUND Independent avulsion fractures with anterior cruciate ligament(ACL)or posterior cruciate ligament(PCL)attachment are relatively common among tibial intercondylar eminence fractures,and their postoperative outcomes are generally favorable.Conversely,huge avulsion fractures of the intercondylar eminence containing the attachment site of both the ACL and the PCL are extremely rare,and the reported clinical outcomes are poor.CASE SUMMARY We describe a 30-year-old Japanese male's huge avulsion fracture of the intercondylar eminence of a tibia containing the attachment site of both the ACL and PCL,together with a complete tear of the medial collateral ligament and a partial tear of both the medial and lateral menisci caused by a fall from a high place.All of these injuries were treated surgically,with anatomical reduction and stable fixation.The limb function at 1 year post-surgery was excellent(Lysholm score:100 points).CONCLUSION Although this patient's complete surgical repair was complex,it should be performed in similar cases for an excellent final clinical outcome.

Osteochondroma formation after avulsion fracture of anterior inferior iliac spine:A case report

BACKGROUNDHip avulsion fractures occur mostly during adolescence when actions such askicking or running cause forceful contraction of attached muscle.Osteochondroma is benign tumor that mostly occurs at the metaphysis of a longbone, being usually asymptomatic.CASE SUMMARYA 15-year-old patient experienced feeling and sound of a break while kicking aball in soccer game three years prior to his visit to our hospital. A simple X-rayrevealed an avulsion fracture of the apophysis of the anterior inferior iliac spine(AIIS). Later in the follow-up X-ray, a palpable mass was found and demonstratedby magnetic resonance imaging to be a pedunculated osteochondroma in thesuperolateral aspect of the AIIS. For surgical treatment, we performed osteotomyfor surgical excision and excisional biopsy. A mass with smooth surface and anunclear superolateral AIIS border was found intraoperatively. Pathologic examshowed definite diagnosis of osteochondroma. Postoperatively, discomfort duringhip flexion was improved, and the hip joint range of motion during walking wasrecovered at the last follow-up, which was three weeks after the surgery.CONCLUSIONThis is a rare case to demonstrate relevant previous trauma history prior to theformation of osteochondroma.

Clinical study on the surgical treatment of atypical Lisfranc joint complex injury

BACKGROUND Lisfranc injuries have not received much attention by orthopedic doctors in the past,and there is little related research on the diagnosis and treatment of these injuries.In recent years with the rise in foot and ankle surgery,doctors are now paying more attention to this type of injury.However,there is still a high rate of missed diagnosis due to insufficient attention causing treatment delays or inadequate treatments,which eventually result in greater sequelae;including long-term pain,arthritis,foot deformity etc.In particular,for cases with a mild Lisfranc joint complex injury,the incidence of sequelae is higher.AIM To select an active surgical treatment for an atypical Lisfranc joint complex injury and to evaluate the clinical efficacy of the surgical treatment.METHODS The clinical data of 18 patients,including 10 males and 8 females aged 20-64 years with Lisfranc injuries treated in our department from January 2017 to September 2019 were retrospectively analyzed.All patients were treated with an open reduction and internal fixation method using locking titanium mini-plates and hollow screws or Kirschner wires.X-ray images were taken and follow-up was performed monthly after the operation;the internal fixation was then removed 4-5 mo after the operation;and the American Orthopedic Foot and Ankle Society(AOFAS)score was used for evaluation on the last follow-up.RESULTS All patients were followed up for 6-12 mo.A good/excellent AOFAS score was observed in 88.9%of patients.CONCLUSION For atypical Lisfranc joint complex injuries,active open reduction and internal fixation can be performed to enable patients to obtain a good prognosis and satisfactory functional recovery.

Radiological evaluation of patellofemoral instability and possible causes of assessment errors:Letter to the editor

This letter to the editor is a commentary on the study titled"Radiological evaluation of patellofemoral instability and possible causes of assessment errors".There are some pertinent structural changes and radiological findings that should be considered in the setting of traumatic knee injuries,as their recognition is of paramount importance.

Arthroscopic fixation of chronic bicruciate tibial avulsion fractures:A case report

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.

A novel arthroscopic procedure for fixation of avulsion fracture of tibial attachment of anterior cruciate ligament guided by meniscal stitching needle

Objective： To introduce a novel technique in which meniscal stitching needle is used as a puller to induct steel wire to secure the tibial eminence avulsion under arthroscopic visualization, and evaluate the cfinical results. Methods： From 1999 to 2005, fifteen cases of tibial eminence avulsion were treated with this new technique. Lysholm scoring scale system was used to assess knee function before and after surgery. Regular plain anteroposterior and lateral X-ray flms were undertaken to detect the bony healing of avulsed fragment. Results： The operating time could be controlled within 30 minutes. No complications such as intraarticular infection, iatrogenic injury, fibroarthritis or nonunion of fracture occurred in this group. X-ray film revealed that bony healing in all 15 cases was achieved from 6 weeks to 12 weeks postoperatively. Lysholm score was improved from 19.1 ± 15.2 （ ranging from 10 to 56 ） preoperatively to 97.5 ± 3.7 （ranging from 91 to 100） postoperatively on average in 12-54 months follow up （mean 23 months）. The statistically significant difference was shown in Student＇s t test （t = 18. 483, P =3. 100×10^-11, P 〈 0. 01）. Wire breakage was found in two patients whose wires were removed 8 months and 14 months after initial operation, respectively. Conclusion： This technique has many advantages, such as simplicity, wide indications from type Ⅱ to type Ⅳ fractures, minimal invasion, short operating time and predictable satisfactory results.

Should proximal ruptures of the anterior rectus femoris muscle be treated surgically?

Purpose:No therapeutic consensus has been established about proximal ruptures of the rectus femoris muscle.The objective of this literature review is to determine a therapeutic course of action.Methods:We conducted a literature review on the PubMed database using the following keywords(in French and English,respectively):"quadriceps/quadriceps","droit antérieur/rectus femoris","proximal/proximal","chirurgie/surgical","avulsion/avulsion".We collected 266 articles,36 of them were selected,which were related to our topic:proximal rupture of the anterior rectus femoris.Patients with a proximal rupture of the rectus femoris,minor or major patient of traumatic origin were included in this study.Patients injured at another lesion level,or non-traumatic lesions of the proximal rectus femoris(tendinitis without ruptures,tumor or others)were excluded.For each patient,the indications,the type of treatment and the functional result were analyzed,with the time to recovery and the level of recovery from sports and professional activities(same sport/profession or not,same level or not)as the main criterion of judgment.Fisher exact test was used for statistical comparison.Results:The aims of conservative treatment are to be pain free for the patient,to fight hematoma and to rehabilitate the injury as quickly as possible.The surgical techniques are varied,with most consisting of either a reinsertion of the musculo-tendon stump or a resection of the scar tissue with myo-tendinoaponeurotic suture in place.The functional results are good for the majority of the treatments proposed,but the conservative treatment has a shorter recovery time(3 months vs.4 months for the best surgical results).Highly displaced bone avulsion is the only indication for first-line surgical treatment.Conslusion:The main disadvantage of conservative treatment is the risk of residual pain beyond 3 months(10%),justifying an MRI to guide secondary surgical treatment.We propose a treatment plan for proximal rupture of the proximal rectus femoris rupture.