A suspensory fixation technique for calcaneal tuberosity avulsion fractures using the TightRope Attachable Button System.

Displaced avulsion fractures of the calcaneal tuberosity generally occur as a result of osteoporotic insufficiency or high-energy injuries. Conventional methods of fixation may be complicated by wound breakdown, metalwork failure, or symptomatic hardware. This is particularly relevant in elderly patients and those with comorbidities, including osteoporosis or diabetes. We describe an innovative technique using the TightRope Attachable Button System (ABS; Arthrex, Naples, FL, USA), adapted from suspensory cortical fixation in anterior cruciate ligament reconstruction, to treat displaced Beavis type II 'beak' calcaneal fractures in such patients. We present the case of a 67 year old female with multiple comorbidities, who successfully underwent this procedure, with no complications at 4 years follow-up.

Flexor Digitorum Profundus Avulsion With Distal Interphalangeal Joint Dorsal Dislocation: A Case Report.

An irreducible closed dorsal dislocation of the distal interphalangeal (DIP) joint of the finger is a rare injury, often caused by factors such as the interposition of the volar plate, entrapment of the flexor digitorum profundus (FDP) tendon behind the head of the middle phalanx, or the buttonholing of the middle phalanx head through the volar plate or flexor tendon. This case report presents a rare instance of FDP avulsion combined with dorsal dislocation of the DIP joint in a 42-year-old male who sustained trauma to his right middle finger during a workplace accident. Clinical examination and imaging confirmed FDP avulsion along with dorsal dislocation of the DIP joint. Urgent surgical intervention was performed, successfully reducing and repairing the FDP tendon and stabilizing the DIP joint. Subsequent follow-up showed satisfactory functional outcomes. This case highlights the importance of prompt diagnosis and appropriate surgical management in treating complex finger injuries.

Ferroptosis Regulated by 5-HT3a Receptor via Calcium/Calmodulin Signaling Contributes to Neuropathic Pain in Brachial Plexus Avulsion Rat Models.

Neuropathic pain is a prevalent complication following brachial plexus avulsion (BPA). Ferroptosis has been implicated in various nervous system disorders. However, the association between ferroptosis and neuropathic pain induced by BPA remains unclear. This study aimed to investigate the role of ferroptosis in BPA-induced neuropathic pain. A rat model of neuropathic pain was established via BPA induction. Pain thresholds of rats were measured after BPA surgery and intraperitoneal injection of Fer-1. On day 14 postsurgery, spinal dorsal horn (SDH) samples were collected for Western blotting, biochemical analysis, and immunohistochemistry to analyze the expression and distribution of ferroptosis-related markers. The relationships among 5-HT3a receptor, calcium/calmodulin (CaM) pathway, and ferroptosis were assessed via Western blotting, biochemical analysis, and lipid peroxidation assays, including iron and calcium content, reactive oxygen species, glutathione peroxidase 4 (GPX4), ACSL, and CaM expression. BPA-induced neuropathic pain was associated with iron accumulation, increased lipid peroxidation, dysregulated expression of Acyl-CoA synthetase long-chain family member 4, and GPX4, and changes in transferrin receptor, divalent metal transporter 1, and ferroportin-1 (FPN1). Intraperitoneal administration of Fer-1 reversed all of these alterations and mitigated mechanical and cold hypersensitivity. Inhibition of the 5-HT3a receptor reduced the extent of ferroptosis. Furthermore, the 5-HT3a receptor can regulate the calcium/CaM pathway via L-type calcium channels (LTCCs), and blocking LTCCs with nifedipine also alleviated ferroptosis in the SDH of BPA rats. Taken together, in rats with BPA, the development of neuropathic pain involves ferroptosis, which is regulated by the 5-HT3a receptor through the LTCCs and the calcium/CaM signaling pathway in the SDH.

Ankle syndesmotic ligaments avulsion fractures: incidence in adult population.

BACKGROUND: Distal tibiofibular syndesmosis injury is often associated with ankle fractures in adults. Injuries to the anterior/posterior inferior tibiofibular ligament (AITFL/PITFL) may present as a mid-substance tear or as an avulsion at insertion. Tibial and fibular avulsion of the AITFL is known as Tillaux fracture and Wagstaffe fracture, respectively. Tibial avulsion of the PITFL is referred to as a Volkmann fracture, and fibular avulsion of the PITFL is still undefined and has not been reported yet. The aim of this study is to summarize the incidence of these four avulsions, that is, tibial and fibular avulsions of the AITFL and PITFL. METHOD: Radiography and computed tomography (CT) imaging data of all adult patients with ankle fractures treated at our hospital between November 2010 and March 2023 were retrospectively analyzed. All ankle fractures were classified according to the Weber-AO and Lauge-Hansen classification systems by two experienced radiologists and two surgeons. The incidence of the four avulsions of the AITFL/PITFL was determined. RESULTS: In total, 1,770 ankle fractures in 1,758 patients were included in this study. The total incidence of avulsions at the four insertions of the AITFL/PITFL (occurring at one, two, or three insertions) was found to be 26.3% (465/1,770). Volkmann fracture had the highest incidence (19.9%, 353/1,770), and it was followed by Tillaux fracture (5.3%, 93/1,770), Wagstaffe fracture (3.3%, 59/1,770), and fibular avulsion of the PITFL (0.5%, 8/1,770). It is noteworthy that fibular avulsion of the PITFL has been reported here for the first time. The incidence of avulsion at one insertion was 23.6% (418/1770) and 2.7% (47/1770) at multiple insertions. CONCLUSION: In adult ankle fractures, avulsion occurs at the four insertions of the AITFL/PITFL in more than 25% of patients. The tibial insertion of the PITFL had the highest incidence of avulsion among the four insertions, while the fibular insertion of the PITFL had the lowest. The four types of avulsions can be isolated or in association with other avulsions. Future research studies on these four types of avulsion fractures would help in accurate diagnosis, decision-making and treatment of ankle Syndesmosis injuries. LEVEL OF EVIDENCE: Level III, retrospective cohort study.

Evaluation of the Suture Pull-Out Technique in Anterior Cruciate Ligament Avulsion Fractures at Different Weeks Post-fracture.

Background Anterior cruciate ligament (ACL) avulsion fractures often necessitate surgical intervention, with various fixation techniques available. Among these, the arthroscopic suture pull-out technique has gained attention as a promising approach. However, the influence of surgical timing on patient outcomes remains insufficiently studied. This study aims to evaluate the efficacy of the arthroscopic suture pull-out technique for ACL tibial avulsion fractures and assess how the timing of surgical intervention affects functional outcomes. Methodology This study was conducted at our hospital from November 2020 to October 2022. A total of 17 patients aged 21 to 41 years with isolated ACL avulsion fractures and no additional injuries or osteoarthritis were included. Participants were divided into three groups based on the interval from injury to surgery (one, two, or three weeks). The surgical procedure involved the suture pull-out technique. Postoperative management included immobilization, isometric exercises, and gradual weight-bearing. Functional outcomes were assessed using the Lysholm score, International Knee Documentation Committee (IKDC) score, Tegner Activity Scale, and Lachman test at 6, 10, and 14 months, along with radiological evaluations. Results Significant functional improvements were observed in all groups, with postoperative Lysholm, IKDC, and Tegner scores showing notable enhancements compared to preoperative values. No significant differences were found among the groups regarding the timing of surgery, indicating that delays within the first three weeks did not adversely impact outcomes. Most patients achieved a full range of motion. Two minor postoperative complications were reported, namely, one case of arthrofibrosis and one case of persistent laxity. Conclusions The arthroscopic suture pull-out technique is effective and reliable for ACL tibial avulsion fixation. The timing of surgery within the first three weeks does not significantly affect functional outcomes. Future research with larger sample sizes and longer follow-ups is recommended to further validate these findings and optimize surgical strategies.

Partial Lateral Rectus Avulsion Due to Cat Scratch.

Isolated rectus muscle rupture due to trauma without globe damage is extremely rare. The most commonly affected muscle is the medial rectus, while the least affected is the lateral rectus. The oblique muscles are much less affected by trauma because they are protected by the surrounding bone structures. Eye movements should be assessed after evaluating the integrity of the globe and performing a detailed eye examination. The most appropriate treatment should be provided as soon as possible after the degree of damage is determined. Especially in animal-related injuries, rabies prophylaxis should be overlooked in addition to tetanus. Here we present a 37-year-old male patient with partial lateral rectus avulsion due to cat scratch.

Arthroscopic mini tunnel suture bridge for ACL tibial avulsion fractures repair.

The study presents an arthroscopic transosseous suture bridge technique for repairing avulsion fractures of the tibial insertion of the anterior cruciate ligament (ACL), specifically tailored for adolescent patients. The technique utilizes two mini tunnels, integrating the principles of transosseous tunneling and suture bridging to ensure stable fixation while minimizing the impact on the bone bed. Over a seven-year period, 39 patients with Meyers-Mckeever types II, III, and IV tibial avulsion fractures underwent this procedure. The surgery had an average duration of 52.7 min and resulted in decreased swelling and pain within two months postoperatively. All patients achieved full knee extension and over 120° of flexion. X-rays confirmed complete fracture healing within six to 12 months, and negative anterior drawer test and Lachman test indicated stable fixation. Significant improvements were seen in Lysholm and IKDC scores. This technique offers several advantages: it is effective, stable, and particularly suitable for adolescents due to the reduced impact on the bone bed and successful avoidance of epiphyseal plate injury.

Utility of Orthodontic Braces as Flexible Splint for Stabilizing an Avulsed Tooth: A Case Report.

Dental avulsion is a traumatic dental injury with complete displacement of the tooth outside the bony socket. Both primary and permanent teeth are predisposed to such traumatic incidents. The most effective treatment in such cases is tooth replantation. Additionally, a short-term flexible splint is needed to stabilize the avulsed/replanted tooth. This case report describes orthodontic braces as a standardized flexible splint option for the treatment of tooth avulsion. Herein, the case of a 9-year-old female patient who presented to a private dental clinic with an avulsed upper left central incisor, 1 h after the accident has occurred. Once the tooth was replanted with all the necessary precautions, orthodontic braces and wire were utilized to stabilize the tooth. Most dental splints are custom-made, requiring thorough professional knowledge and expertise for their fabrication and placement. The protocol described in this report is aimed at easing tooth stabilization using materials within the scope of a basic dental setup consultation room.

Prevalence of presumed endplate junction failure at the lumbosacral intervertebral junction in dogs on computed tomography.

Lumbosacral intervertebral disc herniation (IVDH) is a common cause of lower back pain in dogs and humans. In humans, the vertebral endplate to annulus fibrosus (AF) attachment was implicated as an alternative failure site besides rupture through the dorsal AF (AFF). Endplate junction failure (EPJF) is characterized by IVDH, accompanied by endplate irregularities (type A), rim avulsions (type B), or larger bony avulsions on one (type C) or both endplates (type D), associated with an adjacent endplate defect. This retrospective study reports the CT prevalence of presumed EPJF in dogs and its associations with signalment and other lumbosacral CT abnormalities. CT scans, including the lumbosacral spine of dogs obtained at two institutions, were assessed, yielding 324 scans. Presumed EPJF was found in 69 dogs (21%) and AFF in 68 dogs (21%), commonly at the caudal endplate of the last lumbar vertebra (71%). The remaining 187 dogs did not show presumed EPJF or AFF. Presumed EPJF type A occurred in 49/69, type B in 19/69, and type C in 1/69 dogs. Univariable logistic regression showed that presumed EPJF was associated with significantly higher IVDH grades than AFF. In the multiple regression model, presumed EPJF and AFF remained associated with increasing age and spondylosis deformans. Presumed EPJF was associated with vertebral endplate sclerosis and AFF with zygapophyseal joint osteoarthritis. In conclusion, presumed EPJF was observed on CT in 21% of dogs with lumbosacral IVDH. Prospective studies correlating EPJF on CT with clinical, surgical, and histopathological findings are needed for a better understanding of the underlying pathology and clinical relevance.

Physical Therapy Approaches for Concomitant Anterior Cruciate Ligament and Posterior Cruciate Ligament Avulsion Fractures: A Case Report.

Multi-ligament knee injury, involving complex destruction of structures like the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL), presents significant challenges in treatment as well as diagnosis. This case study focuses on a 55-year-old woman who was the victim of a severe traffic accident and had an ACL and PCL avulsion fracture, a medial condyle fracture, and a medial collateral ligament rupture. Afterward, open reduction and internal fixation of the right tibial plateau surgery was performed after a delay in order to manage the pain and swelling. Her rehabilitation was greatly helped by postoperative physical therapy, which focused on pain control, early mobilization, and gradual strength development. A well-structured rehabilitation plan was found to be beneficial, as indicated by the remarkable improvements in pain reduction and functional mobility. This case highlights the value of effective physical therapy in helping patients through the difficult recovery process following multiple ligament injuries with the goal of restoring function and improving their quality of life.

Transient Apical Breakdown: Incidence, Pathogenesis, and Healing.

BACKGROUND/AIMS: Transient apical breakdown (TAB) is a phenomenon that indicates temporary apical periodontal destruction and root resorption after tooth luxation injuries, followed by the healing process of the dental pulp. Andreasen in 1986, reported that TAB was seen in approximately 4.2% of all luxation injuries. However, there have been no reports thereafter on the types and frequency of the luxation traumatic injuries in which TAB occurs. Therefore, this retrospective study was aimed to assess the incidence and pathogenesis of dental trauma-induced TAB and to suggest a possible mechanism of subsequent healing based on a series of cases. METHODS: Data analysis included mature teeth (n = 56) of 49 patients aged 9-30 years who presented in a private dental office over a period of 10 years (2012-2022) to investigate the incidence and healing sequala of TAB. RESULTS: TAB was observed in 43.8% of subluxation, 62.5% of extrusive luxation, and 75% of lateral luxation injuries. The average age of patients who developed TAB was 14.5 years, ranging from 9 to 28 years old. CONCLUSIONS: TAB can be expected in many cases of luxation injuries with minimal dislocation. Therefore, mild injuries (subluxation, extrusion, and lateral luxation), may exhibit spontaneous healing, recovery of dark discoloration of the crown, disappearance of a periapical radiolucent lesion and return to normal response to EPT as long as 12 months after the traumatic injury. Thus, a decision to perform endodontic treatment in these cases might be postponed until clear evidence for an infection exists.

Arthroscopic Treatment of Combined Anterior and Posterior Cruciate Ligament Avulsion Fracture: A Case Report.

Anterior cruciate ligament (ACL) avulsion fractures without any concomitant injuries are extremely rare in skeletally mature patients and sporadically reported in the literature. Such injuries are more likely to be associated with tibial plateau fractures, other knee ligament ruptures, distal femoral fractures, or knee dislocations. In this article, a case of a 55-year-old male, who suffered a combined displaced ACL-posterior cruciate ligament (PCL) avulsion fracture, without any related injuries, is reported. The fracture was treated all arthroscopically with both an internal fixation and a single-tunnel suture fixation. In this case, arthroscopic anatomic reduction and internal fixation of the displaced tibial eminence was achieved, and internal fixation was performed with two antegrade cannulated screws with additional single-tunnel trans-ACL suture fixation. Six months post-injury, the patient had no signs of post-traumatic osteoarthritis, restoration of range of motion, no pain, and no residual instability of the knee joint. The mechanism of this rare injury, the method of fixation that was used, and the rehabilitation protocol that was followed are demonstrated. Additionally, the clinical outcome in terms of certain parameters is evaluated. Finally, we highlight the importance of this method for additional strength of fixation and the role of early mobilization to establish satisfactory results.

Proximal Hamstring Avulsions: Surgical Versus Conservative Treatment Using a Shared Decision-Making Strategy.

Background: Surgical treatment of patients with proximal hamstring avulsions provides good results; however, less is known about the outcome in patients who are offered conservative treatment. Purpose: To investigate the effect of surgical or conservative treatment (decided by a shared decision strategy) of proximal hamstring avulsions. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 24 patients with magnetic resonance imaging-verified proximal hamstring avulsion were included and had either surgical treatment (11 patients, 45% women; mean age, 50 ± 16 years) or conservative treatment (13 patients, 46% women; mean age, 50 ± 17 years). At baseline, 6 months and 12 months, all patients answered the Perth Hamstring Assessment Tool (PHAT) (0-100 scale) and Hip Sports Activity Scale (0-8 scale). Patients had their maximal hip extension strength and maximal strength at 30° and 90° of knee flexion measured in newton meters per kilogram using a handheld dynamometer. A minimal important change in PHAT was considered >7 points and a minimal important change in strength was considered >0.15 N·m/kg, respectively. Results: The surgical group had a shorter time from injury to initiation of treatment compared with the conservative group (median: 15 vs 64 days; P = .02). The surgical group had a greater amount of retraction of the tendons compared with the conservative group (3 vs 2 cm; P = .04). From baseline to 12-month follow-up, the surgical and conservative groups improved their mean PHAT scores (35 points [95 CI, 24-45 points] and 20 points [95% CI, 9-31 points], respectively) reaching a median of 79 points (interquartile range [IQR], 66-95 points) in the surgical group and 75 points (IQR, 66-85 points) in the conservative group at the 12-month follow-up. Their Hip Sports Activity Scale levels at 12 months were 3 points (95% CI, 1-4 points) and 1 point (95% CI, 0-3 points) (not significant). Furthermore, the surgical and conservative groups improved their maximal hip extension strength by 0.61 N·m/kg (IQR, 0.42-0.80 N·m/kg) and 0.62 N·m/kg (IQR, 0.13-1.10 N·m/kg), respectively. Their maximal knee flexion strength at 30° improved by 0.52 N·m/kg (IQR, 0.29-0.74 N·m/kg) and 0.32 N·m/kg (IQR, 0.12-0.52 N·m/kg) and their maximal knee flexion strength at 90° improved by 0.28 N·m/kg (IQR, 0.19-0.37 N·m/kg) and 0.22 N·m/kg (IQR, 0.02-0.41 N·m/kg). At the 12-month follow-up, the side-to-side difference in maximal muscle strength was 6% and 7%, respectively, during hip extension and 19% to 25% and 16% to 17%, respectively, during knee flexion. Conclusion: Twelve months after treatment of proximal hamstring avulsion, good clinical outcomes were seen when using a shared decision strategy regardless of whether the strategy led to surgical or conservative treatment.

Proximal avulsion of the hamstring in young athlete patients: a case series and review of literature.

Hamstring injuries are a frequent occurrence of athletes, leading to a stop in practice and long-term alterations in sports performance. About 12% of these lesions involve avulsion at the level of the proximal insertion that can be complete (about 6%) or partial. Starting from an epidemiological and treatment evaluation of these lesions in literature, the aim of this study was to examine the functional outcomes and the rate of "return to play" in a population composed of athletes of various levels who have undergone surgery to reinsert the hamstring muscles at the ischial insertion, for a complete detachment of one or more tendon heads. Therefore, a retrospective study was carried out where 18 patients treated at the Orthopedics and Traumatology Unit of the I.R.C.C.S. San Matteo in Pavia (Italy) were identified in a time span ranging from March 2012 to August 2020. The sample was analysed taking into account age, sex and risk factors, as well as the pathophysiology and anatomy of the injury using the Wood classification, the time elapsed before surgery, the duration of the rehabilitation protocol and the possible return to sports activity, comparing the level of sports performance in the pre- and post-operative period using the Tegner Activity Score (TAS). Different post-operative outcome evaluation scores (Perth Hamstring Assessment Tool PHAT and Lower Extremity Functional Scale LEFS) were also compared with each other in order to find a correlation with the real level of return to sporting activity. The mean age at surgery was 26.4 11.6 years. The population is composed of 14 males (77.8%) and 4 females (22.2%). All 18 patients returned to sports following surgery (100%). Of these patients, 17 (94%) maintained a level of sports performance equal to that before the injury. 100% of patients rated the outcome of the surgery as satisfactory. This study has shown that Hamstring reinsertion surgery is a correct indication in all athletes, allowing them a satisfactory return to sports practice.

Augmented suture pull-out with suture-button(triple fixation) yields less radiological residual laxity than suture pull-out technique-for Arthroscopic reduction and internal fixation of posterior cruciate ligament avulsion fractures.

OBJECTIVES: Among numerous arthroscopic reduction and internal fixation (ARIF) techniques for displaced posterior cruciate ligament (PCL) avulsions, residual posterior laxity and non-unions are under reported and the optimal technique is still unclear. The objective of our study is to differentiate the outcomes of arthroscopic suture pull-out(SPO) versus augmented suture pull-out(ASPO) using suture button for acute displaced tibial PCL avulsion fractures. METHODS: Retrospective study of ARIF for displaced tibial PCL avulsion operated between 2015 to 2021.. Chronologically, initial group of patients had underwent SPO(Group I), while the later underwent ASPO(Group II). Assessment included-functional scores (IKDC(International Knee Documentation Committee),Lysholm and KOOS scores(Knee Injury and Osteoarthritis outcome score)), and radiological assessment (union and posterior tibial displacement (PTD)). Student's unpaired t test and Cohen's term d for Effect size was used to compare the groups. Intraclass-correlation-coefficient for assessing inter-observer-reliability. RESULTS: 64 patients-Group I(n=32),Group II(n=32) were compared. |Mean duration of surgery was 48.06 (±9.52) and 54.3 (± 6.97) in group I and II respectively (p=0.004(s)). At mean follow-up of 39.7months(SD-10.6) in Group I and 35.6months(SD-6.6) in Group II, there was a statistically significant improvement in postoperative-IKDC, Lysholm and KOOS scores(p< 0.001). However, there was no significant difference between the two groups with respect to functional outcomes (P >0.05). Effect size(Cohen's-d) was 0.47(medium for IKDC), 0.78(large for Lysholms), 0.05 (small for KOOS), 1.46 (large for PTD). Mean PTD measuring the residual posterior laxity was greater in Group I (7.25 mm)(SD-1.9) than Group II (4.5mm)(SD-2.1) and was statistically significant(P=0.001). There were two non-unions (6.6%) and one popliteal artery injury in Group I. CONCLUSIONS: Both ASPO and SPO techniques result in comparable functional outcomes for ARIF of PCL avulsion fractures. However, augmented SPO with a suture button provides triple fixation and additional compression during ARIF of PCL avulsion fractures to mitigate residual posterior laxity on follow-up. LEVEL OF EVIDENCE: Level III Retrospective cohort study.

Traumatic Dental Injuries: Prevalence, First Aid, and Mouthguard Use in a Sample of Italian Kickboxing Athletes.

BACKGROUND: Traumatic dental injuries (TDIs) are a common complication in sports, with an overall prevalence ranging from 0.71% to 60%. Kickboxing is a high-risk combat sport for trauma to the facial region. METHODS: A total of 142 5-to-65-year-old amateur athletes participated in the survey with a questionnaire that was released during their regular practice days. The questionnaire was structured into three parts: (1) questions about age, gender, type, and time of sports practice; (2) questions about dental injuries, personal experience, and awareness of emergency management, particularly about tooth avulsion; (3) questions about wearing a mouthguard for TDI prevention. RESULTS: A total of 13 percent of athletes suffered a TDI while training or fighting. Regarding first aid, 61% of the participants in this survey are aware of the possibility of replanting a tooth after its avulsion; 10% believe that the tooth should be replanted within 15 min, and 37% of athletes believe that it should be kept wet. The mouthguard is known to the majority of athletes (94%), and 66% were informed by the coach; 68% of the athletes use it. Seventy-four percent of the mouthguards were purchased in a sports shop. CONCLUSIONS: A relatively low prevalence of TDIs was observed in players in the sample. A lack of information about the emergency management of tooth avulsion and about the type of mouthguard to wear emphasizes the importance of educational training by dentists to athletes and coaches.

Black tendon-identifying a rare autosomal recessive disorder: Intraoperative diagnosis of alkaptonuria: A case report.

Tendon injuries in the lower extremities are common in physically active individuals, although spontaneous Achilles tendon ruptures are linked to oral corticosteroid or fluoroquinolone use. Such ruptures are typically due to degenerative changes within the tendon and frequently occur during sudden dorsiflexion of a plantar-flexed foot. Bilateral spontaneous ruptures are especially prevalent in patients undergoing long-term corticosteroid therapy. Here, we present a rare case of bilateral spontaneous calcaneal avulsion in an otherwise healthy woman, ultimately diagnosed with alkaptonuria. This case underscores the importance of considering metabolic disorders in atraumatic tendon ruptures and highlights the diagnostic value of intraoperative findings.

Clinical implications of reconsideration of enthesitis/enthesopathy/enthesial erosion, as tendon attachment-localized avulsions and stress fracture equivalents.

Recognizing the mechanical origin of enthesitis/enthesopathy and the avulsion-nature of what had previously been considered erosions, it seems inappropriate to attribute it to stresses related to a person's normal activities. Conversely, sudden or unconditioned repetitive stresses appears the more likely culprit. Studies of enthesial reaction have lacked standardization as to findings present among individuals who appear to be healthy. Clinical evaluation by palpation and manipulation may be as effective as application of radiologic techniques. Recognition of the mechanical nature of the disease, including individuals with inflammatory arthritis suggests prescription of mechanical solutions that reduce stresses across the involved enthesis.

An unusual Ogden type V tibial tubercle avulsion fracture: a case report and literature review.

BACKGROUND: Ogden type V tibial tubercle avulsion fracture is an unusual type of physial injury. Thus, little is known about its mechanism of injury and treatment. The type of osteosynthesis is variable and depends on the experience of the surgeon. We commonly used cancellous screws fixation combined with tension band wiring for displaced fracture of the anterior tibial tuberosity. CASE PRESENTATION: The present manuscript describes a case of a Han nationality 13-year-old boy who presented with severe pain of the left knee, which began after landing following a high jump. He had no significant past medical history apart from a high body mass index of 30.3. Radiographs revealed that he had an unusual Ogden type V tibial tubercle avulsion fracture. He was treated by open reduction and combined fixation with cannulated screws and tension-band wiring. After 3 months, the fracture healed without any complications or knee symptoms with full range of motion. He underwent reoperation for symptomatic hardware, which was removed at 5 months after initial surgery, and returned to his prior level of sporting activity at 1 year follow-up. CONCLUSION: Our case suggests that excellent functional outcome could be achievable by open reduction with the combination of internal fixation and tension-band wiring for Ogden type V tibial tubercle avulsion fracture. This type of osteosynthesis could not only achieve anatomical reduction and stable fixation for such fractures, but also avoid further damage to the proximal tibial epiphysis, which prevents serious complications, such difference in leg length.

Posterior Cruciate Ligament Avulsion Fracture of Tibia: Fixation with Screw and Augmentation Using Ethibond Suture for Improved Clinical Outcomes.

Introduction: The posterior cruciate ligament (PCL) is a vital structure in knee biomechanics, and its avulsion fractures present a unique challenge. This prospective cohort study was conducted at Grant Government Medical College and JJ Hospital, Mumbai, aimed to assess the clinical outcomes of open reduction and internal fixation (ORIF) utilizing cancellous screws and ethibond suture augmentation for PCL avulsion fractures. PCL avulsion fractures often result from traumatic incidents, such as road traffic accidents, and are associated with complications if left untreated. Materials and Methods: Patients aged 20-45 years with isolated PCL avulsion fractures, confirmed by clinical and radiological assessments, were included. Seven eligible patients underwent ORIF, and outcomes were evaluated through clinical assessments, radiological imaging, and the Lysholm knee scoring system. Follow-ups were conducted for a mean time of 13.2 months, assessing stability, range of motion, and complications. Results: The study demonstrated a mean post-operative Lysholm score of 93.8, significantly improved from the pre-operative score of 49.6. Post-operative knee flexion averaged 125.2°. Fracture healing was observed in all cases, and complications were minimal. The study provides evidence of the effectiveness of ORIF with ethibond suture augmentation for PCL avulsion fractures. Conclusion: The study concludes that the proposed surgical technique yields positive outcomes, including enhanced knee functionality, successful fracture healing, and minimal complications. This approach, combining cancellous screws and ethibond suture augmentation, presents a promising option for the management of PCL avulsion fractures, contributing to the diverse landscape of effective treatment modalities.