A new etiological cause for anterior cruciate ligament injury: E-Scooter.

The usage of electric scooters has been popular because it is a cheap and fast transportation method. Its use has increased in recent years because public transportation is less preferred during the covid-19 pandemic and in parallel, the publications reporting e-scooter accidents are increasing. There is no article examining the relationship between e-scooter and anterior cruciate ligament (ACL) injury in current literature. We aim to examine the relationship between e-scooter accidents and ACL injury incidence. Patients over the age of 18 years who applied to our orthopedics outpatient clinic with the diagnosis of ACL injury between January 2019- June 2021 were evaluated. 80 e-scooter accidents resulting with ACL tears were reviewed. The electronic medical records of the patients were reviewed retrospectively. Information about the age, gender, trauma history of the patients, and type of trauma was obtained. Fifty-eight patients had a history of falling while stopping the scooter, and 22 patients had a history of falling after hitting something. Anterior cruciate ligament reconstruction was performed with hamstring tendon grafts in 62(77,5%) of the patients included in the study. 18 (22,5%) patients were followed up with functional physical therapy exercises because they did not want to be operated on. Various bone or soft tissue injuries while using e-scooters have been reported in the literature until now. ACL injury is also seen quite frequently after these traumas, and necessary information and warnings should be given to the users to prevent ACL injuries.

Is arthroscopic assisted double tibial tunnel fixation a good option for tibial eminentia fractures?

Tibial eminentia fractures are avulsion fractures of the anterior cruciate ligament caused with additional injuries like meniscus tears or ligamentous injuries. Arthroscopic assisted internal fixation has become a preferred technique with the development of arthroscopic techniques. We aimed to present our results for arthroscopic assisted double tibial tunnel fixation in patients with displaced eminentia fracture. Twenty patients who were operated on for eminentia fracture between January 2010 and May 2014 were included in this study. All fractures were type II according to Meyers's classification. Eminentia was reduced with two nonabsorbable sutures through the ACL. Two tibial tunnels were created over the medial proximal tibia with a 2.4 mm cannulated drill. The two suture ends taken out of the 2 tibial tunnels were connected on the bone bridge between the tunnels. Patients were evaluated with Lysholm score, Tegner score, IKDC score and examined for clinical and radiological evidence of bony union. Quadriceps exercises were started on the third day. The patients were followed up with a locked knee brace in extension for 3 weeks after surgery and later patients were encouraged to mobilize as pain allowed. The preoperative Lysholm score was 75 ±3.3 and the postoperative Lysholm score was 94.5 ±3. Tegner score was 3.52±1.02 preoperatively and 6.84±1.099 postoperatively. International Knee Documentation Committee(IKDC) score was abnormal in all of the 20 patients preoperatively but normal postoperatively. The postoperative scores of the patients were statistically significant when compared with preoperative activity scores(p<0,0001). Tibial eminentia fractures may lead to pain, knee instability, malunion, laxity, or extension deficit. The technique we have described together with early rehabilitation may give good clinical results.

Derotation of the mallet piece: A crucial point in mallet fracture surgery.

Mallet fracture is an avulsion of the extensor tendon and fracture of the dorsal rim of the articular surface of distal phalanx at the same time. If a part of the mallet fracture is angled or rotated to such a degree that prevents full anatomic reduction, malunion and deformities may occur as a result. The objective of this study was to describe a new surgical technique to provide derotation of the mallet fracture. A 22G or 21G needle is used like a joystick to reduce the mallet fracture with small, gentle movements. The extension block pinning technique described by Ishiguro was applied after proper alignment had been achieved. Bony union was achieved for all patients 6 weeks later. Derotation of type 2 and 3 mallet pieces with closed reduction to prevent surgical failure is simple but effective.