Tibial Tubercle Avulsion Fractures in Adolescence in Sports Injury about Four Cases Series.

Introduction: Tibial tubercle avulsion fractures are a rare lesion in adolescence that occurs during sports such as basketball, soccer, and volleyball. They result from a forceful extension of the knee against a fixed leg. Case Report: Case 1: A 14-year-old adolescent who reportedly experienced severe knee pain when he jumped to head a ball during a soccer game. Case 2: A 17-year-old teenager who reportedly experienced severe knee pain on takeoff during a high jump event. Case 3: A 16-year-old who reportedly felt pain during takeoff to catch a basketball. Case 4: A 14-year-old adolescent who reportedly felt pain in his left knee on takeoff from a high jump during a basketball game. All of these patients presented with a defective leg extension on clinical examination. Radiographs showed an avulsion fracture of the anterior tibial tuberosity and treatment was surgical. Discussion: Avulsion fractures of the tibial tuberosity are rare lesions. They occur in adolescents during sports and are usually accompanied by fracture fragment displacement, indicating reduction, and internal fixation surgery by screwing. In the short term, the result is satisfactory. Conclusion: Tibial tuberosity avulsion fractures when managed in their entirety, give better results with a precocious return to sport.

Limb-threatening and life-threatening diabetic extremities: clinical patterns and outcomes in 56 patients.

Limb- and life-threatening hand and foot infections in diabetic patients account for a large proportion of amputations and a substantial number of deaths. Between August 2006 and the end of July 2008, we conducted a prospective cohort study of consecutive diabetic patients with serious hand or foot infections, in an effort to identify clinical patterns and outcomes related to the treatment of these infections. Infections were categorized as dry, gas, and wet gangrene; necrotizing fasciitis or cellulitis; acute extensive osteomyelitis; and any of these infections involving the hand. All of the patients underwent a standard examination and treatment protocol, although none of the patients received vascular surgical care. End points included healing following debridement or minor amputation, major (transtibial or more proximal) amputation, or death. A total of 56 patients were included in the final analyses, and their mean age was 70 (range 51 to 86) years. Of the patients, 17 (30.36%) had necrotizing cellulitis, 12 (21.43%) had wet gangrene, 9 (16.07%) had acute extensive osteomyelitis, 5 (8.93%) had dry gangrene, 5 (8.93%) had gas gangrene, 4 (7.14%) had necrotizing fasciitis, and 4 (7.14) had diffuse hand infections. Five (8.93%) patients died (2 after prior amputation), 26 (46.43%) underwent debridement and/or minor amputation, and 27 (48.21%) required major amputations. Based on our findings, we concluded that 7 patterns of serious limb- or life-threatening infection were identified and, in the absence of vascular surgical intervention, mortality can be reduced at the expense of more amputations.