Tibial tubercle avulsion fracture during sport activities in adolescent: a case report.

BACKGROUND AND AIM OF WORK: Tibial tubercle avulsion fractures (TTAF) are uncommon condition in children and adolescents. These lesions may be misdiagnosed and consequently not properly treated. Reduction and fixation is indicated if displacement is higher than 2mm or if the extensor apparatus is damaged. Authors present a case of a TTAF associated with a complete lateral patellar retinaculum lesion in a 13-year-old male adolescent non-professional basketball player. METHODS: Surgery consisted of reduction and fixation with 2 half threaded cancellous and washers; TTA was then basted and reinforced with a non absorbable suture according to Krachow technique and finally the patellar lateral retinaculum through a direct repair with absorbable material. RESULTS: Clinical evaluation after 3 years showed bone healing, a complete resolution of pain, complete range of motion, good strength and complete functionality of the operated limb. CONCLUSIONS: Misdiagnosis or delayed treatment of TTAF can often result in nonunion, functional impairment, and persistent pain. For these reasons, authors believe that a stable and quick fixation associated to specialized rehabilitation are crucial for recovery. (www.actabiomedica.it).

Grice subtalar arthrodesis of bilateral adult flatfoot in a professional dancer: a case report.

BACKGROUND AND AIM: Adult acquired flatfoot deformity (AAFD) is a common pathology and an important cause of pain and disability. This deformity causes a progressive flattening of the foot arch which has traditionally been associated with posterior tibialis tendon (PTT) dysfunction. Operative treatment is indicated after the failure of conservative management aiming to achieve proper alignment of the hindfoot and to maintain as much flexibility as possible. If subtalar osteoarthritis is present, subtalar arthrodesis is usually the best therapeutic option. Grice-Green subtalar arthrodesis is a widely used procedure. METHODS: This report describes a case of bilateral painful AAFD in a 39-years old female professional dancer treated with Grice-Green subtalar arthrodesis with an autologous corticocancellous graft harvested from the ipsilateral proximal tibia. Surgeries were performed 3 years apart from each other. RESULTS: The patient followed had good clinical and radiological outcomes. She returned to dance 4 months after surgery with no referred pain or limitations.  Conclusions: Due to its versatility and capability to restore the shape and thickness of the hindfoot Grice-Green procedure is a simple and effective technique for the treatment of AAFD with subtalar osteoarthritis and a valid option to solve professional disabilities as it happened in this case with a professional dancer.

Medial epicondyle avulsion after elbow dislocation in an adolescent non-professional soccer player treated with a cannulated screw: a case report.

BACKGROUND AND AIM OF THE WORK: Medial epicondyle fractures of the humerus account for 11-20% of all elbow injuries in children and in 30-55% of cases they are associated with an elbow dislocation. Undisplaced fractures are usually treated conservatively but literature is controversial regarding the treatment of displaced fractures (≥5mm) in paediatric fractures. In recent years, there is an emerging consensus that such patients may benefit more from open reduction and internal fixation. Authors report a case of a 15 years old nonprofessional soccer player who suffered of an elbow dislocation with an intra-articular fragment derived from avulsion of the medial epicondyle. METHODS: Clinical and instrumental evaluation confirmed elbow dislocation with an intra-articular fragment derived of the medial epicondyle. After the reduction an open reduction and internal fixation with cannulated screw was performed. RESULTS: Clinical evaluation after 90 days showed resolution of pain and almost complete ROM and complete recovery of strength and of functionality of the operated limb. Furthermore, x-rays demonstrated consolidation of the fracture. CONCLUSIONS: this case confirms that a precise evaluation of the fracture and its displacement is at the base of satisfactory outcomes. If fracture is displaced≥5mm and patient is near skeletal maturity open reduction and fixation is indicated.

High energy trauma with complex fracture of the right tibial plateau, compartment syndrome and infection in a professional freestyler motorcyclist.

BACKGROUND AND AIM OF THE WORK: High-energy tibial plateau fractures are complex lesions that may be associated with extensive soft tissue damages and severe complications, such as compartment syndrome and neurological injuries. This case report interests a professional motocross freestyler with complex tibial plateau fracture associated to compartment syndrome and partial common peroneal nerve impairment which complicated with a dehiscence of the surgical wound and infection after plate and screws fixation. One year later, despite the complexity of the fracture, the gravity of the soft tissue lesions and subsequent complications, the patient healed. This satisfactory result depended on the correct management in terms of type of treatment and timing.

The scapho-capitate syndrome: a case report with follow-up of three years.

The scapho-capitate or Fenton syndrome is characterized by an associate fracture of the scaphoid and capitate with rotation of 90° or 180° of the capitate's head. We report a case of this syndrome which occurred in a fifteen years old professional motorcyclist who came to our observation following a high-energy trauma that occurred during the track tests. Through a dorsal access the fractures of the capitate and scaphoid were reduced and stabilized with Kirschner wires. The patient was radiographically and clinically evaluated three years after surgery; complete healing of scaphoid fracture and reabsorption of the capitate's head as consequence of avascular necrosis with the onset of a midcarpal arthritis were observed. Despite this radiographic evolution, the patient achieved excellent clinical result featured by complete recovery of wrist motion and absence of pain thus allowing the return to motorcycling.

Traumatic extensor tendons injuries of the foot in childhood: a case report.

BACKGROUND AND AIM OF THE WORK: Extensor tendon injuries of the foot in children represent a rare foot injury. We report a case of a 9 year-old male who suffered of a traumatic wound laceration in the distal third of the right leg with a glass the day before in another country, getting a combined injury of tibialis anterior (TA), extensor hallucis longus (EHL) and extensor digitorum longus (EDL). METHODS: After an initial clinical and radiological evaluation, antibiotic prophylaxis was immediately started. Surgery was necessary for the repair of the lesions and after rehabilitation the patient recovered a good function with a complete return to a normal life. RESULTS: 5 years follow-up clinical examination revealed a complete and painless range of movement comparable to the other foot. The patient regained active dorsiflexion without functional limitations, deformity or contracture. CONCLUSIONS: Early exploration is important to allow full definition of the extent of injury and early surgical repair of tendons is recommended to avoid future disability.

Atypical use of pediatric flexible nails in the treatment of diaphyseal fractures in adults.

BACKGROUND AND AIM OF THE WORK: Elastic intramedullary nails are commonly used for the treatment of diaphyseal fractures in adolescents and children. The major advantages are the minimally invasive nature of the technique, the short operation time, and the preservation of the growth plate and periosteum thus allowing bone healing within a closed and intact biological environment. Elastic nails are rarely applied to the adult fractures. METHODS: Five selected adult patients affected by diaphyseal fractures were treated using paediatric flexible nails T2 Kids (Stryker®, Mahwah, NJ, USA) as consequence of their poor clinical conditions, high risk of neurovascular injuries and skin/soft tissues problems. All patients were monthly clinically and radiographically evaluated after surgery until fracture healing. RESULTS: Radiological and clinical outcomes were satisfying. All fractures healed after a mean period of 3 months. No losses of reduction as well as mobilization/breakage of implant were observed. CONCLUSIONS: Use of pediatric elastic nails is a valid surgical option in treatment of diaphyseal fractures in selected adult patients who request fast and minimally invasive surgery as consequence of precarious clinical or soft tissues conditions.

Distal radius nonunion after epiphyseal plate fracture in a 15 years old young rider.

BACKGROUND AND AIM OF THE WORK: Radius and ulna fractures are the most common long bone fractures in children and adolescents. The majority of these injuries involve the distal metaphyseal portion of the radius associated or not to physeal plate injuries. Because of the high remodelling potential of the distal radius in growing children most injuries heal without complication after closed reduction and immobilization in a long arm cast. Nonunions of closed distal radius fracture are an extremely rare occurrence especially in paediatric population. Methods: In this report, we describe a rare case of distal radius fracture nonunion in a 15-years old male rider treated conservatively with cast immobilization. Eight months later he underwent surgical closed reduction and fixation with kirschner wire and cannulated screw. Results: Follow-up at 2 years showed satisfying radiological and functional outcomes. The patient ultimately returned to ride 3 months following surgery. Conclusions: Nonunion is rarely seen in distal radius fractures in healthy children and adolescents, and there are few studies in the literature. Treatment of the nonunion must be individualized and the results are not entirely predictable.

Complex lesion of the third metacarpophalangeal joint: complete tear of the radial collateral and deep transverse metacarpal ligament.

Injuries of collateral ligaments of MCPs joints are often underdiagnosed but have to be considered serious traumas of the hand. In many cases they concern thumb and rarely long fingers. Closed rupture of the deep transverse metacarpal ligament (DTML) is an unusual parallel injury. Both lesions present similar symptoms included local pain, swelling, ecchymosis and deviation of the finger in flexion and can be misdiagnosed. We describe the treatment of a 34 years old woman who sustained a complex lesion of the soft tissues of third metacarpophalangeal joint with complete close tear of the radial collateral and deep transverse metacarpal ligament following a fall during a walk thus leading to a multiplanar instability. Surgery consisted in mini anchor repair or the collateral ligament tear, direct resorbable suture of DTML and a double k-wire stabilization. Follow up at 11 months has shown excellent functional outcomes.

Pectoralis major tendon rupture in a weight lifter: a rare case.

Pectoralis major tendon (PMT) rupture is a rare event, and it was originally described by Patisser in 1822. The PMT is a thick lamina, which has two origins, one from the clavicle and the other from the ribcage sternum. PMT lesions are classified according to 3 levels of severity: Type 1 is contusions and strains, Type 2 is a partial tear and Type 3 is a complete tear. Diagnosis is made through a clinical examination which comprises a positive response to pain upon pressure over the axilla recess, the presence of bruising and limited motion, and is completed with an MRI. Type 3 injuries are treated exclusively through surgery, while Type 1 and 2 lesions are treated conservatively. In this article, we describe a rare case of PMT rupture in a 39-year-old weight lifter, the surgical treatment that was carried out through an open access at the Pectoralis and Deltoid junction and anchor suture, the post-surgical rehabilitation program and a 1-year follow-up assessment at which point return to sport was achieved.

Cosmetic amputation of the fourth ray as possible outcome of the traumatic amputation of the ring finger injury: a case report.

The aim of this work is to describe a case of traumatic amputation of the fourth finger of the left hand. In its first phase, a treatment which consisted in a disarticulation at the level of the metacarpo-phalangeal joint was carried out; in the second phase, three months after this emergency treatment, a cosmetic amputation of the fourth metacarpal ray was required. Surgery was performed in accordance with the technique described by Bunnell, which consisted in the disarticulation of the fourth metacarpal, together with radial traslation of the fifth ray. Eighteen months after the operation The patient reported the absence of any subjective problems, with complete functional recovery of the hand that had been operated on. By that time she was back at her job; she also was satisfied with the cosmetic results that had been achieved.