RESUMO
BACKGROUND: Some children and adolescents can develop persistent pain and instability following inversion injuries of the ankle. In these cases, imaging exams could reveal small bone fragments distal to the lateral malleolus. For these patients, regular conservative treatment may not be successful, requiring additional management, which can include surgical treatment. This study aimed to present the short-to-midterm functional and clinical outcomes of a series of 12 pediatric and adolescent patients who underwent ligament repair surgery due to chronic instability associated with the presence of osseous components in the lateral ligaments. METHODS: A review of 12 patients treated with surgical ligament reconstruction of the ankle was evaluated. Clinical and functional evaluations were based on comparing the Visual Analogue Scale (VAS), AOFAS ankle-hindfoot score, and residual symptoms before and after the surgical intervention. RESULTS: Before the reconstructive approach, the mean VAS was 2.41 and the mean AOFAS score was 74.16. After the procedure, the standard VAS declined to zero, and the AOFAS score was 100 in all patients. The mean follow-up was 6.33 months. CONCLUSION: The surgical approach in children and adolescents with symptomatic ankle instability due to the presence of osseous fragments after an initial inversion trauma provided adequate clinical and functional results at short-to-midterm follow-up. LEVEL OF EVIDENCE: Level IV, retrospective case series.
Assuntos
Fratura Avulsão , Instabilidade Articular , Humanos , Adolescente , Instabilidade Articular/cirurgia , Instabilidade Articular/etiologia , Instabilidade Articular/fisiopatologia , Criança , Masculino , Feminino , Estudos Retrospectivos , Fratura Avulsão/cirurgia , Fratura Avulsão/diagnóstico por imagem , Ligamentos Laterais do Tornozelo/lesões , Ligamentos Laterais do Tornozelo/cirurgia , Resultado do Tratamento , Fraturas do Tornozelo/cirurgia , Fraturas do Tornozelo/diagnóstico por imagem , Ligamentos Articulares/lesões , Ligamentos Articulares/cirurgia , Traumatismos do Tornozelo/cirurgia , Articulação do Tornozelo/cirurgia , Articulação do Tornozelo/fisiopatologiaRESUMO
This research aims to present a novel arthroscopic fixation technique that uses a double-row suture anchor for tibial spine avulsion and to evaluate its short-term clinical outcomes. The surgical technique is described and a retrospective case series is presented. Patients who presented with tibial spine avulsion type III and IV fractures according to the Meyers and McKeever classification and received the same surgical treatment from 2013 to 2018 in two specialised hospitals in Medellín City were included. All interventions were performed by an experienced surgeon. To determine outcomes during clinical follow-up, the Lysholm score and objective and subjective International Knee Documentation Committee scores were obtained before and at least 12 months after surgery. A total of 24 patients were followed, with a mean age of 31 years; 12 patients were female. The median time between trauma and surgical fixation was 12 days (IQR=7-23), with a median follow-up period of 13.5 months (IQR=9.5-31.5). When comparing patients' state initially and during the postoperative period, statistically significant differences were found in all the scores analysed (p<0.05). Likewise, there were no complications and no reinterventions performed during follow-up, and all patients were satisfied with the outcomes of the procedure. Fixation of tibial spine avulsion fractures using the double-row suture anchor technique results in improvement in patients' function, pain and activity level. The main conclusion is that the procedure is an anatomical technique that requires minimal access and leads to satisfactory clinical evolution of patients. Level of evidence: Level V, case series.
Assuntos
Artroscopia/métodos , Fixação Interna de Fraturas/métodos , Fratura Avulsão/cirurgia , Fraturas da Tíbia/cirurgia , Adulto , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Articulação do Joelho/cirurgia , Escore de Lysholm para Joelho , Masculino , Amplitude de Movimento Articular , Estudos Retrospectivos , Âncoras de Sutura , Técnicas de Sutura , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Patellar sleeve avulsion (PSA) fractures are rare injuries that occur in in skeletally immature patients. Initial diagnosis is key to a successful outcome, as these injuries are easily overlooked on plain radiographs with poor results well documented from delayed management. High index of suspicion from the mechanism of injury, thorough clinical examination and Magnetic Resonance Imaging (MRI) help to avoid misdiagnosis. CASE PRESENTATION: The case of a 12-year-old male athlete with an acute PSA after a conservative treatment of a SLJ syndrome is described. The patient was referred to our clinic due to severe pain and loss of function after performing a high jump. Plain radiographs (X-ray) and MRI confirmed an inferior pole PSA which was fixed with double trans osseous ultra-high strength tapes. At the 3-month follow- up visit the patient was able to ambulate brace free. At 2-years follow up the patient was able to play soccer and ice hockey. To our knowledge, there are no case reports of inferior pole PSA with prior SLJ syndrome described in literature. CONCLUSIONS: Early clinical suspicion and distinguishing this PSA from other enchondral ossification disorders around the knee is critical to avoid misdiagnosis. Whether SLJ syndrome increases the risk of sustaining a PSA is still not clear. Trans osseous fixation with suture tapes leads to good functional results in a young athlete with inferior pole PSA.
Assuntos
Traumatismos em Atletas/diagnóstico por imagem , Fratura Avulsão/diagnóstico por imagem , Traumatismos do Joelho/diagnóstico por imagem , Osteocondrite/diagnóstico por imagem , Patela/diagnóstico por imagem , Criança , Fratura Avulsão/cirurgia , Fraturas Ósseas/diagnóstico por imagem , Humanos , Traumatismos do Joelho/cirurgia , Imageamento por Ressonância Magnética , Masculino , Osteocondrite/cirurgia , Patela/lesões , Radiografia , FutebolRESUMO
BACKGROUND: Although open reduction and internal fixation are recommended for displaced tibial tubercle avulsion fractures in young athletes, whether to use unicortical or bicortical fixation is debatable. The purpose of this study is to compare the outcomes of unicortical versus bicortical fixation in a series of pediatric tibial tubercle avulsion fractures. METHODS: We reviewed a consecutive series of patients with tibial tubercle fractures treated surgically at 2 level-1 pediatric tertiary care centers over a 12.5-year period. Patients aged below 18 years of age who received surgical treatment for displaced tibial tubercle fractures with postoperative follow-up were included. Fractures were classified using a modified Ogden classification system. The relative proportion of fracture types treated and incidence of complications were compared. RESULTS: The cohort included 90 fractures in 86 patients. There were 82 male and 4 female individuals; average age was 14.7 years (range, 9.0 to 18 y). In total, 87 of 90 were treated with open reduction and internal screw fixation [51 unicortical (59%), 13 mixed (15%), 23 bicortical (26%)] and 3 with percutaneous pinning. All patients were followed-up until healing and postoperative follow-up average was 8 months (range, 3 to 34 mo). There were no significant differences between the 2 groups with regard to patient age (P=0.22), patient weight (P=0.22), and activity clearance times [unicortical: 19.9 wk (range, 10.4 to 42.3 wk); bicortical: 17.7 wk (range, 12.1 to 32 wk); P=0.19]. The mixed cortical group was cleared at an average of 19.9 weeks (range, 10.6 to 29.1 wk). The relative proportion of fracture patterns treated differed negligibly between the unicortical and bicortical groups. Complications were noted in 9 of 90 procedures (10% rate); all subjects showed evidence of full radiographic healing at last follow-up. CONCLUSIONS: There was no difference in outcome whether unicortical or bicortical fixation was used. All patients exhibited full healing and return to activities with very low-complication rates. The results of this study suggest the adequacy of unicortical fixation for treating tibial tubercle fractures in young athletes. LEVEL OF EVIDENCE: Level III-retrospective comparative study.
Assuntos
Parafusos Ósseos , Fixação Interna de Fraturas/métodos , Fratura Avulsão/cirurgia , Redução Aberta , Fraturas da Tíbia/cirurgia , Adolescente , Pinos Ortopédicos , Criança , Feminino , Consolidação da Fratura , Humanos , Masculino , Complicações Pós-Operatórias , Estudos Retrospectivos , Centros de TraumatologiaRESUMO
Tibial tuberosity avulsion fractures are injuries accounting for less than 3% of all epiphyseal and 1% of all physeal injuries in adolescents. Bilateral injuries are very rare, with only 19 cases described in the literature. These types of fractures occur commonly in male teenagers during sport activities and are often associated with other orthopaedic disorders. We report the case of a male teenager with simultaneous bilateral tibial tubercle fractures, describe the evolution and treatment of this injury and review the literature on this subject. LEVEL OF EVIDENCE: Case report.
Assuntos
Fixação de Fratura/métodos , Fratura Avulsão/cirurgia , Fraturas da Tíbia/cirurgia , Adolescente , Futebol Americano/lesões , Humanos , Traumatismos do Joelho/cirurgia , Masculino , Resultado do TratamentoRESUMO
Posterior cruciate ligament avulsion fracture from its tibial insertion is a rare pathology in children. It is usually caused by high-energy traumas and its diagnosis is not always easy. Late diagnosis leads to late treatment, which can result in suboptimal results. We present a case of a 13-year-old boy hit by a car, who had a delay in diagnosis and treatment because of severe head trauma. The patient was treated 4 months after the trauma with open reduction and internal fixation of the avulsion fracture. After 4 years of follow-up, he has no complaints and has achieved good functional outcome.
Assuntos
Fixação Interna de Fraturas/métodos , Fratura Avulsão/cirurgia , Ligamento Cruzado Posterior/cirurgia , Fraturas da Tíbia/cirurgia , Atividades Cotidianas , Adolescente , Diagnóstico Tardio , Seguimentos , Fratura Avulsão/diagnóstico por imagem , Humanos , Masculino , Ligamento Cruzado Posterior/diagnóstico por imagem , Fraturas da Tíbia/diagnóstico por imagem , Fatores de TempoRESUMO
Las fracturas por avulsión de la tuberosidad anterior de la tibia ocurren generalmente en adolescentes atletas. Estas lesiones son más frecuentes en el sexo masculino y su incidencia puede cifrarse entre el 0,4 por ciento al 2,7 porciento del total de las lesiones epifisarias. Presentamos un adolescente masculino de 15 años de edad, que durante la práctica de voleibol sufrió fractura por avulsión de la tuberosidad anterior de la tibia tipo II A de Odgen. Se le realizó reducción abierta y fijación interna e inmovilización. No presentó complicaciones. Hacemos una revisión de esta entidad por ser poco frecuente(AU)
Avulsion fractures of the anterior tuberosity of the tibia generally occur in adolescent athletes. These lesions are more frequent in males and their incidence can range 0.4 percent to 2.7 percent of the total epiphyseal lesions. We present a 15-year-old male adolescent, who during the volleyball practice suffered an avulsion fracture of the anterior tuberosity tibia Odgen type II A. He underwent open reduction and internal fixation and immobilization. He had no complications. A review of this entity is conducted since it is rare(AU)
Les fractures-avulsion de la tubérosité tibiale antérieure se produisent généralement chez de jeunes athlètes. Ces lésions touchent souvent les garçons, et leur incidence peut aller de 0,4 pourcent à 2,7 pourcent de la totalité des lésions épiphysaires. Le cas d'un garçon âgé de 15 ans, ayant souffert une fracture-avulsion de la tubérosité tibiale antérieure type IIA selon la classification d'Odgen au cours de sa pratique de volleyball, est présenté. Il a subi alors une réduction ouverte et fixation interne, ainsi qu'une immobilisation. Il n'a pas eu de complication. Due à sa rareté, une révision de cette affection est réalisée(AU)