DOCSLIB.ORG

Avulsion Fractures of the Proximal Tibial Epiphysis

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Avulsion Fractures of the Proximal Tibial Epiphysis Br J Sp Med 1991; 25(1) Br J Sports Med: first published as 10.1136/bjsm.25.1.52 on 1 March 1991. Downloaded from Avulsion fractures of the proximal tibial epiphysis G. Inoue MD', K. Kuboyama MD2 and T. Shido MD3 'Department of Orthopaedic Surgery, Branch Hospital, Nagoya University School of Medicine, Nagoya, Japan 2Kuboyama Orthopaedic Clinic, Shizuoka, Japan 3Department of Orthopaedic Surgery, Hamamatsu Medical Centre, Hamamatsu, Japan Fractures of the tibia through the proximal epiphysis are sporting activities: two boys were injured during a rare. This injury usually results from severe direct or high jump, one in a long jump, and one during indirect force about the knee, and has not been described basketball. In three of the five fractures, the patients as resulting from a patellar tendon avulsion injury. Four patients presented with five avulsion fractures of the felt that their injuries occurred on take-off for their proximal tibial epiphysis. All were older adolescent males jump while the remaining two injuries occurred on who had been engaged in jumping sports when the injury landing. All patients presented with pain and occurred; one had bilateral injury. All the patients were swelling about the anteromedial part of the proximal treated by closed reduction and plaster cast immobi- end of the tibia. Three patients were unable to extend lization for 4-8 weeks, with satisfactory results. On the the involved knee or bear weight. basis of our cases and five cases previously reported, the Radiographs revealed a Salter-Harris type II authors would agree with Ryu and Debenham's sugges- fracture of the proximal tibial epiphysis4: this was an tion that the Watson-Jones classification, which divides avulsion fracture of the tibial tuberosity with the avulsion fractures of the tibial tubercle into three types, fracture line extending through the proximal tibial should be expanded to include this fourth type - avulsion physis and metaphysis into the posterior cortex. fracture of the proximal tibial epiphysis. Displacement of the fragment with posterior angula- Keywords: Avulsion fracture, tibia, epiphysis, jumping tion was noted in four fractures: these were treated sports by closed reduction and long-leg cast immobilization for 4-8 weeks. One of these injuries required percutaneous pinning to stabilize the fracture. One Fractures of the proximal tibial epiphysis are rare fracture, where there was no displacement of the adolescent injuries which are produced by two fragment, was treated in a cylinder cast for 4 weeks. different mechanisms: severe direct or indirect force An undisplaced fibular fracture at the same level as about the knee separating the tibia through the full the tibial fracture was recognized in two patients. No http://bjsm.bmj.com/ width of the proximal tibial epiphysis or an avulsion neurovascular damage was noted in our series. force separating the anterior portion of the proximal tibial epiphysis. The former is usually caused by a high-energy motor accident or collision during a Results contact sport, while the latter is caused by a In all patients the fractures healed uneventfully and high-tensile load to the tibial tuberosity during a full weight-bearing was allowed after 4-8 weeks. The jumping sport. A total fracture-separation of the patients were able to return to full activity after on September 27, 2021 by guest. Protected copyright. proximal tibial epiphysis caused by an avulsion force approximately 3 months. They had a minimum is extremely rare. The authors have found only five follow-up of 1 year, with a mean follow-up of 15 1-3 fractures reported in the literature' . months. All patients had a full range of knee In the present report, five such fractures are movement and normal quadriceps function with no described in four patients who were injured in muscle atrophy. Although premature closure of the jumping sports. involved tibial physis was recognized in two patients, there was no discrepancy in length or angular Material and methods deformity of the legs. Table 1 summarizes the clinical information on these Case reports patients. All were boys, two aged 15 years and two Case 1 A 16-year-old boy, experienced sudden right aged 16. Three patients showed unilateral involve- knee pain with 'a pop' when he took-off for a long ment and one bilaterial involvement, and all fractures jump off his right leg. He landed with both knees were closed. All of the injuries were sustained during flexed. The patient noted severe pain in both knees and was unable to stand up. Examination revealed and tenderness the antero- Address for correspondence: G. Inoue MD, Department of gross swelling along Orthopaedic Surgery, Branch Hospital, Nagoya University School medial proximal metaphysis. The patient was unable of Medicine, 1-1-20 Daikominami, Higashi-ku, Nagoya 461, Japan to extend either leg. He had a history of clinically ©) 1991 Butterworth-Heinemann Ltd. asymptomatic Osgood-Schlatter disease of both knee 0306-3674/91/010052-05 joints. 52 Br J Sp Med 1991; 25(1) Avulsion fractures of the proximal tibial epiphysis: M. D. Inoue et al. Table 1. Summary of cases Br J Sports Med: first published as 10.1136/bjsm.25.1.52 on 1 March 1991. Downloaded from Case no. Involved Age at Mechanism Treatment Follow-up Remarks limb Injury ofinjury (months) (years) 1 R 16 Long jump Cast 12 PCP (take-off) L 16 Long jump Cast 12 PCP (landing) Fibular fracture 2 L 16 High jump Cast 16 (take-off) 3 R 15 High jump Cast 12 Fibular fracture (take-off) 4 L 15 Basketball Cast 36 PCP (landing) Percutaneous pinning L, left; PCP, premature closure of the physis; R, right Radiographs showed a Salter-Harris type II frac- pain and swelling over the tibial tuberosity. He was ture in both legs in an anteroposterior plane through able to extend his knee against gravity. the proximal tibial physis and metaphysis, with Radiographs revealed that the tongue-like projec- posterior angulation (Figure 1). There was also a tion of the anterior tibial epiphysis was lifted upward fibular fracture in the left leg. The fractures were and a fracture line extended obliquely downward reduced by a closed manipulation with the knee across the metaphysis into the posterior cortex (Figure extended and direct manual pressure over the tibial 3). The limb was immobilized in a cylinder cast for 4 tubercle. Both knees were immobilized in long-leg weeks, and then full weight-bearing was allowed casts for 6 weeks. Follow-up examination 1 year later with progression to full activity. One year after revealed no bony abnormality and full range of injury, he had full range of movement in the knee, no movement in both knee joints, although radiographs length discrepancy, and no complaints. Radiographs showed premature closure of both tibial physes showed no abnormality in the knee. (Figure 2). Case 2 A 16-year-old boy sustained injury to the left Discussion knee while doing the high jump. He felt that his Fracture of the proximal tibial epiphysis is a rare injury occurred on take-off. At examination he had injury, accounting for between 0.5% reported by http://bjsm.bmj.com/ on September 27, 2021 by guest. Protected copyright. a b Figure 1. Case 1 a Initial lateral radiograph of the right knee showing an avulsion fracture of the tibial tubercle with a Salter-Harris type 11 fracture of the proximal epiphysis. b Initial lateral radiograph of the left knee showing a similar findings to that of the right knee. Note a greenstick fracture of the fibula Br J Sp Med 1991; 25(1) 53 Avulsion fractures of the proximal tibial epiphysis: M. D. Inoue et al. Br J Sports Med: first published as 10.1136/bjsm.25.1.52 on 1 March 1991. Downloaded from a Figure 3. Case 2 Initial lateral radiograph demonstrates that the entire tongue formed by the anterior tibial epiphysis is hinged upward, and a fracture line passes obliquely downward across the metaphysis (arrows) the tubercle is avulsed and displaced upward. In the second type, the secondary centre of ossification in the tubercle has already coalesced with the remainder of the proximal epiphysis and the entire tongue formed by the tibial tuberosity on the epiphysis is http://bjsm.bmj.com/ hinged upward. In the third type, the line of fracture passes upward and backward across the proximal articular surface of the tibia. Burkhart and Peterson8, and Shelton and Canale6 include Watson-Jones type III fracture in their reviews of proximal tibial epiphyseal fractures. However, avulsion fractures of the tibial tubercle seem to constitute a specific subgroup that may be considered to be a separate on September 27, 2021 by guest. Protected copyright. group. b The avulsion type of fracture of the proximal tibial Figure 2. Case 1 Lateral radiographs of both knees (a, epiphysis is extremely rare, especially those fractures right; b, left) 1 year after injury showing premature closure which start at the tibial tubercle and extend up into of the tibial physes. There is no deformity the proximal tibial epiphysis, separating both struc- tures. We found only five cases cited in the literature surveyed. Silberman and Murphy' described a Peterson and Peterson5 and 3.06% reported by Salter-Harris type I fracture of the proximal tibial Shelton and Canale6 of all epiphyseal injuries. This epiphysis in a 12-year-old boy who sustained right injury can occur from direct or indirect force. A direct knee injury after 'pushing off' in a high jump. Ryu injury usually occurs in high-energy motor vehicle and Debenham3 reported a Salter-Harris type II accidents while indirect injury can occur from passive fracture of the proximal tibial epiphysis that occurred hyperextension, abduction or adduction of the legs when a 16-year-old boy jumped for a basketball; they during sports activities or falls.
Load more

Recommended publications
  • Isolated Avulsion Fracture of the Lesser Tuberosity of The
    (aspects of trauma) Isolated Avulsion Fracture of the Lesser Tuberosity of the Humerus in an Adult: Case Report and Literature Review Aman Dhawan, MD, Kevin Kirk, DO, Thomas Dowd, MD, and William Doukas, MD solated avulsion fractures of also describe our operative technique, comminuted 3-cm lesser tuberosity the lesser tuberosity of the including use of heavy, nonabsorb- fracture fragment retracted approxi- proximal humerus are rare. able suture. mately 2 cm from the donor site We report the case of a right- (Figures 1B–1D). No biceps tendon Ihand–dominant woman in her early ASE EPORT subluxation or injury and no intra- C R 30s who sustained such an injury, A right-hand–dominant woman in articular pathology were noted. with an intact subscapularis tendon her early 30s presented with right The lesser tuberosity fracture was attached to the lesser tuberosity frag- shoulder pain 1 day after a fall down surgically repaired less than 2 weeks ment. Treatment included surgery to a flight of stairs. During the acci- after injury. Through a deltopectoral restore tension to the subscapularis dent, as her feet slipped out from approach, the rotator interval and muscle and maintain the force couple underneath her and her torso fell the 3×2-cm fracture fragment were about the shoulder joint. One year after injury, the patient reported no pain, excellent range of motion, and “[To be diagnosed] this injury...requires... return to activities. This case demonstrates the diag- careful review of orthogonal radiographs nostic challenge of this injury, which requires a high index of suspicion and and advanced imaging.” careful review of orthogonal radio- graphs and advanced imaging.
    [Show full text]
  • Broken Bones: Common Pediatric Lower Extremity Fractures—Part III
    10173-06_ON2506-Hart.qxd 11/9/06 3:51 PM Page 390 Broken Bones: Common Pediatric Lower Extremity Fractures—Part III Erin S. Hart ▼ Brenda Luther ▼ Brian E. Grottkau Lower extremity injuries and fractures occur frequently in young usually have pain with hamstring stretching and hip flex- children and adolescents. Nurses are often one of the first ion/abduction). Patients also frequently demonstrate an healthcare providers to assess a child with an injury or fracture. antalgic gait and have pain during their activity or sport. Although basic fracture care and principles can be applied, An anteroposterior radiograph of the pelvis usually reveals nurses caring for these young patients must have a good under- the avulsed fragment. Comparative views of the contralat- standing of normal bone growth and development as well as eral side are often helpful in confirming the diagnosis and avoiding further unnecessary advanced imaging studies. common mechanisms of injury and fracture patterns seen in This injury is usually treated symptomatically and often children. Similar to many of the injuries in the upper extremity, involves rest, application of ice, and relaxation of the in- fractures in the lower extremity in children often can be treated volved tendon (O’Kane, 1999). Conservative treatment of nonoperatively with closed reduction and casting. However, this pelvic avulsion fractures is usually successful. Crutches are article will also review several lower extremity fractures that often needed for several weeks to reduce symptoms and frequently require surgical intervention to obtain a precise rest the extremity involved. Complications following pelvic anatomical reduction. Common mechanisms of injury, fracture avulsion fractures in children are rare, and most patients patterns, and current management techniques will be discussed.
    [Show full text]
  • 5Th Metatarsal Fracture
    FIFTH METATARSAL FRACTURES Todd Gothelf MD (USA), FRACS, FAAOS, Dip. ABOS Foot, Ankle, Shoulder Surgeon Orthopaedic You have been diagnosed with a fracture of the fifth metatarsal bone. Surgeons This tyPe of fracture usually occurs when the ankle suddenly rolls inward. When the ankle rolls, a tendon that is attached to the fifth metatarsal bone is J. Goldberg stretched. Because the bone is weaker than the tendon, the bone cracks first. A. Turnbull R. Pattinson A. Loefler All bones heal in a different way when they break. This is esPecially true J. Negrine of the fifth metatarsal bone. In addition, the blood suPPly varies to different I. PoPoff areas, making it a lot harder for some fractures to heal without helP. Below are D. Sher descriPtions of the main Patterns of fractures of the fifth metatarsal fractures T. Gothelf and treatments for each. Sports Physicians FIFTH METATARSAL AVULSION FRACTURE J. Best This fracture Pattern occurs at the tiP of the bone (figure 1). These M. Cusi fractures have a very high rate of healing and require little Protection. Weight P. Annett on the foot is allowed as soon as the Patient is comfortable. While crutches may helP initially, walking without them is allowed. I Prefer to Place Patients in a walking boot, as it allows for more comfortable walking and Protects the foot from further injury. RICE treatment is initiated. Pain should be exPected to diminish over the first four weeks, but may not comPletely go away for several months. Follow-uP radiographs are not necessary if the Pain resolves as exPected.
    [Show full text]
  • Upper Extremity Fractures
    Department of Rehabilitation Services Physical Therapy Standard of Care: Distal Upper Extremity Fractures Case Type / Diagnosis: This standard applies to patients who have sustained upper extremity fractures that require stabilization either surgically or non-surgically. This includes, but is not limited to: Distal Humeral Fracture 812.4 Supracondylar Humeral Fracture 812.41 Elbow Fracture 813.83 Proximal Radius/Ulna Fracture 813.0 Radial Head Fractures 813.05 Olecranon Fracture 813.01 Radial/Ulnar shaft fractures 813.1 Distal Radius Fracture 813.42 Distal Ulna Fracture 813.82 Carpal Fracture 814.01 Metacarpal Fracture 815.0 Phalanx Fractures 816.0 Forearm/Wrist Fractures Radius fractures: • Radial head (may require a prosthesis) • Midshaft radius • Distal radius (most common) Residual deformities following radius fractures include: • Loss of radial tilt (Normal non fracture average is 22-23 degrees of radial tilt.) • Dorsal angulation (normal non fracture average palmar tilt 11-12 degrees.) • Radial shortening • Distal radioulnar (DRUJ) joint involvement • Intra-articular involvement with step-offs. Step-off of as little as 1-2 mm may increase the risk of post-traumatic arthritis. 1 Standard of Care: Distal Upper Extremity Fractures Copyright © 2007 The Brigham and Women's Hospital, Inc. Department of Rehabilitation Services. All rights reserved. Types of distal radius fracture include: • Colle’s (Dinner Fork Deformity) -- Mechanism: fall on an outstretched hand (FOOSH) with radial shortening, dorsal tilt of the distal fragment. The ulnar styloid may or may not be fractured. • Smith’s (Garden Spade Deformity) -- Mechanism: fall backward on a supinated, dorsiflexed wrist, the distal fragment displaces volarly. • Barton’s -- Mechanism: direct blow to the carpus or wrist.
    [Show full text]
  • Combined Avulsion Fracture of the Tibial Tubercle and Patellar Tendon Rupture in Adolescents: a Case Report
    European Journal of Orthopaedic Surgery & Traumatology (2019) 29:1359–1363 https://doi.org/10.1007/s00590-019-02441-3 UP-TO DATE REVIEW AND CASE REPORT • KNEE - PAEDIATRIC Combined avulsion fracture of the tibial tubercle and patellar tendon rupture in adolescents: a case report Víctor Manuel Bárcena Tricio1 · Rodrigo Hidalgo Bilbao1 Received: 4 December 2018 / Accepted: 12 April 2019 / Published online: 19 April 2019 © Springer-Verlag France SAS, part of Springer Nature 2019 Abstract Simultaneous occurrence of tibial tubercle fracture and patellar tendon avulsion is an extremely rare condition. However, they have become more frequent due to increased participation in sports at a younger age. Diagnosis is not always straightforward, and treatment consists of open reduction and internal fxation. Only a few case reports of such injuries were reported in the literature with limited information according to diagnoses, treatment, and outcome in adolescents. Keywords Knee injuries · Tibial tubercle fracture · Patellar tendon avulsion Introduction and a repair technique and try to increase the awareness of this combined injury. Avulsion fractures of the tibial tubercle are rare injuries in adolescents and represent less than 1% of all physeal frac- tures [1–3], while patellar tendon ruptures are also uncom- Case report mon with no clearly reported incidence. Only a few cases have been reported in the literature with the combination of The patient is a 14-year-old boy who felt severe pain in his a tibial tubercle fracture and patellar tendon rupture [1–13]. left knee while jumping during a soccer match. The patient’s It occurs from violent eccentric contraction of the quadri- height and weight were 1.85 m and 70 kg (BMI 20.45), cep muscle.
    [Show full text]
  • Avulsion Fracture to Your Midfoot
    You have an Avulsion Fracture to your Midfoot This is a small flake fracture that is treated like a sprain Healing: It normally takes 6 weeks for this fracture to heal. Smoking will slow down your healing. We would advise that you stop smoking while your fracture heals. Talk to your GP or go to www.smokefree.nhs.uk for more information. Pain and swelling: You may have foot pain and swelling for 3-6 months after your injury. Swelling is often worse at the end of the day. Taking pain medication, elevating your foot and using ice or cold packs will help. More information is on the next page. Walking and your boot: The boot protects your foot and will make you more comfortable. Wear the boot when you are standing and walking. You can take it off at night and at rest. You need to wear the boot for 2 weeks after your injury. Please inform us if you are diabetic; you may require a specialist boot. You are allowed to put weight through your foot. You may find it easier to use crutches in the early stages. Exercises: It is important to start exercises as soon as possible. Instructions are on the next page. Follow up: A follow up appointment is not normally needed for this injury. If you still have significant pain and swelling after 3 months, then please contact the Virtual Fracture Clinic team. Any questions: If you are concerned about your symptoms, are unable to follow this rehabilitation plan or have pain other than at the site of your injury please contact the Virtual Fracture Clinic team.
    [Show full text]
  • Fracture of the Distal Radius
    Fixation of the Distal Radius Fractures – Is it Safe to Start Moving? Miguel A. Pirela Cruz, M.D., F.A.C.S. Professor of Orthopedic Surgery Paul L. Foster School of Medicine Department of Orthopaedic Surgery & Rehabilitation El Paso, Texas Objectives 1. Understand how distal radius fractures are classified 2. Understand the various types of fixation 3. To determine if a fracture is stable after treatment (and safe to move) 4. Review complications associated with surgical treatment Anatomy (Distal Radius) Three independent articular surfaces: • Scaphoid facet • Lunate facet • Sigmoid facet DRF: Dorsal Displacement R Medoff, MD 2001 DRF: Reversal of the Palmar Tilt R Medoff, MD 2001 DRF: Disruption of DRUJ R Medoff, MD 2001 Introduction • DRF’s most common orthopaedic injury with a bimodal distribution – younger patients - high energy – older patients - low energy / falls • 50% intra-articular • Associated injuries – DRUJ injuries must be evaluated – radial styloid fx - indication of higher energy – soft tissue injuries in 70% • TFCC injury 40% • scapholunate ligament injury 30% • lunotriquetral ligament injury 15% • Osteoporosis – high incidence of distal radius fractures in women >50 – distal radius fractures are a predictor of subsequent fractures • DEXA scan is recommended in woman with a distal radius fracture Introduction • Most common orthopaedic injury with a bimodal distribution – younger patients - high energy – older patients - low energy / falls • 50% intra-articular • Associated injuries – DRUJ injuries must be evaluated
    [Show full text]
  • Isolated Avulsion Fracture of the Lesser Tuberosity of the Humerus Associated with Delayed Axillary Nerve Neuropraxia
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector Injury Extra (2006) 37, 31—33 www.elsevier.com/locate/inext CASE REPORT Isolated avulsion fracture of the lesser tuberosity of the humerus associated with delayed axillary nerve neuropraxia Vinod Kumar *, Jaime Candal-Couto, Amar Rangan Shoulder and Elbow Unit, Department of Trauma and Orthopaedics, James Cook University Hospital, Middlesbrough, TS4 3BW UK Accepted 27 June 2005 Introduction shoulder, following a stumble down a flight of stairs, whilst at work. On initial examination, there was We report a patient with an avulsion fracture of the limitation of movements in all directions due to lesser tuberosity of the humerus, associated with a pain. No ‘signs or symptoms of axillary nerve injury delayed axillary nerve neuropraxia. Isolated avul- were noted. Antero-posterior and axillary lateral sion fractures of the lesser tuberosity are rare and radiographs of the left shoulder revealed an avulsion have been reported, but, to our knowledge, there fracture of the lesser tuberosity of the Humerus are no previous reports of this injury associated with (Fig. 1). He was referred on to the orthopaedic an axillary nerve palsy. The avulsion fracture was department for further management and a compu- treated with open reduction and internal fixation of terised tomography (CT) scan was arranged to the fragment, which led to complete resolution of delineate the fracture fragments and to rule out the axillary nerve neuropraxia. We emphasise hav- any other injuries around the shoulder joint. When ing a high index of suspicion, and prompt fixation of assessed 3 weeks later by the specialist shoulder the fracture, when identified to prevent develop- team, active internal rotation at the shoulder was ment of a axillary neuropraxia.
    [Show full text]
  • Paediatric Hand Trauma: Fractures and Ligament Injuries
    Paediatric Hand Trauma: Fractures and ligament injuries Occupational Therapy Department The Royal Children’s Hospital Melbourne, 2014 Presentation outline • Incidence & common injuries • Paediatric specific considerations • Paediatric fractures • Ligament injuries Incidence & Common Injuries Age: 0-6 years Age: 6-14 years • Distal phalanx crush injury • Proximal phalanx SH2 # • Often injured at home • Thumb metacarpal # • 5th digit metacarpal # • Most commonly injured in sport Paediatric Specific Considerations • Healing time frames • Impact of growth • Inability to specify or verbalise pain • Behaviour and occupations • Mobility – stiffness is not usually an issue Paediatric Fractures • Bone healing • Mineralisation • Epiphyseal Growth plates • Thick periosteum • Fractures involving the growth plate are unique to children: Salter Harris classification system Metaphysis S A L T R Physis (Epiphyseal Plate) Epiphysis Treatment Goals of therapy: • Protect healing fracture • Facilitate occupational performance during healing phase as able • Correct mild deformities • Return to normal hand function Considerations: • Healing occurs faster in children than in adults • Compliance may be limited by developmental and behavioural factors, therefore immobilisation • Remodelling potential Treatment: Immobilisation • Position of safe immobilisation: Wrist 20-30° Ext MCPj >70 ° Flex IPj 0 ° Flex Thumb abducted & opposed • Ideal: include one joint proximal & one joint distal to fracture in splint or plaster • Reality: may need to include more joints
    [Show full text]
  • Ankle Avulsion Fracture/5Th Metatarsal Fracture
    Ankle Avulsion fracture/5th Metatarsal fracture There are many terms you may have heard to describe your injury. The common ones are fracture, break and crack – they all mean the same thing. When you have a fracture not just the bone is affected, you will also have injured some of the soft tissues around it. Soft tissues include the muscles, ligaments, tendons and nerves. Recovery Times Most of the healing happens between 4-6 weeks. It is not unusual to have aches and discomfort beyond this, often when you do activities you haven’t done for a while. Sometimes the area is more sensitive for months and this is normal. Things that could affect your recovery Smoking Smoking slows fracture healing times. In some people, it can stop healing altogether. Smoking affects all your tissues; stopping smoking during the healing phase of your fracture will help ensure the best recovery. For help to stop smoking see (insert link) General Health Some medical conditions may slow down the healing e.g. diabetes Eating a healthy diet and keeping yourself active will help you recovery Medication Some medications you are already taking can slow down fracture healing. If you have concerns about your medication talk to a health professional. Anti-inflammatory medication (such as ibuprofen or naproxen) has been shown to delay healing. What to expect This fracture is a minor fracture and is often treated in the same way as a strain or sprain. Some people may be fitted with a boot or plaster and/or crutches. • Walking on your foot can help your recovery but may be uncomfortable at first • Help and instructions for use of crutches can be found here .
    [Show full text]
  • Coracoid Process Fracture with Acromioclavicular Joint
    (aspects of sports medicine) Coracoid Process Fracture With Acromioclavicular Joint Separation in an American Football Player: A Case Report and Literature Review Matthew DiPaola, MD, and Paul Marchetto, MD ABSTRACT 336 collegiate American football to palpation over the AC joint and Coracoid process fractures are rare players had a history of shoulder coracoid process. In addition, he had and few cases have been report- injury, 41% of which were acromio- pain with cross-body adduction of the ed in the orthopedic literature. In clavicular (AC) joint injuries. None symptomatic arm. Anteroposterior this article, we report the case of of these football players had a his- (AP), lateral, and axillary radiographs an American football player with tory of coracoid fracture. of both shoulders were obtained. The a coracoid process fracture in the setting of acromioclavicular sep- Coracoid fractures and ipsilateral AP radiograph showed a nondis- aration and describe incidence, shoulder injuries often occur concur- placed fracture of the coracoid and mechanism of injury, and treatment. rently. Ogawa and colleagues1 found a grade II AC separation (Figures 1, Although rare, coracoid process that 37 of 67 coracoid fractures were 2). Radiographic examination of the fracture should be considered in the associated with ipsilateral AC dis- asymptomatic shoulder confirmed differential diagnosis for shoulder locations. With the incidence of AC that the growth plates in this region pain. Treatment varies according to fracture type. Based on our lit- erature review, we recommend that clinicians initially treat nondisplaced “There is evidence that, of the athletes coracoid fractures nonoperatively. who sustain this injury, football players oracoid process fractures perhaps are at highest risk.” are relatively rare and have been estimated to account for 3% to 13% injury as high as it is in the football were closed.
    [Show full text]
  • Easily Missed Fractures in Acute Knee Injuries
    ( ' ( % ' ( ! ' ( &!" ' ( "" $ !"& #% #%!" #%' " ) • • ! " # ! $ %& ! $ ' ! # ! ! $ • • # • ! # • "*).!&%%.# • "+'.# • ")(.# • "().# • "().# • "'(.# A B C Fig. 1: AP radiograph (A) showing a Segond fracture (arrow). Sagittal (B) and coronal (C) Proton Density Fat Suppressed (PDFS) MRI showing wavy torn ACL (arrow heads), partial MCL tear (yellow arrow) and the Segond fracture (white arrow) • • # # ! • % &! • $ ! ! ( • !$%#!%#"$&#%#)127* • #&% %$ &#')347* • ! #&$!##%&#).--7* • %# $%#)/37 //7* • !"%&$&$ &#')007* • ! A A Fig. 2: AP (A) and lateral (B) radiographs showing an avulsion fracture (arrows) of the tip of the fibular styloid process (arcuate fracture). Not the Salter-Harris type II fracture of the proximal tibia (open arrow). Fig. 3: Coronal and Sagittal PDFS MRI of the same knee in Fig. 2, demonstrating the arcuate fracture (arrows) • • B A C D Fig. 4: AP and lateral knee radiographs (A and B) , coronal PDFS (B), sagittal PD MRI (C) demonstrating an avulsion fracture at the tibial attachment of the ACL (arrows). Note the Segond fracture (open arrow) • ! ! • ' ! %#"" " "! " !" ! Fig. 5: AP and lateral knee radiographs
    [Show full text]