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Tibial spine avulsion

Eric J Strauss, Daniel James Kaplan, Maxwell E Weinberg, Jonathan Egol, Laith M Jazrawi
Tibial spine fractures are uncommon injuries affecting the insertion of the anterior cruciate ligament on the tibia. They typically occur in skeletally immature patients aged 8 to 14 years and result from hyperextension of the knee with a valgus or rotational force. Diagnosis is based on history, physical examination, and standard radiographs. The use of MRI can identify entrapped soft tissue that may prevent reduction. Open or arthroscopic repair is indicated in patients with partially displaced fractures (>5 mm) with one third to one half of the avulsed fragment elevated, in patients who have undergone unsuccessful nonsurgical reduction and long leg casting or bracing, and in patients with completely displaced fractures...
May 15, 2018: Journal of the American Academy of Orthopaedic Surgeons
Skand Sinha, Durgashankar Meena, Ananta K Naik, M Selvamari, Rajendra K Arya
Introduction: Tibial spine avulsion fracture is more frequent in children than adults. Various methods of fixation have been mentioned, but concern remains about crossing the tibial physis. We present a technique of arthroscopic fixation with non-absorbable suture. Case Report: A total of 10 skeletally immature patients with tibial spine avulsion of Meyers and McKeever Type 2 and 3 were included in the study. The knee was arthroscopically cleared of hematoma. The avulsed tibial insertion of anterior cruciate ligament was reduced and held in place with tibial guide...
November 2017: Journal of Orthopaedic Case Reports
Mohamed M Abdelhamid, Maysara Abdelhalim Bayoumy, Hesham A Elkady, Ayman Farouk Abdelkawi
Several techniques of arthroscopic treatment of tibial spine avulsion fractures have been described in the literature. These techniques include the use of various fixation devices such as screws, K-wires, wiring, sutures, and suture anchors. In this study, we evaluate a new wiring technique for the treatment of these injuries. This technique involves fixation by stainless steel tension wires passed over the fractured spine and tied over a bone bridge. The advantages of this technique are that it aids in reduction, allows for compression of the tibial spine fragment anatomically in its fracture bed, provides stable fixation in difficult comminuted fractures, and allows for early mobilization and weight bearing because of the solid fixation...
December 2017: Arthroscopy Techniques
Jason T Rhodes, Peter C Cannamela, Aristides I Cruz, Meredith Mayo, Alexandra C Styhl, Connor G Richmond, Theodore J Ganley, Kevin G Shea
BACKGROUND: Tibial spine avulsions (TSA) have historically been treated as isolated injuries. Data on associated injuries are limited with existing literature reporting wide ranging incidences. The purpose of this multicenter study was to (1) describe the incidence of meniscal entrapment and associated knee injuries in TSA and to (2) compare surgical and magnetic resonance image (MRI) findings for these injuries. Our hypothesis is that tibial spine injuries are not usually isolated injuries, and other meniscal, ligament, and cartilage injuries may be present...
February 2018: Journal of Pediatric Orthopedics
Joseph T Gamboa, Broc A Durrant, Neil P Pathare, Edward C Shin, James L Chen
Tibial spine avulsion fractures are uncommon knee injuries that predominantly occur in children and young adults. Restoration of anterior cruciate ligament length through surgical reduction and fixation of the fracture is necessary to ensure stability of the knee with suitable range of motion and minimal knee laxity. Arthroscopic repair of tibial spine avulsion fractures is a technically complex procedure, specifically when performing and maintaining the initial anatomic reduction. We describe in this technical note and accompanying video a unique 3-point fixation repair of tibial spine avulsion fractures using an arthroscopic assisted suture lever reduction technique...
February 2017: Arthroscopy Techniques
Jonathan Schiller, Steven DeFroda, Travis Blood
Lower extremity avulsion fractures are uncommon in the pediatric population and can be misdiagnosed without proper imaging and/or clinical suspicion for these injuries. The most common locations of avulsion injuries are the ischial tuberosity, anterior superior iliac spine, and anterior inferior iliac spine. Less often, avulsion fractures occur in the tibial tubercle, calcaneus, and greater and lesser trochanters. When treated properly with rest and altered weight bearing, most of these injuries heal without complication...
April 2017: Journal of the American Academy of Orthopaedic Surgeons
Suraj Pinni, Vineet Kumar, Satish Balkrishna Dharap
Blunt Cardiac Rupture (BCR) is a life threatening injury. Majority of patients do not reach the hospital and in those who reach the emergency department, timely diagnosis and treatment is a challenge. The case is about a patient with multiple blunt injuries who presented in shock. Cardiac tamponade was suspected on clinical grounds and on evidence of mediastinal widening on radiograph. In the absence of songography, the diagnosis was confirmed by subxiphoid pericardial window. Emergency thoracotomy revealed a right atrial appendage rupture which was surgically corrected...
November 2016: Journal of Clinical and Diagnostic Research: JCDR
Varun Chouhan
INTRODUCTION: Arthroscopic fixation of tibial spine fracture in patients with open physis without damaging the growth plate is very important. We have described a very simple and effective technique for the first time in this article. CASE REPORT: A 16-year-old boy sustained avulsion fractures of tibial spine while playing. He was treated arthroscopically with excellent results. CONCLUSION: Arthroscopic fixation of tibial spine fracture in patients with open physis with two cannulated screws perpendicular to each other is a very simple technique providing strong construct, and allowing early mobilization without risk of damage to the growth plate...
April 2016: Journal of Orthopaedic Case Reports
Nihat Demirhan Demirkiran, Olcay Akdeniz, Onur Hapa, Hasan Havıtçıoğlu
INTRODUCTION: Arthroscopic fixation of tibial spine fracture without damage to the growth plate is very important in patients with open physis. The present article describes a simple and effective technique being used for the first time to treat this condition. CASE REPORT: A 16-year-old boy sustained avulsion fractures of tibial spine while playing. He was treated arthroscopically with excellent result. CONCLUSION: Arthroscopic fixation of tibial spine fracture in patients with open physis with two cannulated screws perpendicular to each other is a very simple technique which provides strong construct, and allows early mobilization without risk of damage to the growth plate...
April 2016: Journal of Orthopaedic Case Reports
M Thaunat, N C Barbosa, R Gardon, S Tuteja, R Chatellard, J-M Fayard, B Sonnery-Cottet
BACKGROUND: Tibial spine avulsion fractures (TSAFs) occur chiefly in adolescents. Few published data are available on outcomes after arthroscopic surgical treatment of TSAFs in adults. OBJECTIVES: To evaluate outcomes of consecutive patients with TSAFs managed by arthroscopic bone suture followed by a standardised non-aggressive rehabilitation programme. HYPOTHESIS: Arthroscopic bone suture followed by non-aggressive rehabilitation therapy reliably produces satisfactory outcomes in adults with TSAF...
September 2016: Orthopaedics & Traumatology, Surgery & Research: OTSR
Justin J Mitchell, Meredith H Mayo, Derek P Axibal, Anthony R Kasch, Ryan R Fader, Vivek Chadayammuri, E Bailey Terhune, Gaia Georgopoulos, Jason T Rhodes, Armando F Vidal
BACKGROUND: Avulsion fractures of the anterior tibial spine in young athletes are injuries similar to anterior cruciate ligament (ACL) injuries in adults. Sparse data exist on the association between anterior tibial spine fractures (ATSFs) and later ligamentous laxity or injuries leading to ACL reconstruction. PURPOSE: To better delineate the incidence of delayed instability or ACL ruptures requiring delayed ACL reconstruction in young patients with prior fractures of the tibial eminence...
August 2016: American Journal of Sports Medicine
Leonardo Osti, Matteo Buda, Francesco Soldati, Angelo Del Buono, Raffaella Osti, Nicola Maffulli
INTRODUCTION: Arthroscopy procedures are the gold standard for the management of tibial spine avulsion. This review evaluates and compares different arthroscopic treatment options for tibial spine fractures. SOURCE OF DATA: PubMed, Medline, Ovid, Google Scholar and Embase databases were systematically searched with no limit regarding the year of publication. AREAS OF AGREEMENT: An arthroscopic approach compared with arthrotomy reduces complications such as soft-tissue lesions, post-operative pain and length of hospitalization...
June 2016: British Medical Bulletin
James O Smith, Sam K Yasen, Harry C Palmer, Breck R Lord, Edward M Britton, Adrian J Wilson
PURPOSE: Instability following non-operative treatment of anterior cruciate ligament (ACL) rupture in young children frequently results in secondary chondral and/or meniscal injuries. Therefore, many contemporary surgeons advocate ACL reconstruction in these patients, despite the challenges posed by peri-articular physes and the high early failure rate. We report a novel management approach, comprising direct ACL repair reinforced by a temporary internal brace in three children. METHODS: Two patients (aged 5 and 6 years) with complete proximal ACL ruptures and a third (aged seven) with an associated tibial spine avulsion underwent direct surgical repair, supplemented with an internal brace that was removed after 3 months...
June 2016: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Vivek Pandey, Suman Cps, Kiran Acharya, Sharath K Rao
The aim of this study is to assess the clinical and radiological outcomes of arthroscopic reduction and fixation of tibial spine avulsion in patients with either open physis or closed physis, using high strength nonabsorbable sutures utilizing intravenous cannula needle as suture passer and retriever. Twenty-six patients of mean age 24.5 years were included in the study with a mean follow-up period of 31 months. Twelve patients had McKeever type III avulsion fracture and 14 had type IV. A follow-up analysis was performed using fracture union time, range of motion assessment, and Lysholm and IKDC (International Knee Documentation Committee) scores with instrumental (KT-1000 arthrometer) laxity assessment...
January 2017: Journal of Knee Surgery
Deepak Sampath, Hanumantha Reddy, Chirag Thonse, Jayanth Kumar Bangalore Chikkanna
Patella fractures, tibial spine avulsion and Segond fractures are mainly due to trauma to the knee which may be direct or indirect injuries. While each entity is well documented when occurring in isolation, but bilateral inferior pole patella fracture, tibial spine avulsion in the right knee and bilateral segond fracture in a same patient is a rare occurrence. We report a case of 24-year-old male with such an injury. The diagnosis was confirmed by X-ray, CT scan and MRI imaging of right knee. Then the patient was treated with arthroscopic anterior cruciate ligament (ACL) avulsion fixation with pull through technique and suture disc; bilateral inferior pole patella was treated conservatively with knee brace, segond fracture was treated conservatively similarly...
September 2015: Journal of Clinical and Diagnostic Research: JCDR
Ahmad M Wagih
Severely displaced tibial spine fractures should be treated surgically to restore joint congruity and cruciate integrity with reduction and fixation through an arthrotomy or arthroscopic techniques. Arthroscopy is preferred as it allows for accurate diagnosis and treatment of associated injuries and reduction and fixation of all types of tibial spine fractures while reducing the morbidity associated with open techniques. We report the clinical and radiographical results of 11 cases treated with a technique of arthroscopic internal fixation with non-absorbable sutures, after an average follow-up of 16...
March 2015: Acta Orthopaedica Belgica
Matthew D Milewski, Jason L Booker
No abstract text is available yet for this article.
March 2015: Connecticut Medicine
A Reed Estes, Lasun O Oladeji
Anterior tibial spine fractures are rare and were thought to occur mainly in children; however, recent literature indicates that the incidence in adults is much greater than previously thought. Because the tibial spine is an attachment point for the anterior cruciate ligament (ACL), an avulsion may produce ACL laxity, predisposing to further issues. We report the case of an 11-year-old boy with a tibial spine fracture that failed conservative management. He developed a malunion with impingement anteriorly of the tibial spine on the notch and residual instability of the ACL...
May 2015: American Journal of Orthopedics
Justin J Mitchell, Rebecca Sjostrom, Alfred A Mansour, Bjorn Irion, Mark Hotchkiss, E Bailey Terhune, Patrick Carry, Jaime R Stewart, Armando F Vidal, Jason T Rhodes
BACKGROUND: Pediatric avulsion fractures of the anterior tibial spine are injuries similar to anterior cruciate ligament injuries in adults. Sparse data exists on the association between anterior tibial spine fractures (ATSFs) and injury to the meniscus or cartilage of the knee joint in children. This research presents a retrospective review of clinical records, imaging, and operative reports to characterize the incidence of concomitant injury in cases of ATSFs in children. The purpose of this study was to better delineate the incidence of associated injuries in fractures of the anterior tibial spine in the pediatric population...
March 2015: Journal of Pediatric Orthopedics
James Inklebarger, Matthew J D Taylor, Murray Griffin, Tim Clarke
Tibial eminence avulsion fracture at the ACL footprint may be caused by high-energy forces such as a fall, in which the ACL ligament proves stronger than the forces that hold the bone together. For reasons of bone maturity however, tibial spine avulsion fractures where the ACL remains intact, typically occur in children but are rare in adults. This case demonstrates a rare type of adult tibial avulsion fracture with intact ACL and subsequent fragment fixation failure in which vitamin D deficiency may have been contributory...
April 2014: Journal of Surgical Case Reports
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