• Journal of Korean Foot and Ankle Society
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• v.21 no.4
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• pp.165-169
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• 2017

Secondary soft tissue injuries can occur from the pressure of the displaced fragment of posterior calcaneal tuberosity in calcaneal tongue-type fractures and calcaneal tuberosity avulsion fractures. The soft tissue injury can be prevented by immediate reduction of the displaced fragments. Various techniques can be used to fix the fracture fragments, but the stability of fixation and minimal invasiveness to soft tissue should be considered. This paper reports the successful outcomes of patients with soft tissue compromises in calcaneal tongue-type fractures and calcaneal tuberosity avulsion fractures. The fixation technique of a large cannulated screw and simple cerclage wiring is believed to be a useful surgical option for the treatment of secondary soft tissue compromised calcaneal fractures.

• Journal of Yeungnam Medical Science
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• v.38 no.4
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• pp.289-307
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• 2021

Avulsion injuries result from the application of a tensile force to a musculoskeletal unit or ligament. Although injuries tend to occur more commonly in skeletally immature populations due to the weakness of their apophysis, adults may also be subject to avulsion fractures, particularly those with osteoporotic bones. The most common sites of avulsion injuries in adolescents and children are apophyses of the pelvis and knee. In adults, avulsion injuries commonly occur within the tendon due to underlying degeneration or tendinosis. However, any location can be involved in avulsion injuries. Radiography is the first imaging modality to diagnose avulsion injury, although advanced imaging modalities are occasionally required to identify subtle lesions or to fully delineate the extent of the injury. Ultrasonography has a high spatial resolution with a dynamic assessment potential and allows the comparison of a bone avulsion with the opposite side. Computed tomography is more sensitive for depicting a tiny osseous fragment located adjacent to the expected attachment site of a ligament, tendon, or capsule. Moreover, magnetic resonance imaging is the best imaging modality for the evaluation of soft tissue abnormalities, especially the affected muscles, tendons, and ligaments. Acute avulsion injuries usually manifest as avulsed bone fragments. In contrast, chronic injuries can easily mimic other disease processes, such as infections or neoplasms. Therefore, recognizing the vulnerable sites and characteristic imaging features of avulsion fractures would be helpful in ensuring accurate diagnosis and appropriate patient management. To this end, familiarity with musculoskeletal anatomy and mechanism of injury is necessary.

• Journal of Korean Foot and Ankle Society
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• v.22 no.2
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• pp.74-77
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• 2018

Calcaneal apophysitis is a relatively common disease in young athletes. On the other hand, if not treated properly, it can lead to apophyseal avulsion fracture in rare cases. In the case of apophyseal avulsion fractures, it is often necessary to remove or preserve the bone fragment, which often requires a suture of the Achilles tendon. A 10-year-old badminton athlete visited the outpatients' clinic with pain in both heels from 10 months ago without any trauma history. After conservative therapy, the pain in the left heel was relived but the right heel pain persisted. After 10 months of conservative therapy, the patient visited the outpatients' clinic showing a calcaneal apophyseal avulsion fracture with a total rupture of the Achilles tendon. In the operation room, a bone fragment needed to be removed because of its poor viability and the fragment was too thin for fixation. After removing the bone fragment, the ruptured Achilles tendon was fixed with an anchor system.

• Knee surgery & related research
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• v.30 no.4
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• pp.275-283
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• 2018

Purpose: To compare the clinical outcomes between the open posterior approach and arthroscopic suture fixation for displaced posterior cruciate ligament (PCL) avulsion fractures. Methods: A literature search was performed on MEDLINE, EMBASE, and the Cochrane Library databases. The inclusion criteria were as follows: papers written in English on displaced PCL avulsion fractures, clinical trial(s) with clear description of surgical technique, adult subjects, a follow-up longer than 12 months and modified Coleman methodology score (CMS) more than 60 points. Results: Twelve studies were included with a mean CMS value of 72.4 (standard deviation, 7.6). Overall, 134 patients underwent the open posterior approach with a minimum 12-month follow-up, and 174 patients underwent arthroscopic suture fixation. At final follow-up, the range of Lysholm score was 85-100 for the open approach and 80-100 for the arthroscopic approach. Patients who were rated as normal or nearly normal in the International Knee Documentation Committee subjective knee assessment were 92%-100% for the open approach and 90%-100% for the arthroscopic approach. The range of side-to-side difference was 0-5 mm for both approaches. Conclusions: Both arthroscopic and open methods for the treatment of PCL tibial-side avulsion injuries resulted in comparably good clinical outcomes, radiological healing, and stable knees.

• Journal of Korean Foot and Ankle Society
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• v.9 no.2
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• pp.167-172
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• 2005

Purpose: We report our results of arthroscopic treatment of symptomatic avulsion fracture of the malleolus in chronic ankle pain, and also analyzed the clinical and radiological features for evaluating the good candidate for arthroscopic treatment. Materials and Methods: Fourteen patients who were diagnosed with intra-articular avulsion fractures of the malleolus received arthroscopic surgery and were followed up for at least a year. The clinical and radiological characters including MRI and arthroscopic findings were reviewed. Clinical assessments were done according to the AOFAS score system. Results: There was a history of inversion type of the injury in most cases and local tenderness of lesion site was a unique. MRI study showed thickened anterior talofibular ligament (ATFL) in 8 cases (57%) and discontinued ATFL in 3 cases (21%). Enhanced signal surrounding soft tissue corresponding to synovial inflammation and impingement was found in 12 cases (86%). Preoperative score of all patients were $74.0{\pm}5.5$, which improved to $89.3{\pm}6.7$ at the follow-up after the treatment (P<0.001). Conclusion: Most patients had history of injury and localized tenderness in the area coinciding with radiological findings. Thickened ATFL and contrast enhancement around the ossicle were frequently found. Symptomatic avulsion fractures of the malleolus associated with the clinical and radiological findings above could be a good candidate for arthroscopic treatment.

• Journal of Korean Foot and Ankle Society
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• v.8 no.1
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• pp.92-96
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• 2004

Purpose: To analyze the clinical and radiological results of the operative treatment in the avulsion fracture on the base of the fifth metatarsal. Materials and Methods: We studied retrospectively, 11 patients of avulsion fracture on the base of the fifth metatarsal operated and followed over 1 year, from February 2000 to May 2002. There were eight men and three women and the average age was 39 years old. The mean follow up period was 14 months. Ten cases were slip-down and one case was fall from a height injuries. We used the modified Foot Score by Wiener for the clinical evaluation, and analyzed the time of union and state of reduction radiologically. Results: In clinical results, we had ten excellent and one good cases by the modified Foot Score at last follow-up. In radiologic results, the complete bony union was achieved in all cases and the duration of the bony union was 37 days in average. Conclusion: We had good result for the avulsion fractures on the base of the fifth metatarsal treated by the operation. This study shows the operation was recommended for the moderate and severe displacement of the avulsion fractures on the base of the fifth metatarsal.

• Journal of the Korean Arthroscopy Society
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• v.2 no.2
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• pp.173-176
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• 1998

Isolated posterior cruciate ligament injuries are rare and their management is controversial. But, there is general concept that a bony avulsion of posterior cruciate ligament should be repaired. The treatments for the bony avulsion of posterior cruciate ligament were conservative treatment, open reduction and internal fixation and arthroscopic fixation. We report 2 cases of posterior cruciate ligament avulsion fractures, which were arthroscopically reduced and stabilized with cannulated screws and Kirschner wires, and introduce the arthroscopic fixation technique.

• Clinics in Shoulder and Elbow
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• v.9 no.2
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• pp.216-221
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• 2006

Avulsion of the triceps brachii is an uncommon injury. The usual mechanism of injury is fall onto an outstretched hand but can occur after direct contact injuries. Diagnosis is critical and dependent on history, physical examination, and radiological findings. Rupture of triceps brachii occurs most frequently at the tendo-osseous insertion and may be complete or partial, and could be associated with radial head fracture. Treatments include surgical repair of the complete rupture and immobilization of partial triceps rupture. We report 3 cases of triceps avulsion fractures treated by open surgical repair with literature reviews.

• Journal of the Korean Orthopaedic Association
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• v.55 no.5
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• pp.450-455
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• 2020

Posterior root tear of the medial meniscus are well known. Although very rare, there are reports of anterior root tears of the medial meniscus but no reports on traumatic bony avulsion of the anterior medial meniscus root. This paper reports a case of an isolated bony avulsion of the anterior medial meniscus root, which was successfully repaired arthroscopically.

• Journal of Trauma and Injury
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• v.26 no.3
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• pp.218-221
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• 2013

A patella sleeve fracture is a type of avulsion fracture in which a small osseous fragment gets, along with a sleeve of periosteum and cartilage, is pulled off from the patella. The avulsed sleeve of cartilage and periosteum is not apparent on plain radiographs, which can result in a missed diagnosis or an underestimate of the extent of injury. An avulsion or sleeve fracture of the patella in a child can occur at the superior or the inferior pole of the patella. However, most reported cases of sleeve fractures involve the inferior patellar pole, with fractures involving the superior patellar pole being very rare. The authors report a case of a sleeve fracture of the superior pole of the patella in an adolescent; the fracture was diagnosed with magnetic resonance imaging (MRI) and was treated with surgery after early diagnosis. The course was uneventful, and the outcome was excellent.