• 대한족부족관절학회지
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• 제26권4호
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• pp.183-186
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• 2022

Anterior tibialis ruptures are a rare type of injury related to the foot and ankle. Specifically, chronic and non-traumatic ruptures are related to preexisting chronic tendinopathic conditions and anatomical factors. These ruptures may cause persistent pain and functional impairments if neglected. Chronic tibialis anterior ruptures are frequently diagnosed late because the symptoms are not distinct. In cases with chronic or non-traumatic tibialis anterior tendon ruptures, tendons often become irreparable. Hence, various surgical options have been introduced to address this issue. The current surgical treatment options are as follows: free sliding anterior tibialis graft, extensor hallucis longus tendon transfer, and reconstruction with an allograft tendon. To date, there have been few reports about the reconstruction technique using Z-plasty for irreparable tibialis anterior tendon ruptures. In this report, we present a rare case of the application of the tibialis anterior tendon reconstruction technique using Z-plasty and tenodesis for a middle-aged man with an irreparable avulsion injury rupture. We also present the management plan and prognostic outlook, as well as a subsequent review of the relevant literature.

• Journal of Yeungnam Medical Science
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• 제38권4호
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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.

• 대한정형외과스포츠의학회지
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• 제10권2호
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• pp.117-120
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• 2011

심수지 굴건의 견열성 파열은 상대적으로 드문 손상으로 심수지 굴건의 파열은 주로 심수지 굴건이 수축된 상태에서 순간적으로 일어나는 원위지절의 신전에 의해 일어나거나 중립위의 수지 말단에 강한 신전력이 작용하여 과신전되어 발생한다. 본 증례는 22세 남자 전투 경찰대원으로 방패를 쥔 상태에서 진압훈련 후 2일째 심수지 굴건의 파열이 발생한 드문 경우로 문헌 고찰과 함께 보고하고자 한다.

• 대한정형외과스포츠의학회지
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• 제1권1호
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• pp.75-78
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• 2002

슬근의좌골결절부착부 견열손상은스포츠인구의증가와군대훈련을받고있는 젊은 남자에게 간혹볼수있는손상이며 대부분은젊은성인 특히 운동선수에게주로발생한다. 이는 슬관절이신전된상태에서고관절이 과도히굴곡되면슬근에강력한 긴장을 일으켜야기된다. 조기에진단하여 견열된 근육을 좌골에 부착시키는 수술적 치료로 기능을 회복시키고 기형을 교정할수있으나진단과치료가지연되면기능적으로나임상적으로양호한결과를얻기어렵다. 좌골결절에서슬근견열골절의수술적치료후생길수있는합병증은이소성골형성과고정실패외에크게알려진것이없으며, 특히좌골신경손상은보고된적이없다. 저자들은수상후3개월된슬근의좌골결절부착부파열을수술적치료한후좌골신경손상을경험하여보고하는바이다.

• 대한족부족관절학회지
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• 제7권2호
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• pp.258-262
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• 2003

Avulsion fracture of the calcaneal tuberosity is an uncommon injury. Usually it occurs from indirect trauma, and can be seen in old patients with osteoporosis or in patients with diabetic neuropathy. Follow-up studies showed healing of the fracture in most cases, but skeletal deformity may develop in some cases. Therefore we should take plain X-ray evaluations in diabetic patients with foot and ankle pain, even though there have been no definite trauma history. Four cases of calcaneus avulsion fracture were treated operatively in diabetic patients, and reported.

• Archives of Hand and Microsurgery
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• 제23권4호
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• pp.262-266
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• 2018

청소년에서 심수지굴곡건 파열은 주로 견열 파열로 나타나며 종적 파열은 매우 드물다. 수지의 굴곡건에 발생하는 건내 섬유종의 보고는 지금까지 1예가 있었지만, 건내 섬유종과 관련된 심수지굴곡건의 종파열은 아직까지 보고된 바 없었다. 저자들은 야구 중 충격에 의한 과신전 손상을 받은 이후 좌측 3수지의 건내 섬유종과 동반된 심수지굴곡건의 종 파열을 보고한다. 청소년에서 굴곡건의 종 파열은 드물지만 발생한 경우 병적 질환에 의한 파열일 수 있음을 고려하여야 하겠다.

• Journal of Trauma and Injury
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• 제31권2호
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• pp.112-116
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• 2018

Calcaneal fractures are quite often seen in patients with axial loading injury. In the tongue-type of calcaneusal fractures or tuberosity avulsion fractures, bone fragments are often superiorly and posteriorly displaced, because of the insertion of the Achilles tendon and pull of the gastroc-soleus complex. The Ddisplaced bone fragment compresses the soft tissues, leading tothat makes skin necrosis. To prevent further soft tissue injury, early recognition of the injury by the emergency physician and immediate orthopedic consultation is needed.

• Archives of Reconstructive Microsurgery
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• 제18권2호
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• pp.79-83
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• 2009

Purpose: Avulsion injuries of digits have been presented for a long time as complex management problems. Despite of microsurgical advances, it is difficult to achieve good functional results and their management remains somewhat controversial. However, in a finger there are three transverse digital palmar arches. The middle and distal transverse digital palmar arches are consistently large(almost 1 mm) and may be used for arterial vessel repairs either proximally or distally, depending on the length and direction needed. 39-year-old man presented with avulsion amputation of the ulnar three digits, was operated using only arterial anastomosis with rerouting the transverse digital palmar arches. Methods: Replantation was performed using the artery-only technique. Because the digital arteries had been damaged, we did that the transverse digital palmar arches were transposed in an inverted Y to I configuration and were lengthened with rerouting them for the purpose of direct anastomosis of the digital artery. Venous drainage was provided by an external bleeding method with partial nail excision and external heparin irrigation. Results: The authors conclude that complete avulsion amputations with only soft tissue at the distal to insertion of the flexor digitorum superficialis tendon were salvageable with acceptable functional results. All three fingers survived. Conclusion: With technical advancements, the transverse digital palmar arches play an important role for finger amputation. Three digital palmar arches give us additional treatment option for the finger amputation. In this case, replantation with only-arterial anastomosis was successful and we obtained good aesthetic and functional outcome.

• Archives of Plastic Surgery
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• 제33권6호
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• pp.776-779
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• 2006

Purpose: Prior to closure of the epiphysis of the distal phalanx, fracture usually occurs through the growth plate, Salter-Harris type I or II, or through the juxtaepiphyseal region 1 to 2 mm distal to the growth plate. The terminal tendon of extensor inserts into the epiphysis only, while insertion site of the flexor digitorum profundus spans both the epiphysis and metaphysis. Because of the difference between these tendon insertions, this injury mimics a mallet deformity. But, this type of injury does not involve a tear or avulsion of the extensor, unlike mallet finger of adults. Seymour was the first to describe this type of injury in children and called after his name, Seymour's fracture. This fracture is prone to infection or remain the residual deformity unless adequate treatment. Methods: We report a case of Seymour's fracture. A 9-year-old boy presented a laceration of the nail matrix, with the nail lies degloved from the nail fold on the right middle finger gotten from an impact against a door. An X-ray examination showed the fracture line lying 1 mm distal to the growth plate. The injury was treated with debridement and the fracture was reduced by applying hyperextension force. Under the C-arm, a single 0.7 mm K-wire was used to immobilize the distal interphalangeal joint. Intravenous antibiotics were applied for 5 days after surgery. Results: The K-wire was removed in the 3rd week. No infection or significant deformity was found until follow-up of 12 months. Conclusions: Seymour's fracture may be at first classically mallet deformity by its appearance. But it is anatomically different and more problematic injury. If it isn't corrected at the time of injury, derangement of the extensor mechanism, and growth deformity of the distal phalanx may occur. The fracture site should be debrided, removed of any interposed soft tissue, and the patient should be given appropriate antibiotics. Reduction should be maintained by K-wire fixation. We experienced no infection or premature epiphyseal closure.

• Archives of Plastic Surgery
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• 제43권2호
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• pp.134-144
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• 2016

In adults, mallet finger is a traumatic zone I lesion of the extensor tendon with either tendon rupture or bony avulsion at the base of the distal phalanx. High-energy mechanisms of injury generally occur in young men, whereas lower energy mechanisms are observed in elderly women. The mechanism of injury is an axial load applied to a straight digit tip, which is then followed by passive extreme distal interphalangeal joint (DIPJ) hyperextension or hyperflexion. Mallet finger is diagnosed clinically, but an X-ray should always be performed. Tubiana's classification takes into account the size of the bony articular fragment and DIPJ subluxation. We propose to stage subluxated fractures as stage III if the subluxation is reducible with a splint and as stage IV if not. Left untreated, mallet finger becomes chronic and leads to a swan-neck deformity and DIPJ osteoarthritis. The goal of treatment is to restore active DIPJ extension. The results of a six- to eight-week conservative course of treatment with a DIPJ splint in slight hyperextension for tendon lesions or straight for bony avulsions depends on patient compliance. Surgical treatments vary in terms of the approach, the reduction technique, and the means of fixation. The risks involved are stiffness, septic arthritis, and osteoarthritis. Given the lack of consensus regarding indications for treatment, we propose to treat all cases of mallet finger with a dorsal glued splint except for stage IV mallet finger, which we treat with extra-articular pinning.