Authors: Ana Costa Pinheiro, Carolina Oliveira, Margarida Areias, Bruno Pombo, Filomena Ferreira, Cristina Sousa, Miguel Leal
Categories: Article
Source: Orthopaedic Journal of Sports Medicine
Authors: Ana Costa Pinheiro, Carolina Oliveira, Margarida Areias, Bruno Pombo, Filomena Ferreira, Cristina Sousa, Miguel Leal
Fractures-detached is an injury in the place where the tendon or the ligament is inserted in the bear, in the plates of growth. Thus, in the offspring, or tendons or proximal ligaments of a growth plate, may provide sufficient force to cause a growth plate fracture. Single fractures of the apophysis are rare and rarely known lesions. In this article we present 3 clinical cases of patients with indirect trauma, such as the anterior fracture of the anterior tibial tuberosity, the anterior superior iliac spine fracture, and the small fracture of the femoral trochanter.
Retrospective descriptive of 3 clinical cases based on patients’ electronic clinical processes.
Male of 16 years old, victim of fracture-avulsion of the anterior tuberosity of the tibia (ATT). The injury occurred during football practice, immediately feeling intense knee pain associated with functional impairment of the left lower limb. The Emergency Service was used, with pain in the palpation of the left knee, edema, joint effusion, high patella and incapacity of active extension of the affected limb. The left knee radiograph showed a fracture of the ATT. Computed tomography (CT) revealed an extensive metaphyseal-epiphyseal vein, corresponding to a fracture-avulsion type IIIC in a context of previous Osgood-Schlatter disease. It was subjected to open reduction and internal fixation of the fracture with two cannulated screws, without complications. After surgery, the affected lower limb was immobilized for about 1 month, after which the patient started physiotherapy. After 3 months, the patient initiated complaints of contralateral knee pain related to ATT, with improvement after 3 months of conservative treatment. The patient restarted the sport activity at 6 months postoperatively, without complaints or limitations. After 2 years of follow-up, the patient did not present complaints or limitations of mobility bilaterally and resumed the activity level before the injury.
The adolescent male, an occasional physical exercise student at school, turned to the US for pain on the right side of the basin, 4 days after a jump during a basketball game. The objective test revealed gait claudication, palpation of the right anterior superior iliac spine (ASIS) and limitation of right movements. The radiograph and CT of the basin, to diagnose a fracture-avulsion of right ASIS, with deviation less than 3 cm. Treatment of pain, relative rest and taking oral anti-inflammatories and discharge of the affected member for 4 weeks. X-ray and CT, at 6 weeks, did not show fracture healing. However, the patient recovers from physical activity after 8 weeks, remains asymptomatic and unrestricted in the practice of physical exercise.
An 11-year-old male, he used the Urgency Service with pain at the level of the anterior inner side of the right thigh and functional impotence of the ipsilateral lower limb, after indirect trauma with hyperextension movement in soccer game. The radiographic examination revealed a fracture of the isolated aversion of the small trochanter of the right femur with deviation of less than 2 cm. However, the patient recovers from physical activity after 8 weeks, remains asymptomatic and unrestricted in the practice of physical exercise.
Or diagnosis of clinical substrate, treatment of low energy trauma rarely caused by trauma. In general, conservative treatment with conventional analgesics and restoration of the load is opted for. According to the degree of deviation (> 3 cm), it can opt for surgical treatment, or it prevents functional deficits and deformities, more frequently in the anterior tibial tuberosity fracture.
After a harvest of the clinical history, a careful analysis of the imaging, were identified as 3 different single fractures, tended in 2 of the cases, non-surgical treatment with analgesia and load restriction (single fracture of the anterior iliac spine And the single fracture of the small trochanter of the femur). In the fracture of the anterior tuberosity of the tibia, after the fracture classification, an open reduction and osteosynthesis were performed with 2 cannulated screws. These case reports are important for the determination of vulnerability to low energy trauma, as well as guiding treatment and preventing functional deficits and deformities.
McKinney B, Nelson C, Carrion W. Apophyseal Avulsion Fractures of the Hip and Pelvis. Orthopedics. 2009; 32(1):42.Kameyama O, Ogawa R. Avulsion fracture of the iliac spine during sporting activity: Report of 30 fractures and their outcome. Journal of Orthopaedic Science .1996; 1(6): 356-362.Rosenberg N, Noiman M, Edelson G. Avulsion fractures of the anterior superior iliac spine in adolescents. J Orthop Trauma. 1996; 10:440–3.Veselko M, Smrkolj V. Avulsion of the anterior superior iliac spine in athletes: case reports. J Trauma. 1994; 444–6.T. Pesl, P. Havran. Acute tibial tubercle avulsion fractures in selective use of the closed reduction and internal fixation method.J Child Orthop., 2 (5) (2008), pp. 353–356.R.P. Albuquerque, V. Giordano, A.C.P. Carvalho, T. Puell, M.I.P. Albuquerque, N.P. Amaral. Fratura avulsão bilateral e simultânea da tuberosidade tibial em uma relato de caso e terapêutica adotada.Rev Bras Ortop., 47 (3) (2012), pp. 56–60.L.H. Carvalho Júnior, W.A. Benevides, F.C.S. Nogueira, W.V. Fonseca, R.P. Andrade. Fraturas da tuberosidade tibial anterior em adolescentes. Relato de casos e revisão da literatura. Rev Bras Ortop., 30 (1) (1995), pp. 70–73.Avulsões apofisárias da bacia e do fémur proximal no jovem desportista. Revista de Medicina Desportiva Informa,2011.2(2), pp 13-15.