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Repair of a Proximal Hamstring Rupture in a 14-Year-Old Patient: A Case Report.

ABSTRACT: Proximal hamstring tendon ruptures are rare in children and adolescents. The typical pediatric hamstring injury pattern involves an apophyseal avulsion fracture. We present the case of a 14-year-old male with a widely displaced ischial avulsion fracture and a bony fragment that was too small to allow for bony fixation. The patient presented with left-buttock pain and ecchymosis, as well as tenderness at the ischial tuberosity, following an injury sustained while running 2 weeks prior. Imaging demonstrated an avulsion of the proximal hamstrings with a 4-mm bony fragment, too small to allow for repair. The patient underwent primary repair using two 3-mm suture anchors. The bony fragment was not excised but incorporated into the repair. Although most proximal hamstring injuries in children and adolescents are treated non-operatively, operative treatment may confer a small but clinically important difference in rates of healing and return to play in adolescent athletes. This case demonstrates successful treatment of a proximal hamstring rupture with suture anchor fixation, which may be considered for pediatric and adolescent displaced avulsion fractures when the bony fragment is too small to allow for bony fixation.

SUBMITTER: Buckley PS

PROVIDER: S-EPMC6148575 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

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Repair of a Proximal Hamstring Rupture in a 14-Year-Old Patient: A Case Report.

Buckley Patrick S PS Dodson Christopher C CC

HSS journal : the musculoskeletal journal of Hospital for Special Surgery 20180618 3

Proximal hamstring tendon ruptures are rare in children and adolescents. The typical pediatric hamstring injury pattern involves an apophyseal avulsion fracture. We present the case of a 14-year-old male with a widely displaced ischial avulsion fracture and a bony fragment that was too small to allow for bony fixation. The patient presented with left-buttock pain and ecchymosis, as well as tenderness at the ischial tuberosity, following an injury sustained while running 2 weeks prior. Imaging de ...[more]

PMID: 30258337

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Project description:Introduction and Importance A stab or penetrating wound is one of the etiologies of chest trauma. In the case of penetrating chest trauma, assessment of probable major vascular injuries must be done. Thoracic, vascular injuries, in particular brachiocephalic rupture, require the surgeon to make swift decisions for repair as the wrong approach or incision could quickly lead to mortality. Case presentation Here, we report a case of a hemodynamically stable 9-year-old boy presenting with a stab wound by a fishing arrow. CT scan showed the fishing arrow projection at the suprasternal notch extended to the right hemithorax where the tip was near the brachiocephalic artery posterior wall. A sternotomy exploration and preservation of the proximal brachiocephalic artery, subclavian artery, and common carotid artery was done. We found a 0.5 cm rupture on the brachiocephalic truncus and performed a direct suture repair. Discussion Through this case, we present a vascular technique repair after the major thoracic artery rupture caused by a stab or penetrating wound. The principle of artery repair is to save the proximal and distal end of the ruptured artery, followed by a further safe and precise procedure. Conclusion The overall combination of approaches of chest trauma by a penetrating wound and vascular injury like brachiocephalic rupture without pseudoaneurysm or other asymptomatic high risks of vascular injury resulted in a satisfactory evaluation. In this case, leaving the arrow undisturbed is the key to the success of the first aid management before the patient is sent to the operating room. Highlights • Thoracic vascular injuries require swift decision-making as the wrong approach could quickly lead to mortality.• We present a hemodynamically stable 9-year-old boy with a fishing arrow stab wound on the right hemithorax.• Axial CT showed that the arrow was attached to the posterior wall of the brachiocephalic artery.• Sternotomy exploration was performed followed by direct vascular repair and release of the fishing arrow.

Project description:IntroductionAfter conventional surgical refixation of the hamstrings after proximal hamstring rupture, patients frequently experience pain while sitting and deficits in hamstring muscle strength of the operated side. To improve these outcomes, we have modified the surgical anchor placement and have carried out a thorough follow-up examination.Materials and methodsThirteen older patients (8 female, 5 males) with a median age of 64.2 (range, 52.1-80.4) years were surgically treated for acute proximal hamstring rupture using modified anchor placement and participated in a follow-up assessment at a median of 46.2 (11.2-75.0) months after surgery. Patients completed the Perth Hamstring Assessment Tool (PHAT), quality of life questionnaire (EQ-5D-5L) and the Lower Extremity Functional Scale (LEFS), and rated their satisfaction level on a scale from 0 to 100%. Local tenderness on the ischial tuberosity and maximum passive hip flexion were measured on both limbs. Maximum isokinetic knee flexor muscle strength was measured bilaterally using a dynamometer.ResultsThe median (range) PHAT, EQ-5D-5L and LEFS score were 78.8/100 (54.6-99.8), 0.94/1 (0.83-1) and 88.75/100 (61.25-100). The median satisfaction was 100% (90-100%). Only one patient felt discomfort when the ischial tuberosity was palpated. Neither maximum passive hip flexion nor maximum isokinetic flexor muscle strength differed between the operated and non-operated side (P > 0.58). Clinical scores did not correlate with the leg symmetry index of knee flexor muscle strength (Spearman's rho < 0.448, P > 0.125). There were no tendon re-ruptures, or postoperative sciatic radiculopathy, at the time of follow-up.ConclusionsThe modified extra-anatomical anchor placement resulted in good clinical and functional outcome of surgical repair of acute proximal hamstring rupture. Especially the absence of postoperative pain while sitting and the comparable muscle strength to the contralateral side is promising.Clinical trial registrationClinicalTrials.gov Identifier: NCT04867746, registered.

Dataset Information

Repair of a Proximal Hamstring Rupture in a 14-Year-Old Patient: A Case Report.

Publications

Repair of a Proximal Hamstring Rupture in a 14-Year-Old Patient: A Case Report.

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