Reconstruction of a massive avulsion fracture of the lesser tuberosity using the arthroscopic tension band technique: a case report and brief review of the literature.
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ABSTRACT:
SUBMITTER: de Casas R
PROVIDER: S-EPMC7738591 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Although some literature may suggest that acute nondisplaced lesser tuberosity fractures should undergo nonoperative management, there is a body of evidence that supports surgical stabilization of these injuries due to concern for fracture displacement, nonunion and malunion, anteromedial impingement, and possible biceps tendon subluxation or dislocation. In this Technical Note, we introduce a novel technique for arthroscopic fixation of lesser tuberosity avulsion fractures using a knotless repair. In the lateral decubitus position using standard arthroscopic portals, with the addition of the biceps accessory portal, 2 ULTRATAPE sutures are fixed to the avulsed fragment in luggage-tag fashion to create a secure, knotless fixation. These are used to mobilize and anatomically approximate the lesser tuberosity to the avulsion bed and are held in place with suture anchors placed immediately adjacent to the fracture bed. This technique provides good anatomic reduction with maximal surface area for bone-to-bone healing.
| S-EPMC6153270 | biostudies-literature
Project description:The fracture avulsion of the greater tuberosity (GT) represents 2% of all humerus fractures, but the true incidence is likely to be higher, being challenging the initial diagnosis on radiograph. The fracture avulsion of the GT could have different treatments: nondisplaced or minimally displaced fractures are treated conservatively, whereas for displaced or comminuted fractures surgical treatment is preferred. The most important finding of this study is the employment of an all-arthroscopic transosseous augmented technique for the treatment of a displaced humeral GT fracture avulsion. This technique shows all the advantages of the transosseous fixation and arthroscopic approach.
| S-EPMC8185574 | biostudies-literature
Project description:Isolated fractures of the greater tuberosity of the humerus are an uncommon and frequently missed diagnosis. Mistreated and unrecognized, these fractures can cause chronic pain and diminished shoulder range of motion and function. Operative treatment options include open reduction and internal fixation, as well as arthroscopic-assisted reduction and internal fixation. The purpose of this Technical Note is to describe a bridging arthroscopic technique for the treatment of bony avulsions of the supraspinatus tendon.
| S-EPMC5496116 | biostudies-literature
Project description:Although a tibial eminence avulsion fracture is a rare knee injury, it can result in some complications such as nonunion, limited range of motion, and anterior instability of the knee if the displaced fracture is not well reduced. Arthroscopic procedures for this fracture have been commonly performed in recent years. In patients with small fragments, a pullout operation is usually performed, but arthroscopic suture reduction is technically difficult. In addition, anterior instability of the knee may remain even if the fragment is well reduced at the time of the surgical procedure. Generally, surgeons are concerned about anatomic reduction compared with appropriate tensioning during surgery. Therefore, one of the key points to avoid remaining anterior instability of the knee is to obtain and maintain appropriate tensioning. The purpose of this article is to present an easy and safe technique for acquisition of appropriate tensioning using a tensioning device for tibial eminence avulsion fractures. Although it has limitations, this technique can facilitate the reduction of tibial eminence avulsion fractures and appropriate tensioning of the anterior cruciate ligament.
| S-EPMC5989734 | biostudies-literature
Project description:This study describes an arthroscopic pullout fixation technique for small and comminuted avulsion fractures of the posterior cruciate ligament from the tibia. Intra-articular surgery required 3 arthroscopic portals, the anterolateral, anteromedial, and posteromedial portals. To simplify surgery, the posterolateral portal was omitted. A 2.4-mm K-wire was inserted through the anterior incision to the center of the bone fragment. This central guidewire was subsequently overdrilled with a 4.0-mm cannulated drill. The fixation material consisted of Pass Telos artificial ligaments inserted through the fiber loop of a fixed suspensory device such as RIGIDLOOP. The leading end of the thread of the RIGIDLOOP was pulled out through the anteromedial portal. The button of RIGIDLOOP was gradually advanced through the bone tunnel. The button was pulled out and flipped over the bony fragment. The artificial ligament was pulled distally to reduce the bony fragment, and fixed onto the tibia using a ligament button while applying anterior drawer force to the proximal tibia with the knee flexed at 90°. This minimally invasive procedure was successful in treating small and comminuted avulsion fracture of the tibial attachment of the posterior cruciate ligament.
| S-EPMC7695752 | biostudies-literature
Project description:Identifying and treating avulsion fractures of the pelvis and proximal femur in adolescent athletes has become increasingly more important as the rate of competitive sports participation has grown. The majority of these fractures can be treated conservatively, with most returning to full activity. Surgical treatment of these injuries has been traditionally indicated for >2 cm displacement, painful nonunion, symptomatic exostosis formation, or persistent pain and symptoms. Lesser trochanter avulsion injuries are extremely rare and literature outlining their surgical treatment lacking. We present our method of arthroscopic reduction and fixation of lesser trochanter avulsion nonunions.
| S-EPMC6928366 | biostudies-literature
Project description:Failure of a greater tuberosity fracture fixation with screws can lead to stiffness, pain, and weakness of the rotator cuff. Management of a previously performed open greater tuberosity fracture fixation with screws involves implant removal and refixation of the fragment. Doing this arthroscopically in a previously performed open surgery has its own challenges but distinct advantages. Describe herein is a technique for performing this revision surgery arthroscopically.
| S-EPMC7953265 | biostudies-literature
Project description:Proximal humerus fractures are common fractures that may occur after ground level falls or other traumatic events resulting in a direct injury to the shoulder. Depending on the fracture morphology and the age of the patient, anatomic reduction can vastly improve outcomes, especially in fracture patterns that involve the greater tuberosity. In this case example, we performed a minimally invasive, arthroscopic reduction and fixation of a proximal humerus fracture that involved significant displacement of the greater tuberosity. The technique employed is reproducible and avoids the morbidity of a large open incision while simultaneously providing compression of the fracture fragment for excellent healing potential.
| S-EPMC7528626 | biostudies-literature
Project description:BACKGROUND:Subscapularis tendon avulsions of the lesser tuberosity are relatively rare and often missed acutely and their characteristic appearance is frequently not recognized or is misinterpreted for an osteochondroma or a neoplastic process. QUESTIONS/PURPOSES:This report reviews our experience with six adolescents who had subscapularis tendon avulsions of the lesser tuberosity. METHODS:Six male adolescents (12-15 years) presented with shoulder pain following history of trauma during amateur sport. Clinical notes including range of motion, strength tests, and pain assessment were reviewed along with imaging studies pre- and post treatment. Treatment consisted of either surgical or conservative measures. RESULTS:Two of the six patients had a large avulsion that simulated an exostosis of the proximal humerus that was misdiagnosed as an osteochondroma at two different outside institutions. All six cases were diagnosed with subscapularis tendon avulsion of the lesser tuberosity following clinical and imaging evaluation at our institution. Five of the patients underwent surgical repair and fixation of the tendon and the lesser tuberosity with suture anchors. One patient was treated conservatively. All patients had a good outcome with recovery of full shoulder strength and motion upon follow-up. CONCLUSION:Clinicians should have a high index of suspicion of lesser tuberosity avulsions in adolescents who present with loss of internal rotation and anterior shoulder pain following traumatic injuries. In addition, an osseous fragment or exostosis along the inferomedial humeral head should suggest a subscapularis tendon avulsion and also should not be confused with an osteochondroma or a neoplastic process.
| S-EPMC4171444 | biostudies-literature
Project description: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. Our technique is both simple and efficacious in the reduction of tibial spine avulsion fractures to anatomic position by passing the first suture through the anterior cruciate ligament, and subsequently anterior to the avulsion fragment, and then beneath the fragment through a posteriorly placed bone tunnel within the tibial fracture bed.
| S-EPMC5368284 | biostudies-literature