scholarly journals Combined Lag Screw and Cerclage Wire Fixation for Calcaneal Tuberosity Avulsion Fractures

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Vincenzo Giordano ◽  
Alexandre Leme Godoy-Santos ◽  
Felipe Serrão de Souza ◽  
Hilton Augusto Koch ◽  
Cesar de Cesar Netto ◽  
...  
Keyword(s):  
Soft Tissues ◽  
Plantar Flexion ◽  
Weight Bearing ◽  
Large Diameter ◽  
Minor Trauma ◽  
Cannulated Screws ◽  
Avulsion Fractures ◽  
Cerclage Wire ◽  
Plantar Aspect ◽  
Calcaneal Tuberosity

Avulsion fractures of the calcaneal tuberosity represent a rare injury pattern that is caused by a powerful tension force from the Achilles tendon and is usually seen following minor trauma, especially in elderly patients. The objective of this study is to describe a surgical technique using cerclage wiring through cannulated screws in the treatment of extra- and intra-articular avulsion fractures of the calcaneal tuberosity and to present our results in a small patient’s cohort. Through a 5.0 cm longitudinal skin incision over the posterolateral aspect of the calcaneus, after adequate debridement of the fracture fragments and while keeping the ankle in plantarflexion, the calcaneal tuberosity is anatomically reduced with the help of a periarticular reduction clamp and an accessory plantar longitudinal approach. Provisionally fixation is performed with K-wires. Definitive fixation is achieved with two parallel partially threaded 7.0 cannulated screws, which are positioned from the superior and posterior aspect of the tuberosity to the inferior and anterior aspect of the plantar surface of the calcaneus, and 1.5 mm cerclage wires that are pulled epiperiosteally to the plantar aspect of the calcaneus to avoid damage to local soft tissues. Alternatively, for smaller fracture fragments, two 3.5 mm partially threaded cannulated screws and 1.25 mm cerclage wires can be used. We also report the results of the procedure in a small cohort of four patients. All fractures healed in an anatomic position. There was no failure of fixation, loss of reduction, or need for secondary surgery, including hardware removal. At final follow-up, all patients had regained full plantar flexion range of motion and strength, with no gait or weight-bearing restrictions. In conclusion, the combination of cerclage wire and large diameter cannulated screws represents a promising option in the treatment of avulsion fractures of the calcaneal tuberosity, demonstrating good functional and radiographic results in our cohort of patients.

scholarly journals Achilles tendon rupture in camel (Camelus dromedarius): Radiographic and Ultrasonographic findings

2019 ◽  
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Soft Tissues ◽  
Weight Bearing ◽  
Achilles Tendon Rupture ◽  
Clinical Decision ◽  
Heterogeneous Structure ◽  
Dromedary Camels ◽  
Fracture Of The Calcaneus ◽  
Calcaneal Tuberosity

This study describes the clinical presentation of Achilles tendon rupture and evaluates the utility of radiography and ultrasonography in the diagnosis of such disorder in dromedary camels. Seventeen camels were included in this study based on the clinical, radiographic and ultrasonographic evidence of Achilles tendon rupture. The clinical, radiographic and sonographic findings of studied camels differ according to the type, duration, and location of the tendon rupture. Complete and incomplete rupture of the Achilles tendon was precisely diagnosed in five (29.4%) and twelve (70.6%) camels respectively; ruptured deep and superficial parts of the Achilles tendon were recorded in 10 (58.8%) and 2 (11.8%) camels respectively. Clinically, the camels exhibited an acute non-weight-bearing lameness (second to fourth-grade lameness), with swelling in the tendon near the calcaneus. Radiographs revealed swelling of the soft tissues surrounding the Achilles tendon just proximal to the calcaneal tuberosity in most of the camels with the presence of avulsion fracture of the calcaneus in few cases (n=2). Ultrasonographically, the ruptured part was precisely diagnosed as swollen, oedematous, heterogeneous structure with the presence of anechoic or hypoechoic areas (core lesion). In conclusion, lateromedial radiographs and ultrasonography were helpful in diagnosis and differential diagnosis of different types of Achilles tendon rupture and subsequent clinical decision and surgical interference in dromedary camels.

scholarly journals Achilles tendon rupture in camel (Camelus dromedarius): Radiographic and Ultrasonographic findings

2019 ◽  
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Soft Tissues ◽  
Weight Bearing ◽  
Achilles Tendon Rupture ◽  
Clinical Decision ◽  
Heterogeneous Structure ◽  
Dromedary Camels ◽  
Fracture Of The Calcaneus ◽  
Calcaneal Tuberosity

This study describes the clinical presentation of Achilles tendon rupture and evaluates the utility of radiography and ultrasonography in the diagnosis of such disorder in dromedary camels. Seventeen camels were included in this study based on the clinical, radiographic and ultrasonographic evidence of Achilles tendon rupture. The clinical, radiographic and sonographic findings of studied camels differ according to the type, duration, and location of the tendon rupture. Complete and incomplete rupture of the Achilles tendon was precisely diagnosed in five (29.4%) and twelve (70.6%) camels respectively; ruptured deep and superficial parts of the Achilles tendon were recorded in 10 (58.8%) and 2 (11.8%) camels respectively. Clinically, the camels exhibited an acute non-weight-bearing lameness (second to fourth-grade lameness), with swelling in the tendon near the calcaneus. Radiographs revealed swelling of the soft tissues surrounding the Achilles tendon just proximal to the calcaneal tuberosity in most of the camels with the presence of avulsion fracture of the calcaneus in few cases (n=2). Ultrasonographically, the ruptured part was precisely diagnosed as swollen, oedematous, heterogeneous structure with the presence of anechoic or hypoechoic areas (core lesion). In conclusion, lateromedial radiographs and ultrasonography were helpful in diagnosis and differential diagnosis of different types of Achilles tendon rupture and subsequent clinical decision and surgical interference in dromedary camels.

scholarly journals Achilles tendon rupture in camel (Camelus dromedarius): Radiographic and Ultrasonographic findings

2019 ◽  
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Soft Tissues ◽  
Weight Bearing ◽  
Achilles Tendon Rupture ◽  
Clinical Decision ◽  
Heterogeneous Structure ◽  
Dromedary Camels ◽  
Fracture Of The Calcaneus ◽  
Calcaneal Tuberosity

This study describes the clinical presentation of Achilles tendon rupture and evaluates the utility of radiography and ultrasonography in the diagnosis of such disorder in dromedary camels. Seventeen camels were included in this study based on the clinical, radiographic and ultrasonographic evidence of Achilles tendon rupture. The clinical, radiographic and sonographic findings of studied camels differ according to the type, duration, and location of the tendon rupture. Complete and incomplete rupture of the Achilles tendon was precisely diagnosed in five (29.4%) and twelve (70.6%) camels respectively; ruptured deep and superficial parts of the Achilles tendon were recorded in 10 (58.8%) and 2 (11.8%) camels respectively. Clinically, the camels exhibited an acute non-weight-bearing lameness (second to fourth-grade lameness), with swelling in the tendon near the calcaneus. Radiographs revealed swelling of the soft tissues surrounding the Achilles tendon just proximal to the calcaneal tuberosity in most of the camels with the presence of avulsion fracture of the calcaneus in few cases (n=2). Ultrasonographically, the ruptured part was precisely diagnosed as swollen, oedematous, heterogeneous structure with the presence of anechoic or hypoechoic areas (core lesion). In conclusion, lateromedial radiographs and ultrasonography were helpful in diagnosis and differential diagnosis of different types of Achilles tendon rupture and subsequent clinical decision and surgical interference in dromedary camels.

scholarly journals Achilles tendon rupture in camel (Camelus dromedarius): Radiographic and Ultrasonographic findings

2019 ◽  
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Soft Tissues ◽  
Weight Bearing ◽  
Achilles Tendon Rupture ◽  
Clinical Decision ◽  
Heterogeneous Structure ◽  
Dromedary Camels ◽  
Fracture Of The Calcaneus ◽  
Calcaneal Tuberosity

This study describes the clinical presentation of Achilles tendon rupture and evaluates the utility of radiography and ultrasonography in the diagnosis of such disorder in dromedary camels. Seventeen camels were included in this study based on the clinical, radiographic and ultrasonographic evidence of Achilles tendon rupture. The clinical, radiographic and sonographic findings of studied camels differ according to the type, duration, and location of the tendon rupture. Complete and incomplete rupture of the Achilles tendon was precisely diagnosed in five (29.4%) and twelve (70.6%) camels respectively; ruptured deep and superficial parts of the Achilles tendon were recorded in 10 (58.8%) and 2 (11.8%) camels respectively. Clinically, the camels exhibited an acute non-weight-bearing lameness (second to fourth-grade lameness), with swelling in the tendon near the calcaneus. Radiographs revealed swelling of the soft tissues surrounding the Achilles tendon just proximal to the calcaneal tuberosity in most of the camels with the presence of avulsion fracture of the calcaneus in few cases (n=2). Ultrasonographically, the ruptured part was precisely diagnosed as swollen, oedematous, heterogeneous structure with the presence of anechoic or hypoechoic areas (core lesion). In conclusion, lateromedial radiographs and ultrasonography were helpful in diagnosis and differential diagnosis of different types of Achilles tendon rupture and subsequent clinical decision and surgical interference in dromedary camels.

Anatomical Reduction Is Not Necessary in Treating Non-Porotic Unstable Intertrochanteric Fracture: A Biomechanical Study of Porcine Model

2003 ◽  
Author(s):  
Shi-Wei Lin ◽  
Jaw-Lin Wang
Keyword(s):  
Soft Tissues ◽  
Porcine Model ◽  
Intertrochanteric Fracture ◽  
Weight Bearing ◽  
The United States ◽  
Anatomical Reduction ◽  
Fixation Failure ◽  
Cerclage Wire ◽  
Unstable Intertrochanteric Fracture ◽  
Cerclage Wiring

Intertrochanteric fracture occurred more than 200,000 cases each year in the United States, with mortality rate up to 20 percents. Evans classified the intertrochanteric fracture pattern to stable and unstable group. Most of the complications occurred in the unstable group. It is speculated that in the unstable intertrochanteric fracture, the lag screw migrates easily into the porotic femur head and than causing fixation failure. So the treatment of porotic unstable femoral intertrochanteric fracture depends on the bone quality, severity of comminution, anatomical reduction and methods of fixation. An abundant of studies had been focused on how to reinforce the porotic unstable intertrochanteric fracture including osteotomies, cement augmentation, anatomical reduction, and different implant applications. Among the many techniques, the anatomical reduction using cerclage wiring was widely used to enhance the stability of osteoporotic fractured femur. However, in the young adult, the application of cerclage wiring is controversial. The current study compares the mechanical properties of two anatomical reduction techniques of unstable intertrochanteric fracture reconstructed by a compression hip screw. Four porcine femurs of 10 months-old were used to simulate the non-porotic human bone. The specimens were stripped of all soft tissues. Each femur was prepared with four holes for dynamic hip screws following the standard surgical procedure. The anatomical reduction was achieved by a cerclage wiring and without cerclage wiring. The results reveal that in the non-porotic porcine model, there is no statistically difference in stiffness, plate strain and medial bone strain per load. No matter the unstable intertrochanteric fracture is reduced with cerclage wire or not. The non-porotic unstable intertrochanteric fracture anatomical reduction is not necessary if protective weight bearing is obeyed. However, whether the cerclage wiring is necessary or not for the osteoporotic unstable femur fracture needs further study.

scholarly journals issue 1

2019 ◽  
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Soft Tissues ◽  
Weight Bearing ◽  
Achilles Tendon Rupture ◽  
Clinical Decision ◽  
Heterogeneous Structure ◽  
Dromedary Camels ◽  
Fracture Of The Calcaneus ◽  
Calcaneal Tuberosity

This study describes the clinical presentation of Achilles tendon rupture and evaluates the utility of radiography and ultrasonography in the diagnosis of such disorder in dromedary camels. Seventeen camels were included in this study based on the clinical, radiographic and ultrasonographic evidence of Achilles tendon rupture. The clinical, radiographic and sonographic findings of studied camels differ according to the type, duration, and location of the tendon rupture. Complete and incomplete rupture of the Achilles tendon was precisely diagnosed in five (29.4%) and twelve (70.6%) camels respectively; ruptured deep and superficial parts of the Achilles tendon were recorded in 10 (58.8%) and 2 (11.8%) camels respectively. Clinically, the camels exhibited an acute non-weight-bearing lameness (second to fourth-grade lameness), with swelling in the tendon near the calcaneus. Radiographs revealed swelling of the soft tissues surrounding the Achilles tendon just proximal to the calcaneal tuberosity in most of the camels with the presence of avulsion fracture of the calcaneus in few cases (n=2). Ultrasonographically, the ruptured part was precisely diagnosed as swollen, oedematous, heterogeneous structure with the presence of anechoic or hypoechoic areas (core lesion). In conclusion, lateromedial radiographs and ultrasonography were helpful in diagnosis and differential diagnosis of different types of Achilles tendon rupture and subsequent clinical decision and surgical interference in dromedary camels.

Achilles tendon rupture in camel (Camelus dromedarius): Radiographic and Ultrasonographic findings

2019 ◽  
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Soft Tissues ◽  
Weight Bearing ◽  
Achilles Tendon Rupture ◽  
Clinical Decision ◽  
Heterogeneous Structure ◽  
Dromedary Camels ◽  
Fracture Of The Calcaneus ◽  
Calcaneal Tuberosity

This study describes the clinical presentation of Achilles tendon rupture and evaluates the utility of radiography and ultrasonography in the diagnosis of such disorder in dromedary camels. Seventeen camels were included in this study based on the clinical, radiographic and ultrasonographic evidence of Achilles tendon rupture. The clinical, radiographic and sonographic findings of studied camels differ according to the type, duration, and location of the tendon rupture. Complete and incomplete rupture of the Achilles tendon was precisely diagnosed in five (29.4%) and twelve (70.6%) camels respectively; ruptured deep and superficial parts of the Achilles tendon were recorded in 10 (58.8%) and 2 (11.8%) camels respectively. Clinically, the camels exhibited an acute non-weight-bearing lameness (second to fourth-grade lameness), with swelling in the tendon near the calcaneus. Radiographs revealed swelling of the soft tissues surrounding the Achilles tendon just proximal to the calcaneal tuberosity in most of the camels with the presence of avulsion fracture of the calcaneus in few cases (n=2). Ultrasonographically, the ruptured part was precisely diagnosed as swollen, oedematous, heterogeneous structure with the presence of anechoic or hypoechoic areas (core lesion). In conclusion, lateromedial radiographs and ultrasonography were helpful in diagnosis and differential diagnosis of different types of Achilles tendon rupture and subsequent clinical decision and surgical interference in dromedary camels.

scholarly journals Achilles tendon rupture in camel (Camelus dromedarius): Radiographic and Ultrasonographic findings

2019 ◽  
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Soft Tissues ◽  
Weight Bearing ◽  
Achilles Tendon Rupture ◽  
Clinical Decision ◽  
Heterogeneous Structure ◽  
Dromedary Camels ◽  
Fracture Of The Calcaneus ◽  
Calcaneal Tuberosity

This study describes the clinical presentation of Achilles tendon rupture and evaluates the utility of radiography and ultrasonography in the diagnosis of such disorder in dromedary camels. Seventeen camels were included in this study based on the clinical, radiographic and ultrasonographic evidence of Achilles tendon rupture. The clinical, radiographic and sonographic findings of studied camels differ according to the type, duration, and location of the tendon rupture. Complete and incomplete rupture of the Achilles tendon was precisely diagnosed in five (29.4%) and twelve (70.6%) camels respectively; ruptured deep and superficial parts of the Achilles tendon were recorded in 10 (58.8%) and 2 (11.8%) camels respectively. Clinically, the camels exhibited an acute non-weight-bearing lameness (second to fourth-grade lameness), with swelling in the tendon near the calcaneus. Radiographs revealed swelling of the soft tissues surrounding the Achilles tendon just proximal to the calcaneal tuberosity in most of the camels with the presence of avulsion fracture of the calcaneus in few cases (n=2). Ultrasonographically, the ruptured part was precisely diagnosed as swollen, oedematous, heterogeneous structure with the presence of anechoic or hypoechoic areas (core lesion). In conclusion, lateromedial radiographs and ultrasonography were helpful in diagnosis and differential diagnosis of different types of Achilles tendon rupture and subsequent clinical decision and surgical interference in dromedary camels.

scholarly journals Is postoperative non-weight-bearing necessary? INWN Study protocol for a pragmatic randomised multicentre trial of operatively treated ankle fracture

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ramy Khojaly ◽  
Ruairí Mac Niocaill ◽  
Muhammad Shahab ◽  
Matthew Nagle ◽  
Colm Taylor ◽  
...  
Keyword(s):  
Ankle Fracture ◽  
Multicentre Trial ◽  
Short Form ◽  
Plantar Flexion ◽  
Weight Bearing ◽  
Ankle Fractures ◽  
Hospital Length Of Stay ◽  
Complication Rates ◽  
Fracture Patterns ◽  
Randomised Controlled

Abstract Background Postoperative management regimes vary following open reduction and internal fixation (ORIF) of unstable ankle fractures. There is an evolving understanding that extended periods of immobilisation and weight-bearing limitation may lead to poorer clinical outcomes. Traditional non-weight-bearing cast immobilisation may prevent loss of fixation, and this practice continues in many centres. The purpose of this trial is to investigate the safety and efficacy of immediate weight-bearing (IWB) and range of motion (ROM) exercise regimes following ORIF of unstable ankle fractures with a particular focus on functional outcomes and complication rates. Methods A pragmatic randomised controlled multicentre trial, comparing IWB in a walking boot and ROM within 24 h versus non-weight-bearing (NWB) and immobilisation in a cast for 6 weeks, following ORIF of all types of unstable adult ankle fractures (lateral malleolar, bimalleolar, trimalleolar with or without syndesmotic injury) is proposed. All patients presenting to three trauma units will be included. The exclusion criteria will be skeletal immaturity and tibial plafond fractures. The three institutional review boards have granted ethical approval. The primary outcome measure will be the functional Olerud-Molander Ankle Score (OMAS). Secondary outcomes include wound infection (deep and superficial), displacement of osteosynthesis, the full arc of ankle motion (plantar flexion and dorsal flection), RAND-36 Item Short Form Survey (SF-36) scoring, time to return to work and postoperative hospital length of stay. The trial will be reported in accordance with the CONSORT statement for reporting a pragmatic trial, and this protocol will follow the SPIRIT guidance. Discussion Traditional management of operatively treated ankle fractures includes an extended period of non-weight-bearing. There is emerging evidence that earlier weight-bearing may have equivocal outcomes and favourable patient satisfaction but higher wound-related complications. These studies often preclude more complicated fracture patterns or patient-related factors. To our knowledge, immediate weight-bearing (IWB) following ORIF of all types of unstable ankle fractures has not been investigated in a controlled prospective manner in recent decades. This pragmatic randomised-controlled multicentre trial will investigate immediate weight-bearing following ORIF of all ankle fracture patterns in the usual care condition. It is hoped that these results will contribute to the modern management of ankle fractures. Trial registration ISRCTN Registry ISRCTN76410775. Retrospectively registered on 30 June 2019.

scholarly journals Results of tension band wiring in intra-articular collateral ligament avulsion fractures of the phalanx

2018 ◽  
Vol 6 (2) ◽  
pp. 74-77
Author(s):  
Rajeev Raj Manandhar ◽  
Shishir Lakhey ◽  
Umash Karki
Keyword(s):  
Functional Outcome ◽  
Soft Tissues ◽  
Proximal Phalanx ◽  
Ring Finger ◽  
Ulnar Collateral Ligament ◽  
Tension Band ◽  
Tension Band Wiring ◽  
Collateral Ligament ◽  
Avulsion Fractures ◽  
Radial Collateral Ligament

Background: Avulsion fractures of the base of proximal phalanx associated with ulnar or radial collateral ligament instability are relatively rare. The small size of the fragment and strong deforming pull of the attached soft tissues make the process of reduction and maintenance difficult.Objective: The purpose of this study was to assess the functional outcome of tension band wiring in intra-articular avulsion fractures of the base of the proximal phalanx.Methodology: A prospective study was performed on ten patients with intra-articular collateral ligament avulsion fractures of the proximal phalanx (Jupiter’s classification Type III). A tension band construct was performed using a dorsal approach. The functional outcome was assessed at six months with the quick Disability of Arm, Shoulder and Hand score.Results: The mean age of the patients was 25.8 years (Mean ± SD: 25.80). Six avulsion fractures were of the ulnar collateral ligament of the proximal phalanx of the index finger, one involved the radial collateral ligament of the ring finger and three, the radial collateral ligament of the little finger suggesting an abduction injury. All fractures had united at three months. Eight patients were graded as excellent and two as good. All patients were satisfied with the surgery and the functional outcome of the injured digit. There were no perioperative complications.Conclusion: The functional outcome of tension band wiring in intra-articular collateral ligament avulsion fractures of the base of the proximal phalanx was good to excellent.

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