Stress avulsion of the tibial tuberosity after tension band wiring of a patellar fracture: a case report

INTRODUCTION: To the best of our knowledge there is no other report of an elderly patient who was surgically treated for a patellar fracture with tension band wiring and who subsequently suffered from an avulsion fracture of the tibial tuberosity. The combination of a patellar fracture and avulsion of the patellar ligament has only been described as complication after bone-patellar tendon-bone anterior cruciate ligament reconstructions. However, due to demographic changes and more elderly patients treated this injury may become more frequent in future. CASE PRESENTATION: We present the case of an 81 year old female who sustained an oblique patellar fracture after a direct contact injury of the left knee when falling on ice. Consequently the patellar fracture was openly reduced and stabilized with tension band wiring. The follow-up was uneventful till three months after surgery when the patient noticed a spontaneous avulsion fracture of the tibial tuberosity (Ogden type 3). The tibial tuberosity fragment was reattached with two non-resorbable sutures looped around two modified AO cortical 3.5 mm long neck screws. Intraoperatively multiple bone cysts were seen. Biopsies were not taken to prevent further fragmentation of the tibial tuberosity. The patient was followed up with anteroposterior and lateral full weight bearing radiographs and clinical assessment at 6, 12 weeks and 6 months after surgery. Recovery was completely pain free with full satisfaction. CONCLUSION: In conclusion in elderly patients with a patella fracture a possible associated but not obvious fracture of the tibial tuberosity should be ruled out and the postoperative rehabilitation protocol after tension band wiring of the patella might have to be individually adjusted to bone quality and course of the fracture

Reliability of Shoulder Abduction Strength Measure for the Constant-Murley Score

Reports using the Constant-Murley score often lack details regarding how strength measurement was performed, which may have an important impact on the results obtained. A description of the measurement is especially important when patients are unable to adopt the prescribed position of 90° shoulder abduction, leading to invalid or highly discrepant scores. We investigated the influence of shoulder abduction and torso position on strength measurement with special emphasis on intraobserver reliability. Thirty-three healthy volunteers were examined using a handheld dynamometer (Isobex®) in 30°, 60°, and 90° abduction with or without stabilization of the torso. A linear correlation between strength measurements in different degrees of abduction was observed, with values at 90° abduction on average 15% lower than at 60° and 45% lower than at 30°. In multivariate analysis, gender and weight had a substantial impact on the strength of individual measurement positions. Intraobserver reliability was related to arm and torso position (intraclass correlation coefficients, 0.71–0.93) and was highest for 90° abduction without torso stabilization. These findings emphasize the importance of standardized torso and arm positions ensuring high reliability when performing the strength measurement of the Constant-Murley score

Reliability of shoulder abduction strength measure for the Constant-Murley score

Reports using the Constant-Murley score often lack details regarding how strength measurement was performed, which may have an important impact on the results obtained. A description of the measurement is especially important when patients are unable to adopt the prescribed position of 90 degrees shoulder abduction, leading to invalid or highly discrepant scores. We investigated the influence of shoulder abduction and torso position on strength measurement with special emphasis on intraobserver reliability. Thirty-three healthy volunteers were examined using a handheld dynamometer (Isobex) in 30 degrees , 60 degrees , and 90 degrees abduction with or without stabilization of the torso. A linear correlation between strength measurements in different degrees of abduction was observed, with values at 90 degrees abduction on average 15% lower than at 60 degrees and 45% lower than at 30 degrees . In multivariate analysis, gender and weight had a substantial impact on the strength of individual measurement positions. Intraobserver reliability was related to arm and torso position (intraclass correlation coefficients, 0.71-0.93) and was highest for 90 degrees abduction without torso stabilization. These findings emphasize the importance of standardized torso and arm positions ensuring high reliability when performing the strength measurement of the Constant-Murley score

Water-Soluble Narrow-Line Radicals for Dynamic Nuclear Polarization

The synthesis of air-stable, highly water-soluble organic radicals containing a 1,3-bis(diphenylene)-2-phenylallyl (BDPA) core is reported. A sulfonated derivative, SA-BDPA, retains the narrow electron paramagnetic resonance linewidth (<30 MHz at 5 T) of the parent BDPA in highly concentrated glycerol/water solutions (40 mM), which enables its use as polarizing agent for solid effect dynamic nuclear polarization (SE DNP). A sensitivity enhancement of 110 was obtained in high-field magic-angle-spinning (MAS) NMR experiments. The ease of synthesis and high maximum enhancements obtained with the BDPA-based radicals constitute a major advance over the trityl-type narrow-line polarization agents.National Institutes of Health (U.S.). (Grant GM095843)National Institutes of Health (U.S.). (Grant EB002804)National Institutes of Health (U.S.). (Grant EB002026