8 research outputs found
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
Articular changes in experimentally induced patellar trauma
Only a few studies have described the microscopic pathology of the
articular cartilage after trauma. In the present animal study. we
demonstrate the effect of trauma on the articular cartilage of the
patella and determine the histological changes. Traumatic injury of the
patella was experimentally induced in 45 white New Zealand rabbits aged
4 to 6 months old. The articular cartilage of the patella was observed
after the sacrifice of the animals immediately and at days 1, 2, 4, 8.
and 15 as well as at months 1, 2 and 3 after the traumatic injury.
Macroscopic, light and electron microscopic findings showed progressive
articular cartilage changes with failed effort of cartilage repair.
Osteoarthritic-like degeneration of the articular cartilage was found in
all specimens, According to this experimental study, trauma to the
articular cartilage may progress to arthritis. The reversibility of
cartilage damage or the progression to arthritis seem to be associated
with many factors such as the intensity and frequency of the trauma. the
mechanism of injury, the intrinsic remodeling of the cartilage matrix
and the capability of the articular cartilage to regenerate
Avulsion fractures of the tibial tuberosity in adolescent athletes treated by internal fixation and tension band wiring
Avulsion of the tibial tuberosity is a rarely reported fracture. It is
mainly considered as an athletic injury accounting for less than 3% of
all epiphyseal lesions. In this study, we hypothesized that the use of
tension band wiring as a supplement of the internal fixation for the
avulsion fractures of the tibial tuberosity would lead the adolescent
athletes to a more effective rehabilitation program and an earlier
resumption of their previous activity level. Ten patients were treated
in our department over a period of I I years (1985-1995). Operative
treatment was thought necessary for all our cases due to tibial
tuberosity displacement. Open reduction and internal fixation in
combination with tension band wiring was used. The result in all cases
was that the reduction was maintained intact and the fracture united.
The functional results were excellent, and all patients returned to
their previous athletic activities. Our conclusion is that the
combination of internal fixation and tension band wiring for avulsion
fractures of the tibial tuberosity seems to be more effective and
advantageous than conservative or other surgical methods. Avoiding the
need of external support and allowing early joint motion, the method
described prevents serious quadriceps atrophy, allowing the young
athletes to return earlier to their previous sport activities
Long-term outcome of patients with avascular necrosis, after internal fixation of femoral neck fractures
We retrospectively reviewed 84 patients who underwent internal fixation
of an intracapsular femoral neck fracture. The mean age was 58 years and
the time from injury to operative treatment was 5.3 days. The mean
follow-up was 4.7 years (range, 2-8 years). At the latest follow-up, in
the 46 patients with undisplaced (Garden I, II) fractures, nonunion
occurred in two patients and avascular necrosis of the femoral head in
nine. Six of these nine patients had a good or excellent result, one had
a fair result, and two had a poor result. Of 35 patients with no sign of
avascular necrosis, 32 patients had a good or excellent result, two a
fair and one had a poor result. In the group of 38 patients with
displaced (Garden III, IV) fractures, nonunion occurred in six patients
and avascular necrosis of the femoral head in 15. Of these 15 patients,
10 had a good or excellent result, two had a fair result, and three had
a poor result. Of 17 patients with no sign of avascular necrosis, 14 had
an excellent result and three patients a poor result. Overall only five
of the 24 patients who developed avascular necrosis of the femoral head
had undergone total hip arthroplasty. Internal fixation remains a simple
and safe, method of treatment for both undisplaced and displaced femoral
neck fractures in middle-age patients. Despite the relatively high rate
of avascular necrosis after internal fixation of femoral neck fractures,
only a few of these patients (20%) required further surgical treatment
in the follow-up period of this study. (C) 2003 Elsevier Science Ltd.
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