ObjectiveTo summarize the progress in the treatment of hyperextension tibial plateau fractures.MethodsRelated literature concerning hyperextension tibial plateau fractures was reviewed and analyzed in terms of injury mechanisms, clinical patterns, and treatment outcomes.ResultsHyperextension tibial plateau fractures is a specific type of hyperextension knee injuries, which is happened with the knee in over-extended position (<0°) and characterized by fracture and concomitant ligament injury. It can be classified into 4 patterns: marginal avulsion fractures, unicondylar anteromedial fractures, anterolateral fractures, and bicondylar fractures. The failure of structures occurs according to the diagonal injury mechanism characterized by anterior compression fractures and posterior tension ruptures. It is noted as a rule that a smaller anterior fragment is more likely to accompany by a posterior ligament rupture. Unicondylar anteromedial fracture pattern is caused by hyperextension varus mechanism and usually accompanied by posterolateral corner rupture. Bicondylar hyperextension injury is characterized by posterior metaphyseal cortical tension rupture, anterior articular depression, and reversed posterior slope.ConclusionCurrently there is no consensus on the treatment of hyperextension tibial plateau fractures. Further basic and clinical studies are needed.
ObjectiveTo analyze the possible injury mechanisms in patients with dorsal avulsion fracture of the capitellum combined with medial or posterior medial dislocation of the elbow joint, and to discuss their treatment and prognosis. Methods Retrospective analysis was made on the clinical data of 4 patients with dorsal avulsion fracture of the capitellum combined with medial or posterior medial dislocation of the elbow joint admitted between September 2014 and September 2020, including 3 males and 1 female with an average age of 20.7 years (range, 13-32 years). There were 2 cases of dorsal avulsion fracture of the capitellum combined with medial dislocation of the elbow joint and 2 cases of dorsal avulsion fracture of the capitellum and anterior medial fracture of the coronoid process combined with posterior medial subluxation of the elbow joint. Closed reduction was performed in 3 patients with fresh fracture combined with dislocation, then 2 cases were fixed with tension band and 1 case was fixed with tension band combined with Acumed coronoid anatomic plate. And in patient with old fracture nonunion, the coronoid process was fixed with 1 screw, then the humeral sclerotic bone mass was removed, and finally the lateral collateral ligament was repaired and a hinged external fixator was added. Results All the incisions healed by first intention without early complications such as infection or peripheral nerve injury. The 4 patients were followed up 13-30 months (mean, 20.8 months). The fractures all healed with a healing time of 70-90 days (mean, 79.5 days). At 6 months after operation, heterotopic ossification was seen in the posterior aspect of the right elbow joint in 1 case, and the alkaline phosphatase level was normal (67 U/L); the tension band was removed to clear the heterotopic ossification and the elbow joint was released. The rest of the patients had no heterotopic ossification. At last follow-up, all patients had good functional recovery of the elbow joint, with a Mayo score of 85-100 (mean, 92.5), and the excellent and good rate was 100%. The elbow flexion range of motion was 120°-135°, the extension range of motion was 10°-20°, and the pronation and supination range of motion were all 75°-85°. Conclusion Dorsal avulsion fractures of the capitellum combined with medial or posterior medial dislocation of the elbow may be due to simple varus stress. If an anteromedial coronoid facet fracture also occurs, it may be for the varus posteromedial rotatory instability, which is the opposite mechanism to that of an Osborne-Cotterill lesion. For fresh dorsal avulsion fractures of the capitellum, tension band fixation can be used with good results.
Objective To explore the mechanism, surgical method, and effectiveness of proximal phalangeal bone avulsion fracture caused by A2 circular trochlea injury of the flexor digitorum tendon. Methods A retrospective analysis was conducted on the clinical data of 4 patients with proximal phalangeal bone avulsion fracture caused by A2 circular trochlea injury of flexor digitorum tendon admitted between May 2018 and September 2022. The patients were all male, the age ranged from 26 to 52 years, with an average of 33 years. The injured fingers included 1 case of middle finger and 3 cases of ring finger. The causes of injury were rock climbing of 2 cases and carrying heavy objects of 2 cases. Preoperative anteroposterior and lateral X-ray films and CT examination of the fingers showed a lateral avulsion fracture of the proximal phalanx, with a fracture block length of 15-22 mm and a width of 3-5 mm. The total active range of motion (TAM) of the injured finger before operation was (148.75±10.11)°. The grip strength of the middle and ring fingers was (15.50±2.88) kg, which was significantly lower than that of the healthy side (50.50±7.93) kg (t=−8.280, P<0.001). The time from injury to operation was 2-7 days, with an average of 3.5 days. One Kirschner wire with a diameter of 1.0 mm was used for direct fixation through the fracture block, while two Kirschner wires with a diameter of 1.0 mm were used for compression fixation against the fracture block. The fracture healing was observed, and the TAM of the injured finger and the grip strength of the middle and ring fingers were measured. The finger function was evaluated according to the upper limb functional assessment trial standards of the Chinese Medical Association Hand Surgery Society. ResultsThe incisions all healed by first intention after operation. All patients were followed up 6-28 months, with an average of 19 months. X-ray films showed that all avulsion fractures of proximal phalanx reached bony union, and the healing time ranged from 4 to 8 weeks, with an average of 4.6 weeks. At last follow-up, the grip strength of the middle and ring fingers was (50.50±7.76) kg, which significantly improved when compared with preoperative one (t=−8.440, P<0.001). The TAM of the injured finger reached (265.50±2.08)°, and there was a significant difference when compared with preoperative one (t=−21.235, P<0.001). According to the upper limb functional assessment trial standards of the Chinese Medical Association Hand Surgery Society, the finger function was all evaluated as excellent in 4 cases. ConclusionUsing Kirschner wire fixation through bone blocks and external compression fixation of bone blocks for treating proximal phalangeal bone avulsion fracture caused by A2 circular trochlear injury of the flexor digitorum tendon can achieve good effectiveness.