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Schwend RM, Nguyen BT, Noe MC, Anderson JT, Jiang S. Transiliac-Shortening Osteotomy to Treat Ischial Pressure Injury due to Fixed Pelvic Obliquity: A Case Report. JBJS Case Connect 2024; 14:01709767-202406000-00031. [PMID: 38758928 DOI: 10.2106/jbjs.cc.23.00557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
CASE A 17-year-old adolescent boy with Gross Motor Function Classification System 5 cerebral palsy and neuromuscular scoliosis underwent posterior spinal fusion and segmental spinal instrumentation from T3 to the pelvis. He developed a right ischial pressure injury a few months postoperatively, which persisted despite nonoperative measures. He subsequently underwent an ipsilateral transiliac-shortening osteotomy 16 months after spinal surgery to treat his residual pelvic obliquity and the ischial pressure injury, which healed completely. At the 1-year follow-up visit, there were no further signs of pressure injury. CONCLUSION This case report describes transiliac-shortening osteotomy as a viable treatment option for non-healing ischial pressure injuries secondary to fixed pelvic obliquity.
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Affiliation(s)
- Richard M Schwend
- Department of Orthopaedic Surgery, Children's Mercy Kansas City, Kansas City, Missouri
| | - Brandon T Nguyen
- Kansas City University Graduate Medical Education Consortium (KCU-GME Consortium)/HCA Healthcare Kansas City Program, Kansas City, Missouri
| | - McKenna C Noe
- Department of Orthopaedic Surgery, Children's Mercy Kansas City, Kansas City, Missouri
| | - John T Anderson
- Department of Orthopaedic Surgery, Children's Mercy Kansas City, Kansas City, Missouri
| | - Shao Jiang
- Department of Plastic Surgery, Children's Mercy Kansas City, Kansas City, Missouri
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2
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Kaila R, French SR, Wood DG. Outcomes following adolescent athlete proximal hamstring apophyseal avulsion bone fragment excision and direct tendon-ischial tuberosity reattachment. J Pediatr Orthop B 2023; 32:278-286. [PMID: 35412512 DOI: 10.1097/bpb.0000000000000978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Apophyseal proximal hamstring bone avulsion is uncommon, occurring in adolescents following sudden forceful contraction of the musculotendinous unit. It can be severely disabling, preventing return to sport. This study assessed outcome following avulsed bone excision and direct hamstring tendon-ischial tuberosity reattachment using bone anchors. Validated hamstring-specific Sydney hamstring orthopaedic research evaluation PROMs were prospectively collected from consecutively treated athletes (7 elite and 11 recreational) by a single surgeon over 13 years. Outcomes at 1-year and final follow-up for primary acute surgery at less than 3 months after injury (group 1), primary chronic surgery at more than 3 months after established nonunion (group 2) and revision following failed screw fixation (group 3) were analyzed with sport participation and level at 1 year. Sixteen primary and two revision procedures were analyzed. Mean injury age was 14.6 years (SD, 1.8). Combined primary mean injury scores improved from 11.89 (SD, 7.32) to 33.31 (SD, 2.30) and showed mean 1 year and final follow-up scores within 0.3-6.1% of preinjury values. Pronounced improvement occurred from injured scores for groups 1 versus 2, respectively at 1 year by 247.7% versus 59.0% and at final follow-up by 251.0% versus 64.1%, for groups 1 versus 2, respectively. Final outcome scores of group 3 were high. All cases returned to preinjury sport level by 1 year and indicated satisfaction to repeat treatment. No significant complications occurred. As the largest series to assess outcomes following this surgical technique, success is highlighted by high score improvements close to preinjury values and return to preinjury sport level.
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Affiliation(s)
- Rajiv Kaila
- North Sydney Orthopaedic & Sports Medicine Centre
- Australian Institute of Musculoskeletal Research (AIMS), Mater Clinic Building, Wollstonecraft, Sydney, New South Wales, Australia
- Joint Reconstruction Unit, The Royal National Orthopaedic Hospital, Stanmore, London, UK
| | - Sofie R French
- North Sydney Orthopaedic & Sports Medicine Centre
- Australian Institute of Musculoskeletal Research (AIMS), Mater Clinic Building, Wollstonecraft, Sydney, New South Wales, Australia
| | - David G Wood
- North Sydney Orthopaedic & Sports Medicine Centre
- Australian Institute of Musculoskeletal Research (AIMS), Mater Clinic Building, Wollstonecraft, Sydney, New South Wales, Australia
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3
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Vadhera AS, Knapik DM, Gursoy S, Perry AK, Kunze KN, Singh H, Westrick JC, Chahla J. Avulsion fractures of the ischial tuberosity in the pediatric athlete: a systematic review and return to sport analysis. J Pediatr Orthop B 2022; 31:508-516. [PMID: 35258027 DOI: 10.1097/bpb.0000000000000968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Apophyseal avulsion fractures of the ischial tuberosity (AFIT) in pediatric athletes are relatively uncommon injuries with treatment and return to sport (RTS) outcomes being largely unknown. The purpose of this review is to perform a systematic review analyzing RTS and predictors of successful RTS for pediatric athletes sustaining AFIT. Studies reporting on athletes strictly under the age of 18 years sustaining an AFIT with reported RTS status were included. RTS was analyzed based on injury acuity, mechanism, and management, whereas the incidence of any complications was recorded. A total of 33 studies comprising 90 cases of AFIT were identified. The mean age of athletes sustaining injuries was 14.7 + 1.4 years (range, 9-17 years), most commonly participating in soccer ( n = 25), sprinting ( n = 21), and gymnastics ( n = 7). Acute trauma during sporting activities was responsible for 74.4% ( n = 77/90) of injuries. A total of 82% ( n = 74/90) of athletes reported successful RTS at an average of 7.0 + 5.0 months. Athletes undergoing surgery had a significantly higher RTS rate ( n = 36/38, 94.7%) compared with athletes treated nonoperatively (n = 38/52, 73.08%; P = 0.008). When reported, a high rate of misdiagnosis was reported (39.4%, n = 28/71). Complications were reported in 15.8% ( n = 7/38) and 32.7% ( n = 17/52) of athletes managed surgically and conservatively, respectively. As such, the high rate of misdiagnosis and subsequent high rate of complications and poor rate of RTS highlight the importance of accurate diagnosis and treatment. Future prospective studies evaluating patient outcomes based on fracture displacement, sporting activity, and management strategies are warranted to better treat pediatric athletes. Study design: Level IV, systematic review.
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Affiliation(s)
- Amar S Vadhera
- Division of Sports Medicine, Department of Orthopedic Surgery
| | | | - Safa Gursoy
- Division of Sports Medicine, Department of Orthopedic Surgery
| | - Allison K Perry
- Division of Sports Medicine, Department of Orthopedic Surgery
| | - Kyle N Kunze
- Division of Sports Medicine, Department of Orthopedic Surgery
| | - Harsh Singh
- Division of Sports Medicine, Department of Orthopedic Surgery
| | | | - Jorge Chahla
- Division of Sports Medicine, Department of Orthopedic Surgery
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4
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Moeller JL. Pelvic Avulsion Fractures in Adolescent Athletes: Analyzing the Effect of Delay in Diagnosis. Clin J Sport Med 2022; 32:368-374. [PMID: 35762861 DOI: 10.1097/jsm.0000000000000977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 08/13/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate whether delay in the diagnosis of pelvic avulsion fractures in young athletes leads to prolonged treatment and prolonged return toward sport activities, whether fractures at certain locations are associated with a greater risk of diagnostic delay, and what reasons may exist for delay in diagnosis. DESIGN Retrospective chart review of young patients who presented with pelvic region avulsion fracture to a community-based sports medicine clinic over a 19-year period. SETTING Private practice, primary care sports medicine clinic. PATIENTS Patients younger than 20 years diagnosed with pelvic region avulsion fracture. INTERVENTIONS None, this was a retrospective study. MAIN OUTCOME MEASURES Clearance for return toward sport activities. RESULTS Two hundred twenty-five cases were reviewed for reasons for delay in diagnosis; 208 cases met criteria for the duration of treatment and return to play activities portions of the study. The mean time from date of injury diagnosis was 19.59 days, and the mean duration from date of injury to clearance for return to play advancement was 67.20 days. Duration of treatment varied slightly depending on timing of diagnosis, whereas duration from date of injury to clearance for return to play advancement varied greatly depending on diagnostic delay. Those who did not sense a "pop" at the time of injury were more likely to experience diagnostic delay, as were athletes with ischial tuberosity fractures. The most common cause of diagnostic delay was patient/family decision on when to seek care; misdiagnosis as a muscle strain was also common. CONCLUSIONS Diagnostic delay of adolescent pelvic avulsion fractures may unnecessarily prevent athletes from returning to play within an optimal time frame. Our observations highlight a need for educating athletes and their families on when to seek initial or follow-up medical care as well as educating medical providers regarding the diagnosis of pelvic avulsion fractures.
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Affiliation(s)
- James L Moeller
- Sports Medicine Division, Department of Orthopedics, Henry Ford Health System, Detroit, Michigan
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5
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Schulze A, Schmittenbecher PP. [Apophyseal avulsion in the pelvic region in childhood and adolescence]. Unfallchirurg 2021; 124:519-525. [PMID: 33938973 DOI: 10.1007/s00113-021-01001-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The importance of the apophyseal plates during growth is often underestimated. They act as a muscular insertion and influence the joint mechanics by the load-dependent change in shape. PATHOMECHANISMS An anatomically functional adaptation occurs as protection from overloading. In special kinds of sports with highly dynamic movements, sudden changes of direction and eccentric/concentric muscle activities the resulting stress may exceed the strength of the apophyseal plate. In adolescence this results in a total or partial tearing of the apophysis in the sense of an avulsion injury. In the pelvic region the ischial tuberosity, the anterior superior and inferior iliac spine are mainly affected. DIAGNOSTICS The medical history and clinical diagnostics are supplemented by conventional radiographic imaging. Sectional imaging diagnostics are usually unnecessary. TREATMENT Conservative management by reduced (partial) weight bearing and physiotherapy represents the gold standard in treatment. In cases with a fragment displacement >1.5-2.0 cm and in competitive athletes an open reduction should be considered.
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Affiliation(s)
- A Schulze
- Klinik für Kinderchirurgie, Städtisches Klinikum Karlsruhe, Moltkestr. 90, 76133, Karlsruhe, Deutschland.
| | - P P Schmittenbecher
- Klinik für Kinderchirurgie, Städtisches Klinikum Karlsruhe, Moltkestr. 90, 76133, Karlsruhe, Deutschland
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6
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Theunissen WWES, Jonkers F, Besselaar AT. [A boy with acute pain in his right buttock]. Ned Tijdschr Geneeskd 2020; 164:D4777. [PMID: 32395953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A 14-year-old boy presented to the emergency department with pain in his right buttock after a breakdance move. He got injured while simultaneously hyperflexing his hip and extending his knee. Upon physical examination he had tenderness over his right ischial tuberosity and an inability to perform combined hip extension and knee flexion. Radiography and CT-imaging showed an avulsion fracture of the ischial tuberosity.
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Liu H, Li Q, Shi Y, Zhang Y, Xu K, Qin W, Liu Z, Liu W, Peng B, Dou S, Zhao C, Zhao K, Zhang Q. Surgical treatment for acute ischial tuberosity avulsion fracture: A case report. Medicine (Baltimore) 2019; 98:e15040. [PMID: 30946345 PMCID: PMC6455987 DOI: 10.1097/md.0000000000015040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Ischial tuberosity avulsion fracture (ITAF) is a very rare sports injury, and there is currently no consensus on its diagnosis and treatment. Although conservative treatment is adequate for most patients, those with large displacement of the fracture need surgical management. PATIENT CONCERNS A 13-year-old male athlete experienced tearing pain in the right hip during a sprint. Radiographic examination showed an avulsion fracture of the right ischial tuberosity. DIAGNOSIS Right ITAF. INTERVENTIONS On the 3rd day of injury, the patient was treated with open reduction and internal fixation of ITAF under general anesthesia. OUTCOMES The patient received a systematic postoperative exercise in 2 weeks, and the fracture healed 4 weeks later. After 8 months, the patient returned to the field to participate in the competition. LESSONS Early surgical treatment can bring about good results in the treatment of ITAF with large displacement. The longitudinal incision and subgluteal approach is an ideal choice for the operative procedure.
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Affiliation(s)
- Heng Liu
- Department of Orthopedics, China-Japan Union Hospital of Jilin University
| | - Qiang Li
- Department of Orthopedics, The Second Hospital of Jilin University
| | - Yi Shi
- Department of Orthopedics, China-Japan Union Hospital of Jilin University
| | | | - Kai Xu
- Department of Radiology, China-Japan Union Hospital of Jilin University
| | - Wenheng Qin
- Department of Radiology, China-Japan Union Hospital of Jilin University
| | - Zhengjun Liu
- Department of Orthopedics, China-Japan Union Hospital of Jilin University
| | - Wei Liu
- Department of Orthopedics, Changchun City Orthopedic Hospital, Changchun, Jilin Province, China
| | - Bo Peng
- Department of Orthopedics, China-Japan Union Hospital of Jilin University
| | - Shilu Dou
- Department of Orthopedics, China-Japan Union Hospital of Jilin University
| | - Changfu Zhao
- Department of Orthopedics, China-Japan Union Hospital of Jilin University
| | - Kunchi Zhao
- Department of Orthopedics, China-Japan Union Hospital of Jilin University
| | - Qiao Zhang
- Department of Orthopedics, China-Japan Union Hospital of Jilin University
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Merchant AM, Wagner RA. Displaced ischial stress fracture following revision total hip arthroplasty. Am J Orthop (Belle Mead NJ) 2014; 43:E214-E216. [PMID: 25251536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Stress fractures of the ischium are uncommon and are most likely caused by excessive stretching or contracture of the hamstring muscles. In addition, revision total hip arthroplasty (THA) may weaken the ilium, and metabolic bone disease may also contribute to a fracture. Treatment is usually conservative and prognosis is favorable. We present a rare case of spontaneous displaced fracture of the entire ischium following revision THA that healed without requiring operative intervention.
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Affiliation(s)
| | - Russell A Wagner
- John Peter Smith Hospital, University of North Texas Health Science Center, Fort Worth, TX.
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9
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Hamai S, Nakashima Y, Akiyama M, Kuwashima U, Yamamoto T, Motomura G, Ohishi M, Iwamoto Y. Ischio-pubic stress fracture after peri-acetabular osteotomy in patients with hip dysplasia. Int Orthop 2014; 38:2051-6. [PMID: 24859941 DOI: 10.1007/s00264-014-2375-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 05/04/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE Ischio-pubic stress fracture is one of the potential complications after peri-acetabular osteotomy (PAO) in patients with hip dysplasia. The purpose of this study was to examine the prevalence of and risk factors for ischio-pubic fractures following PAO. METHODS A total of 296 hips in 275 patients who underwent transposition osteotomy of the acetabulum between 2001 and 2012 were retrospectively reviewed. Patient characteristics and radiographic parameters were compared between patients with and without fracture. RESULTS Fourteen ipsilateral hips (4.7%) in 14 female patients had fracture of the inferior pubic ramus (11 hips) or the ischial ramus (three hips) on the same side as the surgery at an average of 4.6 weeks after PAO. Multivariate analysis indicated that younger age at operation (odds ratio of 1.43 per five years, p = 0.0169) and greater degree of correction (odds ratio of 1.98 per five degrees, p = 0.0005) were significantly associated with ischio-pubic fracture as independent risk factors. All fractures healed conservatively with partial weight-bearing. CONCLUSIONS Younger female patients and greater deformity corrections increased the risk of ischio-pubic stress fracture after PAO.
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Affiliation(s)
- Satoshi Hamai
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan,
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10
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Frank M, Dědek T. [Surgical treatment of ischial apophysis avulsion. Case report]. Acta Chir Orthop Traumatol Cech 2014; 81:292-294. [PMID: 25137501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The optimal management of ischial apophysis avulsion, especially indications for surgery, is not well defined. The authors present the case of a 16-year-old man who sustained an avulsion fracture of the ischial apophysis during his athlete training programme. The avulsion was diagnosed by X-ray. Because of displacement, surgery was indicated and open reduction with osteosynthesis was performed using a subgluteal approach on the eighth day after injury. Full weight bearing was allowed at nine weeks after injury, after the post-operative rehabilitation programme had been completed. Return to his sports activity was allowed at four months after injury. At one post-operative year the patient was free of any symptoms. The proper surgical treatment of a displaced ischial apophysis avulsion and subsequent rehabilitation allow for early full weight bearing, including sports activities. The subgluteal approach provides good access to the ischial tuberosity with a minimal risk of complications and a good cosmetic outcome. Key words:apophysis, ischial tuberosity, avulsion.
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Affiliation(s)
- M Frank
- Chirurgická klinika Fakultní nemocnice Hradec Králové
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11
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Gokkus K, Sagtas E, Suslu FE, Aydin AT. Myositis ossificans circumscripta, secondary to high-velocity gunshot and fragment wound that causes sciatica. BMJ Case Rep 2013; 2013:bcr2013201362. [PMID: 24136914 PMCID: PMC3822215 DOI: 10.1136/bcr-2013-201362] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This report concerns an unusual cause of sciatica. The case presented is of a young man with myositis ossificans that resulted in sciatica and was treated with en bloc excision and low-dose radiotherapy and indomethacine. The aim of this study was to explain the different diagnostic properties of myositis ossificans around the hip and non-classic causes of sciatica.
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Affiliation(s)
- Kemal Gokkus
- Department of Orthopaeidcs, Ozel Antalya Memorial Hospital, Antalya, Turkey
| | - Ergin Sagtas
- Department of Radiology, Ozel Antalya Memorial Hospital, Antalya, Turkey
| | - Feride Ekimler Suslu
- Department of Physical Treatment and Rehabilitation, Ozel Antalya Memorial Hospital, Antalya, Turkey
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Affiliation(s)
- S M Thompson
- Department of Geratology, Biomedical Research Centre, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK.
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13
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Sułko J, Olipra W, Oberc A. [Ischial tuberosity fractures in children]. Chir Narzadow Ruchu Ortop Pol 2011; 76:134-137. [PMID: 21961265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Ischial tuberosity fractures in children are a form of avulsion fractures caused by the strong thigh muscles of the back group (ischiotibial muscles). OBJECTIVE Presentation of observations covering the diagnostic difficulties, treatment and follow-up of ischial tuberosity fractures in children. MATERIAL AND METHODS 6 children (one girl and five boys), average age at the time of injury - 13.6 years (12-15.5 years). An analysis of medical and radiological documentation of patients. RESULTS Two patients with chronic pain were suspected of ischial bone tumor, one was suspected of Perthes disease, and only 3 were sent to the Traumatology Department immediately after the football injury. All patients were treated conservatively. Complete healing of fractures was finally achieved in all patients - (fibrous union in two cases) and finally, after an average period of 9 months, the pain subsided. CONCLUSIONS There is a discussion in medical literature about the difficulties in the diagnosis of ischial tuberosity fractures, which were primarily unrecognized. Radiological picture of significant bone rebuilding may suggest neoplastic lesions. In the literature dominates the attitude of conservative treatment. Only in cases of large displacement of fracture and chronic ailments caused by pressure on the sciatic nerve, surgery should be considered.
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Affiliation(s)
- Jerzy Sułko
- Oddział Ortopedyczno-Urazowy, Uniwersytecki Szpital Dzieciecy w Krakowie.
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14
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Somville F, Vriends D, Feyen J. Traumatic avulsion fracture of the ischial tuberosity in an elderly patient. Acta Orthop Belg 2011; 77:122-124. [PMID: 21473458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We present a case of avulsion of a large fragment of the ischial tuberosity in an elderly lady, caused by an extreme abduction of the hip. To our knowledge such an injury has not yet been described in the elderly. The decision to operate was based on the reported experience with this injury in young individuals. We assumed that the same indications applied, while also taking into account the known risk factors of surgery in the elderly.
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Affiliation(s)
- Francis Somville
- Department of Emergency and Traumatology, St-Dimpna Hospital, Geel, Belgium.
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15
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Oliveira F. Differential diagnosis in painful ischiopubic synchondrosis (IPS): a case report. Iowa Orthop J 2010; 30:195-200. [PMID: 21045998 PMCID: PMC2958297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Synchondroses are temporary joints that only exist during skeletal maturation. Bilateral widening of the ischiopubic synchondrosis (IPS) is a normal growth phenomenon, but when it is unilateral and painful it can become a diagnostic challenge. An eight-year-old child with an enlarged symptomatic unilateral synchondrosis is presented. Failure of conservative treatment and its pseudo-tumoral appearance led us to intervene surgically. Pathology revealed a stress fracture. Based on this clinical case, we made a revision of policy regarding pathology, diagnostic workup and treatment strategies for symptomatic synchondrosis.
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Affiliation(s)
- Fillipe Oliveira
- University Hospital Santa Maria, Department of Orthopaedic Surgery, Av. Professor Egas Moniz 1649-028 Lisbon, Portugal.
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16
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Mayrand N, Fortin J, Descarreaux M, Normand MC. Diagnosis and management of posttraumatic piriformis syndrome: a case study. J Manipulative Physiol Ther 2006; 29:486-91. [PMID: 16904496 DOI: 10.1016/j.jmpt.2006.06.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2005] [Revised: 08/16/2005] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The aim of this study is to describe the clinical management of a young male patient with sciatica symptoms that developed after an avulsion of the ischial tuberosity. This is a rare injury, but complications may occur. CLINICAL FEATURE A 19-year-old patient developed sciatica 6 months after a football injury. The patient described his symptoms as a shooting pain from the buttock to the lateral part of the foot, along the back of his thigh and calf, sometimes accompanied by paresthesia. Physical examination showed restricted hip range of motion and a positive Bonnet's test. X-ray analysis revealed a bony overgrowth of the right ischial tuberosity. INTERVENTION AND OUTCOME A treatment plan was designed to decrease the pain level, increase sacroiliac and lumbar joint mobility, and augment muscular extensibility. The patient received 20 treatments over a period of approximately 3 months. Complete recovery was observed 5 months later. CONCLUSION Although many differential diagnoses were contemplated, it is most likely that changes in muscular tension and gait pattern, resulting from the ischial tuberosity avulsion, contributed to overuse of the piriformis muscle leading to a piriformis syndrome.
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Affiliation(s)
- Nancy Mayrand
- Département de Chiropratique, Université du Québec à Trois-Rivières, Québec, Canada
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17
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Abstract
We report a case of an avulsion fracture of the ischial tuberosity treated with a new surgical approach early after injury. Although surgical treatment of this fracture is usually avoided because of the difficulty of the procedure and the risk of sciatic nerve complication, we believe our subgluteal approach is simple and safe. We therefore recommend it for treating avulsion fractures of the ischial tuberosity, especially when the fragment is displaced by >2 cm and the sciatic nerve is not involved. If there is clinical evidence of sciatic nerve disturbance, it is likewise an indication for surgery. However, the incision needs to be deepened to approach the nerve, along the lines of the incisions advocated by both Miller and Spinner.
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Affiliation(s)
- Shuichi Kaneyama
- Department of Orthopaedic Surgery, Akashi Medical Center Hospital, Akashi, Japan.
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18
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Salvi AE, Metelli GP, Corona M, Donini MT. Spontaneous healing of an avulsed ischial tuberosity in a young football player. A case report. Acta Orthop Belg 2006; 72:223-5. [PMID: 16768271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
There is a paucity of orthopaedic literature describing avulsion of the ischial tuberosity, but its spontaneous healing does not seem to have been reported to-date. This article describes the case of a young football player who suffered an avulsion fracture of the ischial tuberosity while kicking vigorously next to the ball during a football match. The diagnosis was not made at the time of trauma, and the fracture was found five years later to have healed spontaneously. A review of the literature is provided.
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Affiliation(s)
- Andrea Emilio Salvi
- Orthopaedic and Trauma Department, Mellino Mellini Hospital Trust, Civil Hospital of Iseo, Brescia, Italy.
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Ubara Y, Higa Y, Tagami T, Suwabe T, Nomura K, Kadoguchi K, Hoshino J, Sawa N, Katori H, Takemoto F, Kitajima I, Hara S, Takaichi K. Pelvic insufficiency fracture related to autosomal dominant polycystic kidney disease. Am J Kidney Dis 2006; 46:e103-11. [PMID: 16310561 DOI: 10.1053/j.ajkd.2005.08.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2005] [Accepted: 08/11/2005] [Indexed: 11/11/2022]
Abstract
We report the case of a patient with autosomal dominant polycystic kidney disease (ADPKD) and an insufficiency-type fracture of the pelvis. A 60-year-old Japanese woman was admitted because of pain in the right ischium and pubis that began suddenly with no precipitating cause. Computed tomography showed the bony pelvis to be compressed by enlarged dependent kidneys and an enlarged liver. We relieved compression on the pelvic bones by means of transarterial embolization (TAE) to the kidneys and liver after initiation of hemodialysis therapy. The fracture healed gradually after TAE, and the patient could walk 4 months later. In an iliac bone specimen obtained before TAE, cancellous bone was intact, but periosteal and endosteal surfaces of cortical bone showed marked resorption and were irregular. Normally, many ligaments are connected tightly to the periosteal surface, supporting the cortical bone. However, because of extensive surface resorption associated with pressure from enlarged kidneys, connections between ligaments and the periosteal surface presumably became fragile, promoting an insufficiency fracture from unapparent external forces. Thus, ADPKD is a potential cause of insufficiency fracture owing to abnormalities of cortical bone.
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Affiliation(s)
- Yoshifumi Ubara
- Nephrology Center, Department of Orthopedics, Toranomon Hospital Kajigaya, Kanagawa, Japan.
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Tynan JR, Schachar NS, Marshall GB, Gray RR. Pathologic Fracture Through a Unicameral Bone Cyst of the Pelvis: CT–guided Percutaneous Curettage, Biopsy, and Bone Matrix Injection. J Vasc Interv Radiol 2005; 16:293-6. [PMID: 15713933 DOI: 10.1097/01.rvi.0000142598.67437.37] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Unicameral bone cysts of the pelvis are extremely rare. A 19-year old man presented with a pathologic fracture through a pelvic unicameral bone cyst. He was treated with computed tomography-guided percutaneous curettage, biopsy, and demineralized bone matrix injection. Treatment has proven successful in short-term follow-up.
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Affiliation(s)
- Jennifer R Tynan
- Department of Diagnostic Imaging, Foothills Medical Center, 1403 29th Avenue NW, Calgary, Alberta T2N 2T9, Canada
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21
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Tao HM, Chen J, Ji YY, Yang DS. Post-traumatic osteolysis of the distal clavicle, pubis and ischium in 7 patients. Chin J Traumatol 2004; 7:247-52. [PMID: 15294106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Post-traumatic osteolysis (PTOL) is a very rare disease occurring after acute trauma or repetitive micro-trauma, which is characterized by persistent pain in the injured site. In this study, we reported 7 patients, in whom osteolysis developed in the distal clavicle, pubis and ischium.
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Affiliation(s)
- Hui-min Tao
- Department of Orthopedics, Second Affiliated Hospital, Medical College, Zhejiang University, Hangzhou 310009, China.
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22
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Affiliation(s)
- Sam Gidwani
- Department of Orthopaedics and Trauma, St George's Hospital, London SW17 0QT.
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23
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Abstract
Hip apophyseal injuries in young athletes are a fairly rare problem, and often go unrecognized by health professionals. These injuries can be extremely painful, and may take months to heal. Timely, accurate diagnosis is imperative so proper treatment can be initiated. In some cases, surgery is required.
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Affiliation(s)
- James L Moeller
- Sports Medicine Associates, PLC, 3100 Cross Creek Parkway, Auburn Hills, MI 48326, USA.
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24
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25
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Johnson AE, Granville RR, DeBerardino TM. Avulsion of the common hamstring tendon origin in an active duty airman. Mil Med 2003; 168:40-2. [PMID: 12546244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
Abstract
Hamstring injuries are common in active athletic populations, such as military service members. Ruptures of the hamstring origin from the ischial tuberosity are rare injuries and missed if not considered in the differential diagnosis of ischial pain. Unlike other hamstring injuries, complete hamstring avulsions must be treated surgically. Results of untreated hamstring avulsions are poor. The purpose of this article is to describe the case of an active duty airman who presented for an unrelated complaint and was discovered to have a 5-week-old hamstring avulsion. Surgical repair of the hamstring avulsion 6 weeks after injury yielded an excellent result and return to full duty. Hamstring avulsions recognized early by history and physical examination and diagnostic imaging permits early and effective treatment. Early surgical repair of the tendon to bone can result in return to full duty.
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Affiliation(s)
- Anthony E Johnson
- Orthopaedic Surgery Service, Brooke Army Medical Center (MCHE-SDR), 3851 Roger Brooke Drive, Building 3600, Fort Sam Houston, TX 78234-6200, USA
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26
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Kocis J, Visna P, Veselý R. [Traumatic avulsion of the tuberosity of the ischium]. Acta Chir Orthop Traumatol Cech 2003; 70:311-3. [PMID: 14669596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
The apophysis of the ischial tuberosity usually becomes united with the hipbone by 25 years of age. The highest incidence of avulsion in this region occurs between 15 and 17 years in young active persons. Apophysitis should be differentiated from apophyseolysis or an avulsion fracture of the ischial tuberosity. Apophysitis may be associated with chronic excessive sports activities in young men and women and is manifested by pain in the region involved. Its presence is confirmed by radiographic findings. The patient with an avulsion fracture of the ischial tuberosity reports an injurious event, usually a sudden movement during sports activities, associated with immediate pain. The diagnosis is again confirmed by radiology. Apophysitis is treated conservatively with no resulting problems. The poor healing of an avulsion fracture may result in chronic complaints, particularly painful sitting. This condition is treated by resection of the fractured apophysis. The authors describe the case of a 28-year-old man who complained of experiencing pain when sitting. At 20 years of age, he suffered an avulsion fracture of the ischial tuberosity that was treated conservatively. He was examined at our department and an unhealed fracture of the ischial tuberosity was diagnosed by radiology and computed tomography. The separated bony fragment was removed and the patient was followed up to 1 year. He remained free from any complaints. An avulsion fracture of the ischial tuberosity is an injury rarely reported in our as well as foreign literature. The available case reports are discussed.
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27
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Abstract
Stress and Urge urinary incontinence may develop after a pelvic trauma especially after pelvic bone fractures. Incontinence may persist even though any type of bladder neck suspension is performed if malunion occurs between fracture ends. In stress and urge urinary incontinence developed after pelvic trauma, patients should also be evaluated for malunion of fractures which may lead to bone spurs and during any type of bladder neck suspension these should also be removed.
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Affiliation(s)
- B Küpeli
- Gazi University, School of Medicine, Department of Urology, Ankara, Turkey
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28
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Affiliation(s)
- M Muscato
- Department of Radiology, Loyola University Medical Center, Maywood, Ill 60153, USA
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29
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Abstract
A case of late sciatic nerve palsy following avulsion of the biceps femoris muscle from the ischial tuberosity in a 27-year-old athlete is reported.
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Affiliation(s)
- H Takami
- Section of Orthopaedic Surgery, Kanto Rosai Hospital, Kawasaki, Japan
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30
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Abstract
An 8-year-old show-jumper gelding was referred for examination as a result of a purchase dispute for reported back pain. Clinical examination identified back pain and atrophy of the left semimembranosus and semitendinosus muscles, but no lameness. Standing pelvic radiography demonstrated a chronic nonunion fracture of the left ischium, the clinical significance of which was uncertain. The apparent back pain was thought to be probably unrelated to the pelvic lesion. We conclude that chronic ischial fracture in the horse can lead to specific atrophy of the semimembranosus and semitendinosus muscles, which originate from this bone.
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Affiliation(s)
- T M Booth
- Department of Veterinary Clinical Sciences and Animal Husbandry, University of Liverpool, Large Animal Hospital, Leahurst, Neston, South Wirral, UK
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31
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Abstract
OBJECTIVE To study the outcome of pelvic fractures and fetuses in pregnant patients involved in blunt multiple trauma. DESIGN Retrospective follow-up study. SETTING Level I trauma center. PATIENTS Pregnant multiple trauma patients with pelvic fractures between 1974 and 1998. INTERVENTIONS Conservative and operative treatment of pelvic fractures adapted to the clinical status of the mother. MAIN OUTCOME MEASURES Clinical, functional, and social outcomes were evaluated. RESULTS Out of 4,196 patients with blunt multiple trauma treated between 1974 and June 1998, seven demonstrated the combination of blunt multiple trauma, pregnancy, and pelvic fractures. These patients had a mean Injury Severity Score of 29.9 points. Five mothers and three fetuses survived their injuries. All dead fetuses died on the scene. One surviving fetus was found to have hydrocephalus unrelated to the injury; the remaining fetuses had an uneventful delivery and were healthy. In two of the three patients whose fetuses survived, the treatment of the pelvic fracture was modified for the sake of fetal well-being. In all of these patients, acceptable outcome was achieved. CONCLUSION Modification of the treatment of the pelvic fracture in pregnant women with multiple trauma may be necessary to minimize the risk of fetal injury. In our experience with these rare cases, this modified treatment did not severely alter the clinical outcome of the mother's pelvic fracture.
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Affiliation(s)
- H C Pape
- Department of Trauma Surgery, Hannover Medical School, Germany
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32
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Affiliation(s)
- W J Bahk
- Department of Orthopaedic Surgery, Uijongbu St. Mary Hospital, Catholic University of Korea
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33
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Jensen IE. [Picture of the month. Pelvic injury]. Ugeskr Laeger 1999; 161:6792. [PMID: 10643367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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Abstract
Obtaining high-quality radiographs of the proximal aspect of equine limbs is difficult because of the large muscles in these regions. The use of scintigraphy may provide further information. Abnormal bone scan findings of the ischial tuberosity or the third trochanter were found in 29 adult horses with obscure hind limb lameness between 1986 and 1996 at the Large Animal Clinic of the University of Bern. Each had abnormal radiopharmaceutical uptake but not all had radiographic changes. Radiopharmaceutical uptake ratios between the ischial tuberosity and the greater trochanter were calculated. The uptake ratio in a control group of 11 clinically sound horses was lower than in 11 lame horses with subjectively enhanced radiopharmaceutical uptake.
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Affiliation(s)
- U Geissbühler
- Clinic for Food Animals and Horses, Faculty of Veterinary Medicine, Department of Radiology, University of Bern, Switzerland
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36
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37
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Abstract
A case is reported of an adolescent sprinter who was chronically disabled by pain after non-operative management for an acute hamstring injury. He had sustained an avulsion fracture of the ischial apophysis with displacement of 2.5 cm. Avulsion fractures of the ischial apophysis with displacement of 2 cm or more are unusual, but they frequently result in a symptomatic non-union, and early diagnosis, open reduction, and internal fixation is to be encouraged.
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Affiliation(s)
- C T Servant
- Institute of Sports Medicine, Royal United Hospital, Bath, United Kingdom
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38
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Abstract
Total hip arthroplasty in the high riding dislocated hip is a technically difficult undertaking, with major reconstruction required on both the acetabular and femoral sides. With reconstruction at a near-anatomic hip center, reduction of the arthroplasty is difficult because of the long-standing limb shortening. The major block to reduction is tension of the soft tissues, particularly the hamstrings. We report a case of ischial tuberosity avulsion fracture following such a complex reconstruction despite femoral shortening subtrochanteric osteotomy. This illustrates the importance of the hamstring group in maintaining the dislocation and emphasizes the need to prevent overtension of the soft tissues in such complex reconstructive procedures.
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Affiliation(s)
- P N Smith
- Royal Australasian College of Surgeons, Princess Elizabeth Orthopaedic Centre, Exeter, United Kingdom
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39
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Abstract
Avulsion fractures of the ischial tuberosity are rare. They are often caused by a typical "splits"-like accident. In general the patients feel sudden severe pain in the buttock with localized tenderness in the region of the ischial tuberosity, rarely in combination with sciatic nerve irritation. According to the functional anatomy, flexion of the knee and extension of the hip may be impaired. Roentgenograms often reveal no abnormality and show no evidence of fracture. Therefore, inadequate therapy because of missed diagnosis can result in avoidable persistent pain. We report on a 42-year-old man with an avulsion fracture of the ischial tuberosity. The epidemiology, symptoms, including irritation of the sciatic nerve, differential diagnoses, diagnostic procedures and therapy are presented in detail.
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Affiliation(s)
- M Neuber
- Klinik und Poliklinik für Unfall- und Handchirurgie, Westfälische Wilhelms-Universität, Münster
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40
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Guigui P, Dessarts I, Morvan G, Benoist M, Lassale B, Deburge A. [Fractures of the ischium after laminoarthrectomy. Retrospective study of a series of 31 patients]. Rev Chir Orthop Reparatrice Appar Mot 1998; 84:247-57. [PMID: 9775047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
PURPOSE OF THE STUDY Pars interarticularis fracture is one possible source of pain after laminoarthrectomy. The purposes of this study were: to describe the pars defect, to determine its causes and to analyse its consequences on the functional final result. MATERIAL AND METHOD 31 patients operated for disc herniation or degenerative lumbar stenosis were retrospectively studied. Clinical symptoms were evaluated before and 3 months after initial surgery, at the time of postlaminectomy radiological examination and at last follow-up according to Beaujon rating scale. Radiological evaluation included: description of the pars defect on plain radiographs and CT imaging, calculation of the amount of bone just above the inferior articular process that was resected, analysis of the postoperative stability of the spine both on static and dynamic radiographs. Any remaining disc herniation or stenosis were also noted. RESULTS 39 pars interarticularis fractures were disclosed. These fractures were identified as a linear luency on plain radiographs or on reformed CT imaging view. Asymmetric widening of the facet joint space just below the pars defect was easier to observe and was present in 66 per cent of the cases on plain radiographs and in 79 per cent on CT imaging. After initial surgery 12 slipping appeared. In all of these cases pars fracture was bilateral at the same level or associated to a complete unilateral facetectomy at the same level. The amount of bone resected just above the inferior facet process was 66 per cent in average, range from 45 to 84 per cent. All the patients complained for low back pain and/or leg pain. In 62 per cent of cases symptoms occurred within one year after surgery, at an average onset of 7.6 months postlaminectomy. 27 patients were reported Revision surgery was in all cases a posterolateral fusion with or without instrumentation; new decompression was performed in 15 cases. At last follow-up, according to our classification, results were very good in 9 cases, good in 15 cases and fair in the remaining 3 cases. Improvement rate obtained after the initial surgery was 75 per cent in average, it was 59 per cent after revision surgery, difference was statistically significant. CONCLUSION Pars interarticularis fractures may be a source of postlaminectomy pain. They appear to be caused primarily by an excessive resection (more than one half) of the bone immediately superior to the inferior articular process at the level of the laminectomy. These results suggest that caution in resection of this bone or additional posterolateral fusion in case of large resection of pars interarticularis, can avoid the problem. Asymmetric widening of the joint space just below the defect seems to be the key to this diagnosis in the postoperative lumbar laminectomy patient with persistent or recurrent pain.
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Affiliation(s)
- P Guigui
- Service de Chirurgie Orthopédique, Hôpital Beaujon, Clichy
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41
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Takayanagi H, Watanabe H, Shinozaki T, Takagishi K. Overgrowth of the ischial tuberosity complicating femoral bone and muscle atrophy: implications for a delayed complication of malunited apophyseal avulsion fracture. Am J Orthop (Belle Mead NJ) 1998; 27:308-12. [PMID: 9586730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Delayed complications occurring several years after the fused avulsion of ischial tuberosity have rarely been reported. We present a patient with overgrowth of the ischial tuberosity who complained of knee pain associated with significant bone and muscle atrophy in the thigh, which occurred 10 years after the ischial injury. Reinforcement exercise of the hamstrings relieved the knee pain. Here, we emphasize that avulsion fractures of the ischial tuberosity can cause persistent disability and that patients with avulsion fracture of the ischial apophysis in the adolescent period should actively maintain the strength of the hamstrings, even after more than 1 decade.
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Affiliation(s)
- H Takayanagi
- Department of Orthopedic Surgery, Gunma University School of Medicine, Takagi Hospital, Japan
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42
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Abstract
OBJECTIVE To evaluate the MRI appearances in insufficiency fractures. DESIGN A retrospective analysis of spin echo MR images with gadolinium-enhancement was undertaken with the emphasis on the signal change and the shape of the fracture gap and the adjacent bone marrow. PATIENTS Five elderly women who had ischiopubic insufficiency fractures (pubis, 4; ischium 1) underwent MRI to exclude the possibility of pathologic fractures. RESULTS AND CONCLUSIONS In no case was contrast enhancement noted at the fracture gap or the adjacent bone marrow, but a cleft-life, elongated bright signal area suggesting "fluid collection" was noted within the fracture gap. Absence of contrast enhancement and "fluid collection" at the fracture gap might suggest non-union of a fracture, which is additional information provided only by MRI.
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Affiliation(s)
- G S Seo
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan
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43
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Peterson HA, Robertson RC. Premature partial closure of the triradiate cartilage treated with excision of a physical osseous bar. Case report with a fourteen-year follow-up. J Bone Joint Surg Am 1997; 79:767-70. [PMID: 9160952 DOI: 10.2106/00004623-199705000-00019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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44
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Abstract
Ischial tuberosity pain in athletes may be caused by several clinical entities, which include acute and old bony or periosteal avulsions and apophysitis. We studied the natural course of these injuries based on our clinical case series of fourteen patients with apophysitis and twenty-one with avulsion of the ischial tuberosity. Only patients with the diagnosis confirmed by X-ray finding were included. The clinical diagnostic criteria by ischial apophysitis consisted of gradually increasing functional and palpatory pain at the ischial tuberosity without any major trauma at the beginning of the symptoms. Typically there was asymmetry on plain radiographs of the ischial tuberosities in apophysitis; the involved apophyseal area became sclerotic, wider than the non-symptomatic apophysis, osteoporotic patches developed and the lower margin of the ischial tuberosity became irregular. The patients with avulsion reported an acute trauma at the beginning of the symptoms and an avulsion fragment was immediately after injury or later seen in plain radiographs. The mean age of the patients with apophysitis (14.1 yrs) was lower than that of the subjects with avulsions (18.9 yrs). Apophysitis of the ischial tuberosity usually healed well without complications. Avulsions often caused more prolonged pain with referral pain to the posterior parts of the thigh which often required operative interventions. A small bony or periosteal avulsion sometimes grew to a pseudotumor calcification. We recommend conservative treatment as the primary treatment modality for both ischial tuberosity apophysitis and avulsion fractures.
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Affiliation(s)
- U M Kujala
- Unit for Sports and Exercise Medicine, University of Helsinki, Finland
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45
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Abstract
Avulsion of the ischial apophysis is a rare injury. We report the successful treatment of an avulsion of the ischial apophysis by open reduction and internal fixation.
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Affiliation(s)
- D R Gill
- Department of Orthopaedic Surgery, Cairns Base Hospital, Queensland, Australia
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46
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Abstract
The differential diagnosis of pelvic pain and possible injury in the female athlete is quite broad and must include gastrointestinal and genitourinary aetiologies, as well as musculoskeletal injuries. These considerations reflect the anatomical complexity of the female pelvis. The pelvic bones house the lower gastrointestinal and genitourinary viscera and transmit stress from the lower extremities to the upper body. The innervation of the pelvic structures also complicates evaluation and diagnosis when somatic and visceral afferent information affects the athlete's interpretation of pain. An algorithmic approach can facilitate evaluation and rehabilitation of pelvic injuries in the female athlete in the contest of previously described mechanisms of musculoskeletal injury.
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Affiliation(s)
- J W Short
- Primary Care Sports Medicine Section, Duke University Medical Center, Durham, North Carolina, USA
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47
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Abstract
We treated eight patients who had complete rupture of the ischial origin of the hamstring muscles. This uncommon injury results from a sudden forceful flexion of the hip joint when the knee is extended and the hamstring muscles powerfully contracted. The injuries occurred during athletic exercise in six men and two women who had a mean age of 40 years (range, 22 to 53). With prompt diagnosis and surgery the final functional results in these patients were good. If the diagnosis is delayed, it is not possible to accomplish a primary suture of the hamstring muscles to the ischial bone. Consequently, another surgical procedure will need to be performed to restore function. Unlike cases of bony avulsion of the ischial apophysis in growing children, acute complete rupture of the proximal hamstring muscles origin in adults should be treated with prompt surgery.
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Affiliation(s)
- S Orava
- Hospital Meditori and Sports Medical Research Unit, University of Turku, Turku
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48
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Poulsen TK, Enggaard TP. [Avulsion fracture of the ischial tuberosity. A rare lesion whose early diagnosis and correct treatment may prevent late sequelae]. Ugeskr Laeger 1995; 157:6140-1. [PMID: 7483092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Avulsion fractures of the ischial tuberosity are often mistaken for sprains or a muscle tears. We present two cases of displaced fractures with a diagnostic delay of eighteen months and two years, respectively. Both cases were treated conservatively and resulted in discomfort on sitting and in one case persistent functional disability. Since early diagnosis is important for a successful treatment, an anteroposterior radiograph of the pelvis is recommended in patients presenting a history and symptoms indicating a lesion in the posterior aspect of the upper thigh. Accumulated experience indicates, that acute displaced fractures should be treated by open reduction and internal fixation.
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Affiliation(s)
- T K Poulsen
- Ortopaedkirurgisk afdeling O, Odense Universitetshospital
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49
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Abstract
Differences in size and shape of ischiopubic synchondrosis in childhood may present problems in diagnosis and differential diagnosis. Whereas asymptomatic swollen ischiopubic synchondrosis represents a normal ossification process, painful swelling is a symptom of underlying pathology. Five children are described with symptomatic ischiopubic synchondrosis swelling, four representing stress reaction and one with osteomyelitis. Radiologists should be careful when reporting on swollen ischiopubic synchondrosis in symptomatic children.
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Affiliation(s)
- K Kozlowski
- Department of Radiology, Royal Alexandria Hospital for Children, Sydney, Australia
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50
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Affiliation(s)
- C Smets
- Department of Orthopaedics, Royal Devon and Exeter Hospital, Exeter, UK
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