双侧髂前上棘骨骺撕脱1例

1病例资料患者,男,14岁。因双髋部疼痛、活动受限5 d入院。主诉5 d前上体育课医结合七年制2000级,四川成都6100752成都中医药大学附属医院骨科,四川成都610072参加50 m短跑,跑至终点时即感双髋部疼痛,行走受限,当时未摔倒。外院就诊行骨盆正位X线片及骨盆CT检查,诊断为双侧髂前上棘骨骺撕脱,未予处理。因双髋疼痛症状未缓解而来我院就诊。查体:双侧髂前上棘处轻度肿胀,明显压痛,触诊时有骨擦感,可扪及裂缝及骨折块;无放射痛,无明显的血管、神经损伤症状,双侧阔筋膜张肌、缝匠肌肌张力降低。仰卧位时双髋关节可屈曲40°,双髋关节其余各方向…     

Avulsion fractures of the pelvis - a qualitative systematic review of the literature

Objective

To assess a causal relationship between physical activity or boney surgical intervention and the occurrence of avulsion fracture in the pelvis. Secondarily to assess the average age at which avulsion fracture occurs in cases associated with physical activity or boney surgery.

Method

A literature search was performed on a variety of databases using text words and MeSH terms. Results were limited to English language. Cases involving trauma or pathological disease were excluded. Causation Criteria scores were calculated for each paper to establish a link between the suspected mechanism of injury and avulsion fracture.

Results

48 papers were retrieved encompassing 66 cases of avulsion fracture. 88% of cases were associated with physical activity while 12% were associated with a history of surgery. Average age in the physical activity cases was 16.8(range 13–43) and 56.4(range 31–74) in the surgery related cases. Causation Criteria scores were definite in 76% of activity related cases and probable in 60% of boney surgery related cases.

Conclusions

Avulsion fractures of the pelvis represent a highly prevalent pathology among the adolescent athletic population. A population of skeletally mature patients with history of boney surgical intervention are also at risk.     

不可吸收缝线治疗髂前上棘撕脱性骨折

正2012年7月~2015年10月,我们采用不可吸收缝线治疗11例髂前上棘撕脱骨折患者,效果满意,报道如下。1材料与方法1.1病例资料本组11例,均为男性,年龄11~16岁。就诊时可见患者轻度屈髋体位,髂前上棘处肿胀、压痛。受伤至手术时间4 h~5 d。1.2治疗方法全身麻醉下手术。患者仰卧,患肢稍屈髋屈膝外旋位。以髂     

青少年髂前上棘撕脱骨折的诊治探讨

[目的]探讨青少年髂前上棘撕脱骨折的发病原因及诊疗方法。[方法]上海儿童医学中心骨科2001年1月-2006年1月共收治了15例骨盆髂前上棘撕脱骨折病例，男14例，女1例，年龄12—16岁，急性14人，慢性1人；10例发生在短距离赛跑时，2例发生在足球运动时，各有1例发生在排球、篮球和棒球运动时；X线片和CT检查可以明确诊断并根据撕脱骨片的大小及移位的方向及距离，分别采用切开复位内固定、外展屈髋位石膏固定、卧床休息等不同治疗方法。[结果]14例急性病例，保守及手术治疗效果优良，均达到局部无疼痛，髋关节满幅活动，步态正常，可参加各类体育活动。1例慢性病例为外院保守治疗2个月后转来，局部仍明显疼痛，经本院手术治疗后效果满意。作者认为手术复位内固定者可达到解剖复位，康复时间短，早期活动。[结论]明确髂前上棘撕脱骨折的病因、分类，可以做到正确诊断，合理治疗，早期康复，杜绝各种不良后果。     

双侧髂前上棘撕脱骨折1例

患者，男，18岁，学生，以“双侧髂前上棘肿痛1周，加重1d”就诊。1周前患者上体育课跑步后感双髂前上棘处疼痛，当时未予重视，休息后稍缓角，1d前再次参加田径比赛后出现双侧髂前上棘处疼痛加重，拒按，肿胀明显，双正肢伸直时疼痛加剧，行走困难，以肌肉拉伤外搽消肿止痛酊治疗，体息后症状不缓解，遂来我院求治。     

Avulsion fractures of the scaphoid and triquetrum in a 15 year- old male

Avulsion fractures of the perilunate ligaments occur in isolation, and multiple fractures are typically not seen in the same carpus. We present a case of a 15-year-old male who injured his wrist during football practice. He presented without wrist dislocation or deformity. Radiographs demonstrated avulsion fractures to the proximal pole of the scaphoid and proximal radial aspect of the triquetrum. The patient was immobilized with an upper extremity thumb spica cast; however, there was persistent non-union of both fractured segments. Magnetic resonance imaging confirmed avulsions at the site of the scapholunate and lunotriquetral ligaments, with both ligaments relatively intact. At the last follow-up, one year after the initial injury, the patient had a normal clinical exam, with no pain and full wrist range of motion despite fracture non-union at both locations. This is a unique injury with an unclear mechanism and complicated management.     

Avulsion Fracture of the Calcaneal Tuberosity: Case Report and Literature Review

Avulsion fractures of the calcaneal tuberosity are predominantly seen in patients with poor bone quality, the commonly used lag screw fixation might not be strong enough even with bony fragments of sufficient size. We present a case of a closed displaced avulsion fracture of the calcaneal tuberosity due to blunt trauma to the calf in a 74-year-old female. Open reduction and internal fixation with two 3.5-mm cannulated cortical screws with washers was performed, and anatomic reduction was achieved. Without further trauma, secondary displacement of the fracture occurred on day 3. Revision was performed with a single 3.5-mm cortical screw and transosseous fixation with 2 suture anchors, followed by partial weightbearing for 6 weeks. At 12 weeks postoperative, the fracture had completely healed, and she was doing well at 16 months after the revision surgery. Transosseous suture anchor fixation of an osteoporotic avulsion fracture of the calcaneal tuberosity seems to provide better and stronger fixation than that using lag screws.     

Avulsion fracture of the anterior superior iliac spine: misdiagnosis of a bone tumour

Avulsion fractures of the anterior superior iliac spine are rare. This injury is usually seen in adolescents, as an avulsion fracture of the apophyses, a result of sudden vigorous contraction or repetitive contraction of the sartorius and tensor fasciae latae muscles. Treatment for this injury is usually conservative; however, surgical management has been reported in those with significant displacement. We present a 14 year old male patient who was referred to our unit for biopsy of a possible pathological fracture of his right ilium. The authors feel it is essential to understand the importance of ruling out a bone tumour, if the possibility has been raised, before managing a suspected fracture. If there is any doubt, the case should be referred to an appropriate sarcoma unit for review prior to any intervention.     

可吸收缝线治疗髂前上棘撕脱骨折

1990—2004年,我院采用可吸收缝线经骨折片钻孔缝扎治疗髂前上棘撕脱骨折25例,取得了满意疗效,报道如下。     

Operative treatment of avulsion fractures of the anterior inferior iliac spine: a two-case report

Abstract Avulsion fractures of the anterior inferior iliac spine (AIIS) are rare injuries of the pelvic ring. In two male athletes this injury was missed during initial examination and therefore was not treated optimally. Six months after the initial injury, the patients felt constant pain, and there was a lump in the thigh region; they both also had limited range of hip motion. Therefore, radiography and magnetic resonance imaging of the hip were performed. Avulsion fracture of AIIS was diagnosed and treated surgically with excision of the avulsed fragment. Two years later, both athletes have completely recovered and returned to their usual sporting activities. Isokinetic muscle testing disclosed that the extensor muscles of the operated side of the knee were weaker than those on the uninjured side.     

Avulsion fractures of the anterior inferior iliac spine: the case for surgical intervention

Two cases of avulsion fracture of the anterior inferior iliac spine are reported. One was a missed diagnosis that resulted in exostosis formation needing excision. The second case was an adolescent with significant displacement of the fragment and a primary open reduction and internal fixation was done. A high index of suspicion is necessary to diagnose this relatively rare injury and surgery has a role in carefully selected cases.     

Avulsion fracture of the anterior superior iliac spine in a volleyball player

Avulsion fractures of the apophyses of the pelvis rarely occur in adolescent athletes as a result of sudden and strong contraction of the muscles attached to the growth cartilage. We present a 16-year-old male patient who had an avulsion fracture of the left anterior superior iliac spine while he was playing volleyball. He presented with complaints of pain in the left hip and difficulty in walking. The diagnosis was made by means of pelvis x-rays, computed tomography, and three-phase radionuclide bone imaging. He underwent conservative treatment with a non-steroidal anti-inflammatory drug and bed rest. After two weeks, ambulation with crutches was allowed. At the end of four weeks, he was able to walk without crutches. He returned to his preinjury level of sports activities at the end of six weeks, without any complaint of pain.     

脊柱骨盆骨折合并腹部闭合伤的早期诊断

目的 探讨脊柱骨盆骨折合并腹部闭合损伤的诊断方法,提高其诊断水平。方法 回顾分析１９８０￣１９９８年本院收治的８４例脊柱骨盆骨折合并腹部闭合损伤病人的临床资料,对比各种诊断方法与手术结果。结果 腹腔穿刺阳性率８２％,ＣＴ阳性率７４％,Ｂ超阳性率７０％。１２ｈ内手术病死率９．８％,７２ｈ后手术病死率３６％。结论 脊柱骨盆骨折合并腹部闭合损伤易发生误诊,漏诊。其病死率与手术时机有明显关系,腹腕穿刺是一     

Distal Disinertion of the Patellar Ligament Combined with Avulsion Fractures at the Medial and Lateral Margins of the Patella a Case Report and an Experimental Study

A 12-year-old boy presented with a proximally retracted patella 5 months after an injury to the left knee. The clinical and radiographic features and the findings at operation led to the conclusion that the original lesion had been a distal disinsertion of the patellar ligament combined with avulsion fractures at the medial and lateral margins of the patella, produced by the medial and lateral longitudinal patellar retinacula. Loading experiments on amputation and cadaver specimens showed that these retinacula, apart from being tendons for the vastus medialis and the vastus lateralis, respectively, constitute a direct fibrous connection of considerable strength between the patella and the tibia and thus are capable of producing avulsion fractures.     

Avulsion of the flexor digitorum tendon secondary to enchondroma of the distal phalanx

Flexor digitorum profundus (FDP) tendon avulsion is a common injury in sports. This is secondary to forced extension against flexor digitorum profundus contraction. However, avulsion injury of the FDP tendon secondary to an enchondroma of the distal phalanx is extremely rare. There have only been three previous reports of such an occurrence. This report describes a fourth case of an avulsion injury of the FDP tendon secondary to enchondroma of the distal phalanx of the fourth digit.     

Avulsion fracture of the scapular spine: A case report

Fractures of the scapula are infrequent injuries usually associated with direct, violent trauma to the shoulder girdle. We present a rare case of an avulsion fracture of the scapular spine occurring in a patient during a game of badminton. Open reduction and internal fixation with a tension band-wiring technique was performed. The patient had an uncomplicated recovery and rapidly returned to sporting activity.