Bilateral simultaneous avulsion fractures of the anterior tibial tubercle (ATT) are extremely rare. Since the first description in 1954, 15 similar cases have been reported. We report a further case in a 16-year-old boy who sustained bilateral simultaneous tibial tubercle avulsion fractures (Watson-Jones Type III) from jumping during a gymnastics session. The right knee presented an associated partial avulsion of the patellar tendon. Both knees were treated successfully by open reduction and internal fixation with two cannulated screws. The recovery of the patient was complete; the screws were removed six months later. After one year follow-up, the patient had no complaint and had resumed his sporting activity.
Can read freely here
https://sethiortho.blogspot.com/
Challenges and Solutions in
Management of Distal Humerus Fractures
Epidemiology
Anatomy
Classification
Controversies and Recent studies
Approach
Implants selection
Plate configuration
Ulnar nerve transposition
Role of total elbow arthroplasty in DHF
Role of hemiarthroplasty in DHF
Metaphyseal comminution –
Anatomic complexity of the distal humerus
Positioning of the plates
TBW –
Skin closure
Osteoporotic nature of the bone –
Less BMD/Thin metaphysis
Screw Pullout strength is low
DHF account for 2% of all adult fractures
The common pattern of fracture
Intraarticular and involves both columns
Bimodal distribution
Peak incidence in young male and in older female patients
Young male – High-velocity injury
Older female - Osteoporosis
The distal humerus is flattened and expanded bony structure
It is composed of lateral and medial columns with the trochlea situated between these columns.
The location of the trochlea is central rather than medial
Formed by Medial SCR + M/Epicondyle
The distal end has 450 angulation with humeral shaft
M/ Epicondyle gives attachment for MCL & Common Flexor Origin
The MCL originates from the undersurface of the medial epicondyle where it is vulnerable to excessive dissection
Ulnar nerve
Formed by Lateral SCR and L/Epicondyle and Capitulum
Distal end has 200 with humeral shaft
L/ epicondyle gives attachment for LCL & common extensor origin
Its posterior surface is non articular and can be used as a site for a plate fixation
The lateral column curves anteriorly
Placement of a straight plate on the posterolateral surface of the humerus risks straightening of distal humerus.
The medial column including the medial epicondyle is in line with the humeral shaft.
It forms the center of the triangle
It has 30 - 80 – external rotation & 250 anterior divergent with the shaft
It forms a 40 - 80 degree valgus direction
X-ray -
Anterior-posterior view
lateral View
Traction View – This can help to define articular fragments and aid in pre-operative classification of the fracture.
NCCT – Elbow
Articular surfaces
Position of the fracture fragments
useful for identifying impacted fracture fragments that make reduction challenging
Olecranon Osteotomy Approach – 52-57%
Triceps sparing VS Olecranon osteotomy approach
The lateral column was often the first to fail as a result of excessive varus forces acting on the elbow during normal activities of daily living. Small anterior-posterior diameter
Smaller diameter of the humerus, permitting only one or two short screws for fixation.
Interruption of blood supply to the lateral column
blood supply to the lateral column is also derived from posterior segmental vessels. Sagittal plane plating has less risk of injuring these structures, which may improve the chances of union
Can read freely here
https://sethiortho.blogspot.com/
Challenges and Solutions in
Management of Distal Humerus Fractures
Epidemiology
Anatomy
Classification
Controversies and Recent studies
Approach
Implants selection
Plate configuration
Ulnar nerve transposition
Role of total elbow arthroplasty in DHF
Role of hemiarthroplasty in DHF
Metaphyseal comminution –
Anatomic complexity of the distal humerus
Positioning of the plates
TBW –
Skin closure
Osteoporotic nature of the bone –
Less BMD/Thin metaphysis
Screw Pullout strength is low
DHF account for 2% of all adult fractures
The common pattern of fracture
Intraarticular and involves both columns
Bimodal distribution
Peak incidence in young male and in older female patients
Young male – High-velocity injury
Older female - Osteoporosis
The distal humerus is flattened and expanded bony structure
It is composed of lateral and medial columns with the trochlea situated between these columns.
The location of the trochlea is central rather than medial
Formed by Medial SCR + M/Epicondyle
The distal end has 450 angulation with humeral shaft
M/ Epicondyle gives attachment for MCL & Common Flexor Origin
The MCL originates from the undersurface of the medial epicondyle where it is vulnerable to excessive dissection
Ulnar nerve
Formed by Lateral SCR and L/Epicondyle and Capitulum
Distal end has 200 with humeral shaft
L/ epicondyle gives attachment for LCL & common extensor origin
Its posterior surface is non articular and can be used as a site for a plate fixation
The lateral column curves anteriorly
Placement of a straight plate on the posterolateral surface of the humerus risks straightening of distal humerus.
The medial column including the medial epicondyle is in line with the humeral shaft.
It forms the center of the triangle
It has 30 - 80 – external rotation & 250 anterior divergent with the shaft
It forms a 40 - 80 degree valgus direction
X-ray -
Anterior-posterior view
lateral View
Traction View – This can help to define articular fragments and aid in pre-operative classification of the fracture.
NCCT – Elbow
Articular surfaces
Position of the fracture fragments
useful for identifying impacted fracture fragments that make reduction challenging
Olecranon Osteotomy Approach – 52-57%
Triceps sparing VS Olecranon osteotomy approach
The lateral column was often the first to fail as a result of excessive varus forces acting on the elbow during normal activities of daily living. Small anterior-posterior diameter
Smaller diameter of the humerus, permitting only one or two short screws for fixation.
Interruption of blood supply to the lateral column
blood supply to the lateral column is also derived from posterior segmental vessels. Sagittal plane plating has less risk of injuring these structures, which may improve the chances of union
Osseous anatomy, Types of approaches(Position,landmarks,Incision,Superficial and Deep surgical dissection) , structures at risk, Extensile approaches with diagrams and eponymous .
Posterolateral corner injuries of knee joint Samir Dwidmuthe
Missed posterolateral corner injuries of knee joint is a common cause for failure of ACL and PCL reconstruction only next to malpositioned tunnels.
Isolated PLC injuries are uncommon, making up <2% of all acute knee ligamentous injuries. Covey JBJS 2001
Incidence of PLC injuries associated with concomitant ACL and PCL disruptions are much more common (43% to 80%). Ranawat JAAOS 2008
A recent (MRI) analysis of surgical tibialplateau fractures demonstrated an incidence of PLC injuries in 68% of cases. Gardner JOT 2005
Take home message
PLC injuries to be ruled out in every case of ACL& PCL rupture.
Neurovascular integrity to be checked in every case.
Grade I & II can be managed conservatively.
Grade III Acute- Repair.
Grade III Chronic- Anatomic PLC recon.
Beware of varus knee alignment.
Osseous anatomy, Types of approaches(Position,landmarks,Incision,Superficial and Deep surgical dissection) , structures at risk, Extensile approaches with diagrams and eponymous .
Posterolateral corner injuries of knee joint Samir Dwidmuthe
Missed posterolateral corner injuries of knee joint is a common cause for failure of ACL and PCL reconstruction only next to malpositioned tunnels.
Isolated PLC injuries are uncommon, making up <2% of all acute knee ligamentous injuries. Covey JBJS 2001
Incidence of PLC injuries associated with concomitant ACL and PCL disruptions are much more common (43% to 80%). Ranawat JAAOS 2008
A recent (MRI) analysis of surgical tibialplateau fractures demonstrated an incidence of PLC injuries in 68% of cases. Gardner JOT 2005
Take home message
PLC injuries to be ruled out in every case of ACL& PCL rupture.
Neurovascular integrity to be checked in every case.
Grade I & II can be managed conservatively.
Grade III Acute- Repair.
Grade III Chronic- Anatomic PLC recon.
Beware of varus knee alignment.
A practical 2-day management communication training seminar for second-languge English speaking executives who wish to show their intellect, knowledge, educational level and professional status when emailing.
Triumful miscarii comuniste in Romania, ar insemna: desfiintarea Bisericii, desfiintarea Familiei, desfiintarea proprietatii individuale si desfiintarea libertatii. Inseamna, intr-un cuvant deposedarea noastra de ceea ce formeaza patrimoniul moral al omenirii si in acelasi timp deposedarea de orice bunuri materiale. (Corneliu Zelea Codreanu)
Carte publicata cu ISBN.
All the rights for multiplication, translation, diffusion of this work are absolutely free (free of charge and unconfined) for each of the countries of the world.
Dreptul de copy pentru aceasta lucrare este gratuit si neingradite, atat pentru Romania cat si pentru fiecare dintre celelalte tari ale lumii.
Bilateral Varus Deformity Correction and Leg Lengthening with an Ilizarov Fixator in a Female with Trichorhinophalangeal Syndrome Type 1 (TRPS I) – Case Report
Very rare complication for radial head fracture and even other trauma (elbow dislocation, radius/cubitus shaft fracture,…)
Lost of range of motion and specifiquely for pronosupine
Lot of treatment in litterature as:
- preventive irradiation
- resection without interposition
- resection/interposition
- resection wo interposition + irradiation
- resection/interposition + irradiation
Still no consensus
Orthopaedic support with 3D printing in childrenROBERT ELBAUM
En orthopédie pédiatrique l’immobilisation d’un membre s’effectue
traditionnellement par une contention plâtrée. Très peu d’avancées majeures se sont produites
dans ce domaine. Cependant, l’émergence des nouvelles technologies, permet d’envisager des
contentions produites par technologie 3D, propre aux caractéristiques anatomiques du patient.
Une start-up a ainsi développé un processus de modélisation et de production de ces
contentions. Ce papier vise à déterminer la faisabilité du processus de développement de ces
contentions.
Digitized manual palpation: a new method of evaluating posture and its defor...ROBERT ELBAUM
The aim of this study was to be able to apply this method for adolescents with idiopathic scoliosis and to try to draw the following elements: postural equilibrium parameters, evaluate the asymmetries present at the spine deformations, make an assessment of the curvature profile both in the frontal and sagittal plane and also a count of the position of the shoulders
Aspect particulier en traumatologie pédiatriqueROBERT ELBAUM
L ’enfant n’est pas un petit adulte
Particularités propres à la traumatologie pédiatrique
Connaissance du potentiel de remodelage mais ne pas le surestimer
Connaissance RX des points d ’ossifications
Fractures in Children: Is conservative treatment still alive?ROBERT ELBAUM
Pediatric traumatology represent the first cause of death in chidren.
It is also the first cause of inability
And also the first reason of hospital stay
SPONDYLOLYSE: solution de continuité au niveau de l’isthme de la vertèbre
SPONDYLOLYSTHESIS: « glissement en avant d’un corps vertébral, provoqué par la rupture de la continuité ou l’élongation des isthmes » (TAILLARD)
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
2. Avulsion-fracture of the anterior tibial tubercle (ATT)
occurs in adolescents, predominantly male.
Avulsion fracture of the ATT represents 3% of all
injuries of the proximal tibia and 0.4 to 2.4% of all
epiphyseal fractures .
From 1853 till now, more than 250 cases have been
reported in the literature.
3. Simultaneous bilateral avulsion fractures of the tibial tubercle
are very uncommon.
Since the first description by Borsch-Madsen in 1955 ,
15 cases have been reported. Associated patellar ligament
avulsion is also uncommon .
We report another bilateral case featuring these two rare
injuries.
We will also discuss the appropriate classification, the
aetiopathogenenesis of this injury and the proposed
treatment.
4. a 16-year old boy
Following a jump on both
feet.
2 swollen knees and a
marked tenderness over the
tibial tubercles.
Active extension was
impossible bilaterally.
X-Ray :bilateral avulsion
fracture of the tibial
tubercle, type 3A according
to Ogden’s classification.
5. L knee: complete avulsion of the
tibial tuberosity with an intact
patellar ligament.
R knee: partial disruption of the
patellar ligament
the fragments were reduced and
fixed with two cannulated
screws. The right patellar
ligament was repaired.
6. Six months later the
cannulated screws were
removed in one day
surgery.
1Y FU: no pain, no
functional limitation and
had resumed his sporting
activity (judo).
X-Ray :complete
remodeling of the tibial
tubercle.
7. WATSON-JONES (1976) OGDEN (1980)
type I: avulsion fracture of the distal part of
the tibial tubercle;
type II: displacement of the lip of the
anterior part of the tibial epiphysis.
type III :fracture of the base of the lip with
propagation into the knee joint.
3 subgroups A or B, with a possible
intra-articular extension of the fracture
as well as comminution of the fragment
8. In 1990, Frankl described two cases of ATT
avulsion-fracture associated with avulsion of the
patellar ligament. He proposed an addition to
the classification to include avulsion of the
patellar ligament (Type I-C).
Ryu and Debenham subsequently added a
fourth type corresponding to an extension of the
fracture to the posterior cortex through the
growth plate (Salter Harris type 2).
9. The tibial tubercle physis
is in continuity with that
of the tibial plateau. The
physis progressively fuses
from posterior to
anterior, making it most
vulnerable to avulsion in
adolescents aged 13-16
years.
10. During take-off or a jump,
the quadriceps mechanism
forcefully contracts against
the patellar tendon
insertion. When the force
exceeds the strength of the
tibial tubercle physis, a
fracture is generated,
leading to avulsion of the
tibial tubercle.
11. Indirect force caused by sudden
contraction of the quadriceps
muscle.
Acute passive flexion of the knee
against a contracting quadriceps,
such as landing after a jump (as in
our case) is another mechanism of
injury
14. AUTHORS YEAR SEX AGE N Classification Circonstance Mechanism simultaneity TR last FU
BORCH-MADSEN 1954 M 17 1 W-J TYPEIII ORIF
OGDEN and coll 1980 M 14 1 W-J TYPEIII ORIF
HENRARD et coll 1983 M 1 ORIF
MAAR et coll 1988 M 16A 1 W-J TYPE III Basketball jump YES ORIF 3Y
LEPSE et coll 1988 M 14A 1 W-J TYPE III Gymnast forward flip YES ORIF 1Y
INOUE et coll 1991 M 16Y 1 W-J Type IV
SIEBERT et coll 1995 M 16A 1 OGDEN 1B L
+SALTER 2 R
Athletism Starting YES ORIF 20W
MIRLY and coll 1996 M
MOSIER et coll 2000 M 15Y 1 OGDEN IIIB+ IV YES
ERGUN et coll 2003 M 16Y 1 OGDEN 2B Bilat Basketball landing
after
forcefull
jump
YES ORIF 27M
HAMILTON et coll 2006 M 13Y 1 TYPE I R+TYPE II L Soccer jump YES ORIF
SLOBOGEAN et coll 2006 M 16Y 1 TYPE IV L+TYPE III
R
Running sudden stop YES L:Closed
reduction
R:ORIF
1Y 6M
GEORGIOU et coll 2007 M 17Y 1 W-J TYPE III Sport jump YES ORIF
NEUGBAUER et coll 2007 M 16Y 1 OGDEN 3A bilat Gymnast jump YES ORIF
ARREDONDO-GOMEZ
et coll
2007 M 14Y 1 OGDEN3 A R
+OGDEN 3B G
Soccer Indirect YES ORIF
SCHAFFER et coll 2008 M 13Y 1 SALTER 2 R+
SALTER 3 L
Long Jump take off and
landing
YES ORIF
15. Male,13 - 17 y ,close to skeletal maturity.
Causal mechanism :sudden jump with a landing on the
ground while contracting the quadriceps muscle.
According to the Watson-Jones and Ogden
classifications, most cases were type IIIA or B.
The type III fractures involving a growth plate and
extending through the articular surface, appear to do
well following open reduction and internal fixation
despite their bilateral nature.
No report of growth disturbance of the proximal tibial
epiphysis after that type of injury.
16. Recommandation for type III fracture: CT scan to
evaluate the intraarticular surface.
Accurate diagnosis of the lesion is important to
determine the appropriate treatment in order to
avoid malfunction of the extensor mechanism of
the knee in case of avulsion of the patellar
ligament (type 1-C).
Open reduction with internal fixation (screw,
wiring or K-wire) has been the common treatment
for this type of lesion.
17. Bilateral simultaneous avulsion fracture of the
anterior tibial tubercle (ATT) are extremely rare.
We believe that treatment should always include
open reduction and internal fixation for all type II
or III lesions.
It appears from the literature that the recovery
and functional outcome of bilateral injuries is
comparable to those of unilateral tibial tubercle
avulsion fractures: results have been good to
excellent in most of the cases.