Avulsion fracture

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Avulsion fracture
MalletFinger.PNG
Avulsion fracture of a fingertip bone
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Avulsion fracture of the proximal middle phalanx on the palm side
Specialty Orthopedic

An avulsion fracture is a bone fracture which occurs when a fragment of bone tears away from the main mass of bone as a result of physical trauma. This can occur at the ligament by the application of forces external to the body (such as a fall or pull) or at the tendon by a muscular contraction that is stronger than the forces holding the bone together. Generally muscular avulsion is prevented by the neurological limitations placed on muscle contractions. Highly trained athletes can overcome this neurological inhibition of strength and produce a much greater force output capable of breaking or avulsing a bone.

Contents

Types

Dental avulsion

Traumatic complete displacement of a tooth from its socket in alveolar bone. It is a serious dental emergency in which prompt management (within 20–40 minutes of injury) affects the prognosis of the tooth. [1]

Tuberosity avulsion of the 5th metatarsal

Proximal fractures of 5th metatarsal Proximal fractures of 5th metatarsal.jpg
Proximal fractures of 5th metatarsal

The tuberosity avulsion fracture (also known as pseudo-Jones fracture or dancer's fracture [2] is a common fracture of the fifth metatarsal (the bone on the outside edge of the foot extending to the little toe). [3] This fracture is likely caused by the lateral band of the plantar aponeurosis (tendon). [4] Most of these fractures are treated with a hard-soled shoe or walking cast. This is needed until the pain goes away and then the patient can return to normal activities. [3] Healing is usually completed within eight weeks. [5]

Tibial tuberosity avulsion

X-ray of a 15-year-old male, showing an older avulsion fracture of the tibial tuberosity. Avulsion fracture of tibial tuberosity, annotated.jpg
X-ray of a 15-year-old male, showing an older avulsion fracture of the tibial tuberosity.

A tibial tuberosity avulsion fracture is an incomplete or complete separation of the tibial tuberosity from the tibia. This occurs as a result of a violent contraction of the quadriceps muscles, most often as a result of a high-power jump. Incomplete fractures are usually treatable with the traditional RICE (rest, ice, compression, elevation) method, but complete/displaced fractures will most often require surgery to pin the tuberosity back in place. Tibial tuberosity avulsions occur most often in teenagers that engage in a large amount of sporting activities, and many studies [ which? ] have shown a history with Osgood-Schlatter's disease to be linked to the fracture.

Treatment

If the fracture is small, it is usually sufficient to treat with rest and support bandage, but in more severe cases, surgery may be required. Ice may be used to relieve swelling. [6]

Displaced avulsion fractures are best managed by either open reduction and internal fixation or closed reduction and pinning. Open reduction (using surgical incision) and internal fixation is used when pins, screws, or similar hardware is needed to fix the bone fragment.[ citation needed ]

Other animals

Dinosaurs

In 2001, Bruce Rothschild and other paleontologists published a study examining evidence for tendon avulsions in theropod dinosaurs. Among the dinosaurs studied, avulsion injuries were only noted among Tyrannosaurus and Allosaurus . Scars from these sorts of injuries were limited to the humerus and scapula. A divot on the humerus of Sue the T. rex was one such avulsion. The divot appears to be located at the origin of the deltoid or teres major muscles. The localization in theropod scapulae as evidenced by the tendon avulsion in Sue suggests that theropods may have had a musculature more complex and functionally different from those of their descendants, the birds. [7]

See also

Related Research Articles

<span class="mw-page-title-main">Biceps</span> Muscle on the front of the upper arm

The biceps or biceps brachii is a large muscle that lies on the front of the upper arm between the shoulder and the elbow. Both heads of the muscle arise on the scapula and join to form a single muscle belly which is attached to the upper forearm. While the biceps crosses both the shoulder and elbow joints, its main function is at the elbow where it flexes the forearm and supinates the forearm. Both these movements are used when opening a bottle with a corkscrew: first biceps screws in the cork (supination), then it pulls the cork out (flexion).

<span class="mw-page-title-main">Bone fracture</span> Physical damage to the continuity of a bone

A bone fracture is a medical condition in which there is a partial or complete break in the continuity of any bone in the body. In more severe cases, the bone may be broken into several fragments, known as a comminuted fracture. A bone fracture may be the result of high force impact or stress, or a minimal trauma injury as a result of certain medical conditions that weaken the bones, such as osteoporosis, osteopenia, bone cancer, or osteogenesis imperfecta, where the fracture is then properly termed a pathologic fracture.

<span class="mw-page-title-main">Stress fracture</span> Medical condition

A stress fracture is a fatigue-induced bone fracture caused by repeated stress over time. Instead of resulting from a single severe impact, stress fractures are the result of accumulated injury from repeated submaximal loading, such as running or jumping. Because of this mechanism, stress fractures are common overuse injuries in athletes.

<span class="mw-page-title-main">Osgood–Schlatter disease</span> Inflammation of the patellar ligament

Osgood–Schlatter disease (OSD) is inflammation of the patellar ligament at the tibial tuberosity (apophysitis). It is characterized by a painful bump just below the knee that is worse with activity and better with rest. Episodes of pain typically last a few weeks to months. One or both knees may be affected and flares may recur.

<span class="mw-page-title-main">Jones fracture</span> Medical condition

A Jones fracture is a broken bone in a specific part of the fifth metatarsal of the foot between the base and middle part that is known for its high rate of delayed healing or nonunion. It results in pain near the midportion of the foot on the outside. There may also be bruising and difficulty walking. Onset is generally sudden.

<span class="mw-page-title-main">Fibularis brevis</span> Shorter and smaller of the fibularis (peroneus) muscles

In human anatomy, the fibularis brevis is a muscle that lies underneath the fibularis longus within the lateral compartment of the leg. It acts to tilt the sole of the foot away from the midline of the body (eversion) and to extend the foot downward away from the body at the ankle.

<i>Velocisaurus</i> Extinct genus of dinosaurs

Velocisaurus is a genus of noasaurid theropod dinosaur from the Late Cretaceous period of Argentina.

<span class="mw-page-title-main">Ischium</span> Lower and back region of the hip bone

The ischium forms the lower and back region of the hip bone.

<i>Elmisaurus</i> Extinct genus of dinosaurs

Elmisaurus is an extinct genus of caenagnathid dinosaur from the Late Cretaceous Nemegt Formation of Mongolia. It was a theropod belonging to the Oviraptorosauria.

<span class="mw-page-title-main">Tuberosity of the tibia</span> Slight protrusion at the top front end

The tuberosity of the tibia or tibial tuberosity or tibial tubercle is an elevation on the proximal, anterior aspect of the tibia, just below where the anterior surfaces of the lateral and medial tibial condyles end.

<span class="mw-page-title-main">Fifth metatarsal bone</span>

The fifth metatarsal bone is a long bone in the foot, and is palpable along the distal outer edges of the feet. It is the second smallest of the five metatarsal bones. The fifth metatarsal is analogous to the fifth metacarpal bone in the hand.

<span class="mw-page-title-main">Calcaneal fracture</span> Medical condition

A calcaneal fracture is a break of the calcaneus. Symptoms may include pain, bruising, trouble walking, and deformity of the heel. It may be associated with breaks of the hip or back.

Shoulder surgery is a means of treating injured shoulders. Many surgeries have been developed to repair the muscles, connective tissue, or damaged joints that can arise from traumatic or overuse injuries to the shoulder.

Biceps femoris tendon rupture can occur when the biceps femoris is injured in sports that require explosive bending of the knee as seen in sprinting. If the athlete is fatigued or has not warmed up properly he/she may suffer a hamstring strain/rupture, which is the tearing of the hamstring muscle. Avulsion of the biceps femoris tendon is the complete pulling away of the tendon from the bone. This most commonly occurs where the long head attaches to the ischial tuberosity. Injuries to biceps femoris are more common than to other hamstring muscles.

<span class="mw-page-title-main">Humerus fracture</span> Medical condition

A humerus fracture is a break of the humerus bone in the upper arm. Symptoms may include pain, swelling, and bruising. There may be a decreased ability to move the arm and the person may present holding their elbow. Complications may include injury to an artery or nerve, and compartment syndrome.

<span class="mw-page-title-main">Supracondylar humerus fracture</span> Medical condition

A supracondylar humerus fracture is a fracture of the distal humerus just above the elbow joint. The fracture is usually transverse or oblique and above the medial and lateral condyles and epicondyles. This fracture pattern is relatively rare in adults, but is the most common type of elbow fracture in children. In children, many of these fractures are non-displaced and can be treated with casting. Some are angulated or displaced and are best treated with surgery. In children, most of these fractures can be treated effectively with expectation for full recovery. Some of these injuries can be complicated by poor healing or by associated blood vessel or nerve injuries with serious complications.

Dinosaur diets and feeding behavior varied widely throughout the clade, including carnivorous, herbivorous, and omnivorous forms.

Theropod paleopathology is the study of injury and disease in theropod dinosaurs. In 2001, Ralph E. Molnar published a survey of pathologies in theropod dinosaur bone that uncovered pathological features in 21 genera from 10 theropod families. Pathologies have been seen on most theropod body parts, with the most common sites of preserved injury and disease being the ribs and tail vertebrae. The least common sites of preserved pathology are the weight-bearing bones like the tibia, femur and sacrum. Most pathologies preserved in theropod fossils are the remains of injuries, but infections and congenital deformities have also been documented. Pathologies are less frequently documented in small theropods, although this may simply be because the larger bones of correspondingly larger animals would be more likely to fossilize in the first place.

<span class="mw-page-title-main">Proximal humerus fracture</span> Break of the upper part of the bone of the arm

A proximal humerus fracture is a break of the upper part of the bone of the arm (humerus). Symptoms include pain, swelling, and a decreased ability to move the shoulder. Complications may include axillary nerve or axillary artery injury.

In the skeleton of humans and other animals, a tubercle, tuberosity or apophysis is a protrusion or eminence that serves as an attachment for skeletal muscles. The muscles attach by tendons, where the enthesis is the connective tissue between the tendon and bone. A tuberosity is generally a larger tubercle.

References

  1. Zadik Y (December 2008). "Algorithm of first-aid management of dental trauma for medics and corpsmen". Dent Traumatol. 24 (6): 698–701. doi:10.1111/j.1600-9657.2008.00649.x. PMID   19021668.
  2. Robert Silbergleit. "Foot Fracture". Medscape . Retrieved October 19, 2011.
  3. 1 2 Gary A. Rosenberg & James J. Sferra (September–October 2000). "Treatment Strategies for Acute Fractures and Nonunions of the Proximal Fifth Metatarsal". Journal of the American Academy of Orthopaedic Surgeons. 8 (5): 332–338. doi:10.5435/00124635-200009000-00007. PMID   11029561. S2CID   40453020.
  4. Richli WR, Rosenthal DI (October 1984). "Avulsion fracture of the fifth metatarsal: experimental study of pathomechanics". American Journal of Roentgenology. 143 (4): 889–91. doi:10.2214/ajr.143.4.889. PMID   6332501.
  5. JC DeLee (1993). RA Mann; MJ Coughlin (eds.). Fractures and dislocations of the foot. Surgery of the Foot and Ankle. Vol. 2 (6th ed.). St Louis: Mosby-Year Book. pp. 1627–1640.
  6. "Avulsion fracture: How is it treated?". Mayo Clinic. April 8, 2010. Retrieved April 22, 2010.
  7. Rothschild, B., Tanke, D. H., and Ford, T. L., 2001, Theropod stress fractures and tendon avulsions as a clue to activity: In: Mesozoic Vertebrate Life, edited by Tanke, D. H., and Carpenter, K., Indiana University Press, p. 331-336.