Sleeve Fracture Research Articles

KNEE INJURY-SOCCER

HISTORY A 13-year-old male soccer goalie sustained a left knee injury during a collision with another player in which he was kicked in the medial aspect of the knee. He continued play for approximately 5 minutes, at which time he left the game due to increasing anterior knee pain exacerbated by flexion and severe knee swelling and stiffness. PHYSICAL EXAMINATION Left knee: 3+ effusion. Held at position of comfort at 20 degrees of flexion. Tenderness over medial patellar retinaculum, lateral patellar facet, in inferior pole of patella. Range of motion 10–90 degrees flexion, with increasing pain in flexion. Ligamentous testing and meniscal provacative tests negative within pain limited range of motion. DIFFERENTIAL DIAGNOSIS Patellar dislocation/subluxation. Knee contusion. Patellar fracture. Ligamentous disruption. Quadriceps mechanism strain or rupture. TESTS AND RESULTS Left knee anterior-posterior and lateral radiographs – Fibrous cortical defect proximal left tibial shaft – Minimal irregularity inferior pole of patella Left knee MRI – Small nondisplaced avulsion fracture inferior patella – Large knee effusion – No ligamentous or meniscal injury. FINAL/WORKING DIAGNOSIS Avulsion fracture of inferior pole of the Patella (Patellar Sleeve Fracture). TREATMENT AND OUTCOMES Knee immobilizer non-weight bearing for two weeks. Passive extension range of motion exercises at 2 weeks. Gradual weight bearing in immobilizer at 3 weeks. Active knee extension range of motion exercises at 4 weeks. Gradual Weight bearing out of immobilizer at 4 weeks. Proprioceptive and gradual sport-specific training at 6 weeks. Return to play soccer at 9 weeks 8. Follow-up at 4 months – asymptomatic with full participation.

半月板縫合術後に生じた膝蓋骨上極裂離骨折（ｓｌｅｅｖｅ ｆｒａｃｔｕｒｅ）の１例

We report a case of sleeve fracture of the upper pole of the patella after medial meniscal repair. A sixteen-year-old boy presented a history of medial meniscal repair. He fell down the stairs, and landed on his knees, after which he could not walk with sudden pain in the left knee. Local examination showed severe effusion and localized tenderness on the upper pole of the patella. He was unable to extend the knee actively. Aspiration produced blood-stained fluid containing fat globules. Lateral radiograph showed avulsion of the upper pole of the patella. Surgical treatment was performed. The avulsed patella fragment of the upper pole included a sleeve of cartilage. The patella, its cartilage sleeve, and the extensor retinaculum were repaired. Three days later, he started passive knee flexion. Now he has regained/recovered full range of movements and is able to extend his knee completely. Patients with fracture of this type usually have a history of trauma or operation around the knee. It was concluded that the mechanism of the injury is inherent weakness at the growth plate of the patella during rapid growth in adolescence, combined with the detrimental effect of immobilization, with the quadriceps contracting against resistance. Accurate reduction and fixation are considered important to present development of the patella magna and persistence of anterior knee pain.

Sleeve fracture of the upper pole of the patella in an adult with osteogenesis imperfecta

Sleeve fracture of the upper pole of the patella in an adult with osteogenesis imperfecta Taro Kakazu a,∗, Hitoshi Tatemoto b, Masanori Kawamura b, Takehiko Sugita a a Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, 980-8574 Sendai-City, Japan b Department of Orthopaedic Surgery, Iwate Prefectural Central Hospital, 1-4-1 Ueda, Morioka-City 020-0066, Japan

KNEE INJURY-BASKETBALL

HISTORY: A 13 year old freshman basketball player stopped suddenly in the game and turned on his right knee. Immediately, he felt a pinch in the anterior knee but was able to continue the game. Next morning, he woke up with swelling in his right knee. He presented to the Emergency Room with a diffusely tender right knee with a positive McMurray's test. He was told he had a normal xray and that he had torn a meniscus. He then was given an appointment to the sports medicine clinic two weeks later. PHYSICAL EXAMINATION: In the sports clinic, an examination revealed a moderate effusion, range of motion of 2 to 130 degrees, tenderness at the inferior pole of the patella with resisted extension, no extensor lag, and no joint line tenderness. DIFFERENTIAL DIAGNOSIS: Avulsion fracture of the inferior pole of the patell Sindig-Larsen-Johanssen disease Bipartite patella Oagood Schlatter's disease TESTS AND RESULTS: Emergency Room Radiographs Knee anterior-posterior and lateral radiographs: small subchondral defect of the lower half of the articular aspect of the patella with loose bone fragment associated suggestive of osteochondritis dissecans per radiology reprot. Sports Medicine Clinic Radiographs Knee anterior-posterior, lateral, tunnel, sunrise radiographs: patellar avulsion fracture displaced posteriorly 2mm. FINAL/WORKING DIAGNOSIS: Sleeve fracture of the inferior patella TREATMENT AND OUTCOMES: Patient was placed in a knee immobilizer and referred to orthopedics. Repeat exam one week later by consultant showed a persistent effusion, tenderness at the superior patellar tendon, and an extensor lag of 15 degrees. MRI is order. MRI shows an osteochondral fracture of the posterior surface of the inferior pole of the patella with fracture fragment displaced posteriorly into the retropatellar joint space. Conservative treatment is continued. 2nd opinion from another orthopedic consultant was obtained. His exam showed mild effusion, patellofemoral clunk, and no extensor lag. Options of arthroscopy vs. observation were discussed with the patient and mother. After the discussion, the family decided on observation. Patient is to follow up in 6 weeks with repeat knee xrays and exam.

Single screw fixation of a patellar sleeve rupture: a case report

The patellar sleeve fracture is an unusual injury that is seen only in children. It is an avulsion fracture of the inferior pole of the patella with a variable amount of articular cartilage attached. Open reduction of the displaced fragment may be associated with osteonecrosis of the patella and fragmentation of the articular cartilage. Despite this, it is clear that this injury requires surgical repair. Acute surgical exploration in a juvenile case of extensor mechanism rupture revealed an inferior patellar pole rupture with associated rupture of the patellar retinaculum. Standard fixation techniques involve Kirschner wires and tension banding, ensuring reduction of the associated chondral fragment. K-wire fixation may fail due to wires dislodging, and may predispose to pin site infection. This case was fixed using a single partially threaded cancellous screw and washer, supplemented with suturing of the retinaculum. The chondral fragment was excised. This technique of repairing patellar sleeve rupture has not been previously reported.

Partial Sleeve Fractures of the Tibia in Children: An Unusual Fracture Pattern

Sleeve avulsion fractures of the patella are a well-recognized fracture pattern in children. Less appreciated is a similar fracture pattern involving the anterior metaphyseal area of the tibia. These metaphyseal sleeve fractures represent a fracture pattern characterized by the avulsion of a large area of periosteal attachment of the patellar tendon associated with small subchondral fragments of bone, encountered in skeletally immature children secondary to contraction of the quadriceps associated with forced knee flexion. Although an avulsion fracture of the tibial tubercle is the usual result of this type of trauma, partial sleeve avulsion fractures of the tibial apophysis and adjacent metaphysis occasionally occur and have not been adequately described. It was the authors' purpose to describe their experience with this fracture pattern. Since 1998, three boys have presented to a major pediatric trauma center with a partial sleeve fracture of the tibia. The average age was 13 years 6 months (range 10 years 3 months to 15 years 3 months). Follow-up ranged from 1 year 5 months to 2 years 3 months, with an average of 1 year 9 months. All three boys were treated with open reduction and internal fixation with small cancellous screws and postoperative plaster immobilization. At the time of most recent follow-up, each child showed full range of knee motion and had returned to all sports activities.

Partial sleeve fractures of the tibia in children

Partial sleeve fractures of the tibia in children

Pelvic Fibrosis — A Rare Variant of Idiopathic Retroperitoneal Fibrosis: Case Reports

Plain radiographs may not show a sleeve fracture if the distal bony fragment is small. When there is a bone fragment visible, the cartilaginous fragment greatly exceeds it in size. Ultrasound is a rapid, accessible, safe and cost-effective means of imaging soft tissues, cartilage and bony interfaces and of measuring the separation of fragments. The axial resolution of the 10-5 MHz transducer (quoted at ˇ20 dB level relative to peak amplitude) is 0.9 mm at a depth of 20 mm. Magnetic resonance imaging has been used to confirm the diagnosis and define the cartilaginous injury, including that to the articular surface. Sagittal fast spin echo T2 weighted sequences may show patellar marrow oedema with a hyperintense fracture line within adjacent hypointense cartilage [5]. CONCLUSION Sleeve fractures of the patella are rare but are underestimated by plain radiology. The diagnosis of a primarily cartilage based injury with assessment of fracture separation and displacement can be made with ultrasound. These findings are helpful in determining management of this fracture.

Ultrasound Diagnosis of Sleeve Fracture of the Patella: Case Reports

Ultrasound Diagnosis of Sleeve Fracture of the Patella: Case Reports

The co-extrusion of metal-sheathed high-temperature superconductors

The co-extrusion of copper cans containing Ag-clad high-temperature superconductor (HTS) cores using a direct extrusion technique was investigated. Composite rods were produced by simultaneous cladding and consolidation of the superconducting material, however, a range of deformation behaviour occurred, including core and sleeve fracture, non-uniform wavy core and sound flow. The flow patterns varied consistently as the initial core diameter ( D ci) and reduction ratio ( R) were varied, allowing domains of specific deformation behaviour to be defined. The large variation in flow behaviour was also attributed to stiffness mismatch between the HTS core and the cladding metal.

Fractures of the patella in children.

Fractures of the patella are relatively rare injuries for children. Fourteen patients with patellar fractures were reviewed. There were 12 boys and two girls with the age ranging between 9 and 15 years and an average of 11.4 years. Sleeve fractures were the most common type of patellar fractures observed (eight cases), followed by transverse fractures (four cases) and comminuted fractures (two cases). All the fractures were treated with open reduction and followed up for 2 to 20 years. Overall results were good in 13 patients, and flexion limitation of the knee was seen in one. Fractures of the patella in children are characterised by sleeve fractures. The prognosis of the patients treated with open reduction is generally good.

膝蓋骨上極ｓｌｅｅｖｅ ｆｒａｃｔｕｒｅの一例

We report a case of the sleeve fracture of the upper pole of the patella. A sixteen-year-old boy presented with a history of falling down the stairs, landing on his knee, after which he could not walk with sudden pain in the right knee. Local examination showed a severe effusion and localised tenderness on the upper pole of the patella. He was unable to extend the knee actively. Aspiration produced 130ml of blood-stained fluid containing fat globules. Radiographs demonstrated avulsion of the upper pole of the patella. T1-weighted magnetic resonance images in the sagittal plane showed an avulsion fracture of the upper pole of the patella with an attached sleeve of cartilage. Thease findings were confirmed in the operation room. The avulsed patella fragment of the upper pole had included an sleeve of cartilage. The patella and its cartilage sleeve and the extensor retinaculum were repaired. After three days he started passive knee flexion. Now he has regained recovered his full range of movements and he is able to extend his knee completely. Such fracture may be misdiagnosed because of the painful swelling, the absence of a palpable gap in the extensor mechanism, and a fragment of avulsed bone that is too small to be detected radiographically. Early diagnosis, operative reduction, and fixation are thus important.

How I Manage Physeal Fractures About the Knee

Knee injuries in children and adolescents often involve the growth plate (physis), as well as the adjacent bony areas of the femur, tibia, or patella. Young patients who have injured knees require careful clinical and radiographic assessment to determine the extent of their injuries, with specific management to minimize the potential for growth arrest and resultant deformity. This article discusses distal femoral physeal, proximal tibial physeal, tibial eminence, patellar sleeve, and tibial tubercle fractures in skeletally immature patients.

The Two-to Six-Year Results With a Proximally Modular Noncemented Total Hip Replacement Used in Hip Revisions

A review of the two- to six-year results of revision cases using a proximally modular noncemented total hip replacement has been carried out. There were 91 cases. A primary stem was used in 29 and a long curved revision calcar replacement stem in 62. The results of the primary cases were 80% excellent, 6% good, 9% fair, and 5% poor. In the revision stem cases, 69.4% were excellent, 11.5% good, 7.6% fair, and 11.5% poor. One primary stem case was revised for acetabular migration. Ten of the revision stem cases were rerevised, four for femoral perforation, three for sepsis reactivation, one for acetabular migration, one acetabular component for dislocation, and one stem for trochanteric nonunion. There have been no stems or sleeve fractures, no implant dissociations and no osteolysis. In those reexplored, no metallosis has been found. Only three cases required structural allografting on the femoral side. These early results are promising and no untoward reactions have occurred as the result of the use of a modular stem.

Incidence, mechanism of injury, and treatment of fractures of the patella in children.

Fractures of the patella in skeletally immature patients are rare. The charts of 185 patients treated for patella fractures at the University of Kentucky Medical Center between 1976 and 1988 were retrospectively reviewed. The 12 patients of these 185 aged 8 to 16 years were included in this study. The incidence was calculated to be 6.5% of all patella fractures. All patients studied were male with an average age of 12.7 years. Sleeve fractures were the most common type of patella fracture observed (five), followed by transverse fractures (four). Ten of the 12 cases required operative management ranging from irrigation and debridement to open reduction and internal fixation. Partial patellectomy was performed when indicated. Indications for operative management in this age group were similar to those for adults. As in adults, the mechanism of injury was predominantly motor vehicle and motorcycle crashes. Laws requiring seatbelt restraints for children should have a positive effect on the incidence of such fractures resulting from dashboard injuries. One mechanism of injury not reported previously was that of a flexed knee striking the gym wall after performing a basketball lay-up because the basket was placed flush with the wall.

Sleeve fracture of the patella in children

Sleeve fracture of the patella in children

Sleeve Fracture of the Patella in Children

Sleeve Fracture of the Patella in Children

Anterior Sleeve Fracture of the Capitellum

The case of an articular sleeve fracture of the capitellum in an 8-year-old girl is presented. An accurate diagnosis of this injury and its extent was able to be made preoperatively only by arthrography. The use of arthography in injuries about the elbow in children is recommended.

Accessory Ossification Patterns and Injuries of the Malleoli

An accessory, distal focus of epiphyseal ossification may develop in either malleolus. These foci are not anatomically separate entities, even though they appear to be radiographically. They usually are asymptomatic. However, they may be injured, either acutely or chronically. The diagnosis of such injury by conventional radiography is limited. Bone scintigraphy may be positive if there is a stress fracture. The fracture pattern, a type 7 growth mechanism injury, extends through a segment of the malleolus. An ossicle may also be avulsed as a ligament failure analogue, similar to a sleeve fracture of the patella. This is more common in the lateral than in the medial malleolus. These avulsions, if not adequately diagnosed and treated, may progress to delayed union, nonunion, or a chronically painful ankle.

Bilateral simultaneous sleeve fractures of the patella in secondary hyperparathyroidism

Bilateral simultaneous sleeve fractures of the patella in secondary hyperparathyroidism