An avulsion fracture occurs when a small chunk of bone attached to a tendon or ligament gets pulled away from the main part of the bone. Avulsion may … Primarily a ligamentous injury that can result in fracture. This fracture should be specifically looked for in a patient with the typical history, since it may be the only … Radiography Radiographs obtained after an ankle sprain will commonly show soft-tissue swelling at the lateral aspect of the ankle. The lateral view will allow visualization of a bony avulsion at the dorsal base of the distal phalanx (Figure 108-2). Pathology. At presentation, most mallet fingers manifest as tendon injuries without radiographically depicted fractures . A volar avulsion fracture develops as a result of forced hyperextension of the finger. (b, c) Sagittal CT images (bone [b] and soft-tissue [c] windows) show the fracture fragment (white arrowhead in b and c) attaching to the ECRL tendon (black arrowheads in c), with resultant proximal fracture fragment displacement. Philadelphia, 2005, WB Saunders.) A fracture with an offset of 2 mm or more in any plane or 2 mm offset involving the articular surface is considered displaced. Dorsal dislocations are often associated with volar plate tears and may be associated with avulsion fractures (44% in one series) . Through the distal interphalangeal joint. Figure 108-2 Radiograph showing avulsion fracture. Talar fractures represent less than 1% of all fractures in the human body and between 3% and 6% of fractures in the foot. Fractures of the tu-berosity are either from an avulsion or shear-compression mechanism of injury, with the latter constituting most fractures. Common classifications will be reviewed with their radiology, and how they can influence intervention and surgical decisions. Radiographic features Phalangeal fractures are common injuries1, 2 that are frequently missed or underestimated, 3 potentially leading to significant impairment of function. The fracture is created by pull of the extensor tendon that inserts on the dorsal surface of the base of the terminal phalanx. Volar Plate Fracture. Andrew Murphy and Dr Joachim Feger et al. Eaton type II (dorsal dislocation) Complete dorsal dislocation of the PIP joint and avulsion of the volar plate. On this page: The base of the middle phalanx rests dorsally on the condyles of the proximal phalanx, with no contact between the articular surfaces. If the distal radial fragments are predominantly dorsal, they may be held with dorsally applied plates, but if there is a significant radial styloid fragment, this is help more effectively with a radial plate (see Dorsoradial double plating). You may need to spend a few weeks on crutches if you have an avulsion fracture around your hip. Figure 7. Isolated fractures of carpal bones other than the scaphoid are relatively uncommon. 1. (Adapted from Raby N, Berman L, de Lacey G: Accident and emergency radiology. 2 —Classification for calcaneal avulsion fractures. The findings helped confirm avulsion fracture from … 1 Less commonly, hyperextension may cause a mallet injury secondary to a dorsal lip fracture as the hyperextended distal phalanx impacts on the head of the middle phalanx. (a) Lateral radiograph shows a dorsal avulsion fracture fragment (arrowhead) with an uncertain donor site. Volar plate fractures are often associated with dorsal subluxation or dislocation at the PIP joint. Leon S. Benson MD, Robert J. Medoff MD, in Fractures and Injuries of the Distal Radius and Carpus, 2009 Dorsal Shear Fracture. Volar plate avulsion fractures: •Treated differently to other fractures –have their own protocol •Often associated with a dislocation injury therefore need to assess for other structural damage ie collateral ligaments and adjust treatment accordingly •Protected mobilisation indicated immediately post fracture Avulsion of the extensor tendon. When the volar avulsion fracture involves a significant portion of the articular surface, instability and dorsal dislocation of middle phalanx can occur. The main dorsal carpal ligaments insert on the dorsum of the triquetrum. Cartilaginous in its insertion onto the middle phalanx. Jersey Finger. Avulsion fractures also occur from the dorsal surface of the base of the terminal phalanx ( Figure 5-7 B ) often associated with a flexion deformity of the DIP. Type 4 : Avulsion fracture. The angle normally has volar tilt of 11° to 12°. It is an unstable fracture and requires operative fixation and immobilization. Lateral Condyle fractures. Axial shortening, radial inclination and radio-ulnar displacement can be measured on the routine posterior/anterior film. They tend to be unstable and become displaced because of the pull of the forearm extensors. Involves PIP joint of fingers. Distal phalanx fractures are among the most common fractures in the hand.. Hyperextension injury involving the PIP of the finger can avulse the volar plate which is commonly associated with a volar avulsion fracture at the base of the middle phalanx. Fragment arising from the volar base of the distal phalanx with hyperextension. Volar plate forms floor of PIP joint and separates the joint space from the flexor tendons. They occur between the ages of 4 and 10 years. The injury is characterized by multifragmentary dorsal rim fractures and dorsal dislocation of the carpus. A dorsal tilt of 0° (11° - 12° deviation from normal anatomic position) causes a substantial risk of developing pain and impaired function. It usually involves injury to the volar plate and may include a volar plate avulsion fracture. Dorsal or palmar fracture of the base of the distal phalanx. Many of these fractures are sport or work related, but they may also occur in common activities of daily living such as housework, cleaning, and dressing. The loose fragment is generally visible on the lateral image only and frequently involves the PIP joint (fig. Dorsal PIP joint dislocation can injure the volar plate or cause an avulsion fracture of the middle phalanx (Figure 1). The volar Barton fracture is thought to occur with the same mechanism as the Smith fracture, with more force and loading on the wrist. Cortical flake-type avulsion fractures are commonly seen in younger patients and probably account for the majority of rounded or ovoid ossicles seen in the anterolateral gutter in adults. Distal radial fracture. Mallet Finger. Avulsion fracture. This fracture is the second most common distal humerus fracture in children. Dorsal Barton: Dorsal rim fracture of distal radius Mechanism: Fall with dorsiflexion and pronation of the distal forearm on a flexed wrist. Distal phalanx… 7 – 10 One objective of fragment-specific fixation is to restore a stable, anatomical joint surface by direct and independent fixation of each major fracture fragment. 4 In this article, four intra-articular injury types and fractures will be discussed. Dorsal, palmar, or lateral fracture of the base of the middle phalanx. In Eaton's classification of proximal interphalangeal joint injuries, the volar plate avulsion fracture is a type 1 injury and occurs when the middle phalanx is hyperextended up to 70–80 degrees at the time of injury. Distal radial fractures are a heterogeneous group of fractures that occur at the distal radius and are the dominant fracture type at the wrist. Volar plate is ligamentous at its origin on the proximal phalanx. If a fracture fragment is large, involving greater than 40% of the volar articular surface, it can result in an unstable fracture-dislocation. Fig. Fragment-specific fixation is a treatment approach in which each independent major fracture fragment is stabilized with an implant specifically designed for that particular fracture element (). Finger fractures may be caused by blunt trauma, hyperextension, hyperflexion, or twisting forces. Oth-er less common theories include direct trau-ma to the dorsum of the hand or sudden resis-tance against twisting motion of the wrist [9]. Avulsion fractures have reportedly been seen at the ulnar aspect of the base of the proximal phalanx in up to 40% of acute UCL ruptures, though in Radsource’s experience the frequency of fractures is much lower. Eaton type III (fracture dislocation) A fracture dislocation with an avulsed small fragment. The dorsal Barton fracture is caused by a fall onto an extended and pronated wrist, increasing carpal compression force on the dorsal rim. Avulsion of the Flexor Digitorum Profundus. Introduction. Isolated triquetral fractures usually involve the dorsal surface and are seen best on lateral or slightly oblique radiographs (Fig. Anatomical and radiological studies indicate that these fractures arise from a ridge on the dorsum of the scaphoid at the distal end of the radial facet. In some cases, an avulsion fracture fragment (“mallet fracture”) is seen at the dorsal base of the distal phalanx . Note: the above fracture types are less applicable in non-tubular bones (e.g. Isolated lunate fractures usually involve the dorsal or volar surface and are ligamentous avulsions. Dislocation. The hip, elbow and ankle are the most common locations for avulsion fractures in the young athlete. A volar or dorsal dislocation of the joint can also cause volar plate fractures. Type 1 is simple avulsion with variable sized bone fragment, type 2 is beak fracture with horizontal fracture extending into posterior body, type 3 is avulsion by superficial fibers of middle third of Achilles tendon, and type 4 is small beak fracture avulsed from deep fibers of tendon. Spiral fracture of distal fibula (a) Avulsion fracture of the quadriceps tendon with retraction of the muscle (b). 24). SH I fracture is a fracture that involves the epiphyseal plate only while SH II involves the epiphyseal plate and the ... Avulsion Fracture Lateral radiograph of the elbow (a), magnified in (b), shows a small fragment ... shows a distal radius fracture (yellow arrow) with dorsal (posterior) angulation of the distal segment (red line in This can produce an extensor tendon avulsion from its insertion or with a fragment of bone. The PIP joint can dislocate in dorsal, volar, or lateral directions. The fracture is due to axial compression of the scaphoid into the distal radius with radial styloid fracture and radial collateral ligament avulsion. A volar plate avulsion is a fracture of the volar aspect of the articular base of the middle phalanx, and is commonly caused by a hyperextension injury with axial pressure applied to the fingertip. These liga- Through the metacarpo-phalangeal joint. Three cases of acute dorsal avulsion fracture of the scaphoid are presented. Hutchinson fractures are often associated with scapholunate injury and perilunate dislocation. Dr Sean Carter and Dr Jeremy Jones et al. Fractures involving the dorsal rim of the distal radius represent a spectrum of injuries, with variation in the size of the dorsal fragments. They are frequently related to sports, with lesions such as the mallet finger and the Jersey finger.When associated with a crush injury, open fracture is more likely. Volar Plate Fractures Volar Plate Fractures Nance, E. Paul; Kaye, Jeremy J.; Milek, Michael A. Plain radiograph If there is a bony avulsion, a plain film will classically show a triangular avulsion fragment at the insertion of the common extensor tendon on the dorsal … Abstract. 1979-10-01 00:00:00 Rupture of the volar plate of the proximal interphalangeal joint, usually secondary to hyperextension Injury, may be accompanied by a radiographically evident avulsion fracture at the base of the middle phalanx. 2.Volar Barton: Palmar rim fracture of distal radius Mechanism: It is due to palmar tensile stress and dorsal shear stress and is usually combined with radial styloid fracture. Talar fractures are usually the result of high-energy trauma. A dorsal PIP dislocation is the most common type of finger dislocation. Distal femoral fractures - ICD-11 NC72.6Z involve the femoral condyles and the metaphyseal region and are often the result of high energy trauma such as motor vehicle accidents or a fall from a height. The dorsal shear fracture, or posterior marginal fracture, is equivalent to a “dorsal Barton” fracture and requires stabilization from the dorsal side (Fig. Rupture of the volar plate of the proximal interphalangeal joint, usually secondary to hyper-extension injury, may be accompanied by a radiographically evident avulsion fracture at the base of the middle phalanx. ed: first, ligament avulsion fracture [4, 5]; and second, ulnocarpal impaction [7, 8]. Volar plate injuries are spectrum of soft-tissue and bone injuries usually due to joint hyperextension. The most common complication of a volar plate injury or dorsal dislocation is the development of pseudo-boutonniere deformity, which is a persistent PIP … This is not the site suggested by other authors. These fractures occur when a varus force is applied to the extended elbow. Isolated tendon injuries are best depicted on sagittal MR images. fractures of the calcaneus and carpal bones).In this case the terms ‘horizontal, vertical, coronal, sagittal or axial’ fracture lines are more appropriate. Avulsion fractures of the calcaneal tuber-osity are uncommon, accounting for 1.3–2.7% of calcaneal fractures [9]. Often soft tissue injury only. They represent > 50% of all phalangeal fractures and frequently involve the ungual tuft 1.. Findings were reviewed in 55 patients with 58 cases of volar plate fracture. Hyperextension injury. Mechanism: avulsion fracture usually associated with ligamentous injury Stability: unstable Displacement pattern: dorsal, volar, radial or proximal Number of fragments: 2-part: radial styloid, ulnar styloid; 3-part: volar, dorsal margin; comminuted; Associated lesions: frequent ligamentous injury These common fractures usually occur when significant force is applied to the distal radial metaphysis. Significantly displaced avulsed fracture fragments are generally associated with a displaced ligament tear or Stener lesion. These injuries are described in Eaton classification of volar plate injury: type I (hyperextension with rupture of volar plate and longitudinal split of collateral ligaments), type II (dorsal dislocation), and type III (fracture-dislocation). The salient feature is a subluxation of the wrist in this die-punch injury. 2.10). Finger fractures are the most common types of fractures seen in primary care settings. Distal femoral fracture. Dorsal, palmar, or lateral fracture of the base of the proximal phalanx. Large fragments may be suitable for plating or even lag screw fixation, while smaller fragments may require fixation with K-wires or suture anchors. In the elderly, they may occur as a domestic accident 1-3. Displacement can be dorsal, volar, radial or proximal. Fragment arising from the dorsal base of the distal phalanx with fixed flexion. The most common fracture pattern usually demonstrates malalignment of this angle and collapse in a dorsal direction.

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