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Avulsion Case Studies

Decent Essays

Because of their unusual occurrence, there are currently no randomized controlled trials determining optimal management for the adolescent athlete who has not reached full skeletal maturity sustains an IT avulsion fracture. Therefore, one must rely on lower levels of research evidence, consisting of primarily case reports and retrospective case series for management guidelines. Currently, the only suggested treatment option is a prolonged period of conservative care or surgery with or without cessation of sport. In reviewing the literature, little to no discussion of specific physical therapy rehabilitation management exits, so the current authors share a therapy progression which was developed based on tissue healing rates, symptom presentation, …show more content…

Most adolescents, when diagnosed early, appear to heal well with a prolonged period of rest, but in those patients who presented with delayed diagnosis and/or failure of conservative care surgery is often recommended. The amount of displacement of the avulsion fracture is often used to help determine the need for early surgical intervention. While there is no exact consensus, some authors state that in those with fragment displacement of more than 10‐20 millimeters ,or in those patients with persistent symptoms after more than two months of relative rest, surgery may be warranted. Although surgical technique described in the literature is variable, open reduction‐internal fixation (ORIF) appears to be the treatment of choice for fragments displaced more than 1‐3 centimeters. Gidwani1 reported …show more content…

In comparison, those who were diagnosed early (less one month post injury) and who followed a period of prolonged rest fared better. For patients with persistent symptoms in this series, surgery consisted an ORIF for a fracture displaced more than three centimeters as well as posterior femoral fasciotomy. Eight other patients had surgery for persistent symptoms, five consisting of debridement of scar tissue around the sciatic nerve and biceps tendon, and two excisions of bone fragments. Neurolysis of sciatic nerve following chronic symptoms was also described by other authors' as an adjunct procedure. Neurolysis of the sciatic nerve at the area of the proximal hamstrings for symptoms consistent with hamstring syndrome has been more frequently described in the literature , but not in the adolescent population.
Percutaneous needle tenotomy, or fenestration, has been described both with and without image guidance as an effective treatment for chronic

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