Search Results (67)

Objectives: To systematically review the evidence on horse-related maxillofacial trauma, with emphasis on horse-kick injuries, anatomical patterns, associated injuries, management, outcomes, and prevention. Methods: This systematic review followed the PRISMA 2020 statement. PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library were searched for original clinical studies reporting facial, craniofacial, orbital, dental, or maxillofacial injuries related to horse-associated activities. Data were extracted on study characteristics, demographics, mechanism, mounted/unmounted status, anatomical site, associated injuries, treatment, complications, outcomes, mortality, and protective equipment. Due to substantial heterogeneity in study design, denominators, and outcome reporting, a structured narrative synthesis was performed without formal meta-analysis. Results: Twenty-eight original clinical studies were included. Maxillofacial-specific series consistently identified horse kicks as a major mechanism, especially among unmounted individuals. Injuries most frequently involved the midface, orbit, zygomaticomaxillary complex, mandible, nasal region, and dentoalveolar structures. Severe presentations included optic nerve avulsion, orbitocranial penetrating trauma, naso-orbito-ethmoid and frontal sinus fractures, airway compromise, intracranial injury, and multisystem trauma. Management ranged from conservative treatment to operative fixation, orbital reconstruction, soft tissue repair, advanced airway management, and multidisciplinary care. Helmet use was often absent or poorly documented, particularly during unmounted activities. Conclusions: Horse kicks represent a distinct localized high-energy mechanism of maxillofacial trauma. Prevention should extend beyond riding and include facial protection, protective eyewear, and safety protocols for ground-based horse handling. Full article

Tibial spine avulsion injuries represent a distinct pattern of anterior cruciate ligament (ACL) injury in children and adolescents, reflecting the unique anatomical and biomechanical properties of the skeletally immature knee. Unlike midsubstance ACL ruptures, these injuries involve avulsion of the tibial insertion and pose specific diagnostic and therapeutic challenges. Management strategies remain heterogeneous, particularly for partially displaced fractures, with variation in surgical indications, fixation techniques, and rehabilitation protocols. This narrative review provides a structured synthesis of current evidence on the anatomy, biomechanics, clinical presentation, and management of pediatric tibial spine avulsion injuries. Nonoperative and operative approaches are compared, with attention to fixation strategies, complications, physeal considerations, and rehabilitation principles. Return-to-sport (RTS) outcomes are examined, with available evidence suggesting that RTS rates may be comparable between operative and nonoperative management in selected patients, although interpretation is limited by heterogeneous and predominantly retrospective data. Early mobilization appears important for reducing arthrofibrosis risk, while rehabilitation should be individualized. RTS decision-making remains inconsistent, with commonly used criteria largely extrapolated from ACL reconstruction literature and lacking validation in pediatric populations. Multifactorial assessment incorporating functional testing and patient-reported outcomes is increasingly advocated, although evidence for psychological readiness remains limited. Overall, the current literature is characterized by methodological heterogeneity and limited comparative data, restricting definitive conclusions. This review provides a clinically oriented synthesis while highlighting key uncertainties and priorities for future research. Full article

This study aimed to describe the anatomical composition of the Achilles tendon in dromedary camels and to characterize the clinical, radiographic, and ultrasonographic features of tendon laceration and rupture. Six pelvic limbs from an adult healthy Mejhem camel were dissected following fixation in 10% formaldehyde. Additionally, 19 camels with confirmed Achilles tendon injuries were evaluated clinically and by imaging. Anatomically, the tendon is a composite structure formed by the semitendinosus, gastrocnemius (medial and lateral heads), and superficial digital flexor muscles, arranged in superficial and deep layers and inserting at the tuber calcanei. Clinically, affected camels showed acute hindlimb lameness, reduced weight-bearing, and swelling near the calcaneus. Wadeh camels were more frequently affected than other breeds (p < 0.05–0.001). Age > 2 years (OR = 14.06; p < 0.001) and male sex (OR = 28.4; p < 0.001) were significant risk factors, with blunt trauma as the main cause (p < 0.001). Ruptures were more common than lacerations (OR = 28.4; p < 0.001). Radiography revealed soft tissue swelling and occasional calcaneal avulsion fractures, while ultrasonography showed tendon enlargement, fiber disruption, and hypoechoic gaps. These findings highlight the diagnostic value of combined imaging for accurate evaluation and management. Full article

Background and Clinical Significance: Mallet finger is a common injury of the extensor mechanism at the distal interphalangeal (DIP) joint; however, open double mallet lesions are rare and may present a complex reconstruction challenge. Case Presentation: A 15-year-old male high school student who sustained an open injury to the left ring and little fingers after a high-energy buggy accident. The ring finger showed an open double mallet lesion in which the extensor tendon remained attached to a tiny avulsion fragment, and a separate dorsal base fragment was also present. The adjacent little finger had a concomitant open fracture with substantial soft tissue injury. Emergency surgery was performed on the day of the injury. For the ring finger, reduction of the tendon-attached avulsion fragment and separate dorsal base fragment was achieved using extension-block pinning, transarticular DIP pinning, and pull-out fixation over a volar button. For the little finger, cross-pinning was performed because the distal fragment was too small for stable non-transarticular fixation. Serial radiographs showed maintained alignment and progressive healing. At the final follow-up, 21 months after the injury, residual deformity and limitation of DIP motion remained; however, no infection, major skin complications, or nail deformity were observed. The little finger DIP joint became ankylosed, whereas some residual mobility remained in the ring finger DIP joint. Despite persistent functional limitations, the patient was able to continue school attendance and percussion-related activities. Conclusions: This case highlights that in an open double mallet lesion, disruption of both the tendon-attached fragment and its bony bed should be considered, and stabilization of the base may be useful in selected injury patterns before definitive tendon-side repair. Full article

Fractures of the posterior malleolus are key determinants of ankle stability and long-term functional outcome in complex ankle injuries. The posterolateral rim fragment represents a bony avulsion of the posterior syndesmotic complex. Anatomical reduction of this fragment restores the fibular incisura, posterior tibiotalar stability, and syndesmotic integrity. Based on a geriatric case of a trimalleolar ankle fracture with a Bartoníček type 2 posterior malleolar component, this review describes a modified minimally invasive inside-out fixation technique performed under intraoperative three-dimensional imaging. The posterior malleolar fragment was stabilized using a posterior-to-anterior headless double-threaded compression screw. The medial malleolus was fixed with two parallel partially threaded cannulated cancellous screws, and the distal fibular fracture was stabilized using a reamed intramedullary locking nail. The surgical technique, potential complications, and postoperative management are described in detail. This approach combines the biomechanical advantages of direct posterior malleolar fixation with minimal soft-tissue disruption, providing a stable and reliable construct for the treatment of complex ankle fractures, particularly in geriatric patients and in those with compromised soft-tissue conditions. Full article

Background/Objectives: Avulsion fractures of the fifth metatarsal often require surgical fixation when displacement or instability is present. This study aimed to compare the biomechanical performance of hook-plate and bicortical screw fixation using anatomically accurate 3D-printed metatarsal models analyzed through digital image correlation (DIC). Methods: Multi-material 3D-printed specimens were subjected to simulated gait-phase loading (α = 0°, 90°, 180°), combined with three interfragmentary distances (d = 0.1, 0.5, 1 mm) following a replicated 3 × 3 factorial design (n = 27 per fixation method). Full-field strain and displacement maps were quantified using ARAMIS DIC. Results: Hook-plate fixation consistently produced lower maximum stresses compared with bicortical screws (reductions of 9–36 MPa across conditions). The highest stresses were observed for screw fixation at α = 90° and d = 0.1 mm (100.3 ± 1.5 MPa), while the lowest occurred for hook plates at α = 180° and d = 1 mm (33.3 ± 1.5 MPa). ANOVA confirmed significant α×d interactions (p < 0.01). Conclusions: Hook-plate fixation provided superior angular stability and suggested improved cyclic performance compared to bicortical screws, favoring early mobilization. The combined use of 3D printing and DIC represents a valuable framework for preclinical implant evaluation. These results provide useful insights for selecting the optimal fixation technique in clinical management of fifth metatarsal avulsion fractures. Full article

Objectives: The aim of this study was to determine the epidemiological characteristics of bicycling-related maxillofacial fractures in a defined population and to identify factors contributing to these injuries. Methods: An 8-year cohort study was carried out, including all patients presenting with bicycling-related maxillofacial fractures at a tertiary care center from 2017 through 2024. Data recorded for each patient included age, gender, date and cause of injury, contributing factors, type of facial fractures, other injuries, hospital stay, and helmet use. Statistical analysis was performed. Continuous variables were assessed for normality (Shapiro–Wilk test) and compared using the Mann–Whitney test. Categorical variables were analyzed with chi-square tests. A p-value ≤ 0.05 was considered statistically significant. Results: Out of 899 cycling accident patients seeking medical treatment, 122 (13%) sustained facial fractures, accounting for 4% of all facial fracture cases in our department during the study period. In our cohort, the male–female ratio was 2.6:1, and the mean age was 29.5 years (SD 12.8, range 13–77). Collision with another object/vehicle was the most common cause (64%), followed by isolated falls (36%). A total of 135 facial fractures were recorded (some patients had multiple fractures). Mandibular fractures were most frequent (49% of patients), followed by zygomatic (32%), orbital (13%), nasal (7%), maxillary (2%) and frontal (2%) fractures. Among mandibular injuries, condylar fractures were the most common subtype (63%). Dental injuries were found in 27% of patients. The most common dental trauma was tooth fracture (43% of those with dental injuries), followed by tooth luxation (32%) and tooth avulsion (25%). In 80% of cases involving dental injuries, the upper anterior teeth were involved. Concomitant injuries were present in 20% of patients, most often orthopedic limb injuries. Only 27% of patients reported always wearing a helmet, whereas 43% reported never having worn one. Conclusions: Bicycling-related facial injuries are a noteworthy subset of facial trauma. Missed or delayed diagnosis can lead to lasting deformities and functional issues. Preventive strategies—especially promoting helmet use and improving helmet design—along with broader safety measures are important to reduce the incidence and severity of these injuries. Full article

Background and Objectives: Tibial tuberosity avulsion fractures are rare injuries in pediatric athletes, with limited data on the potential role of an elevated body mass index (BMI) as a risk factor. Previous studies have primarily focused on age, sex, and sport type, but the association between BMI and these injuries remains underexplored. Tibial tuberosity avulsion fractures are rare injuries predominantly affecting adolescent boys during sports activities involving strong quadriceps contractions. This pilot study aimed to analyze the epidemiological and anthropometric characteristics of patients with these fractures, including the distribution of injury mechanisms and the fracture types, to test whether the prevalence of overweight/obesity among cases exceeded national population benchmarks, and to describe the associated clinical outcomes. Materials and Methods: A retrospective analysis was conducted on medical records and radiographs of patients under the age of 18 treated between 2017 and 2024. The data collected included demographic and anthropometric characteristics, injury mechanisms, fracture classification, treatment methods, complications, and outcomes. The patients were categorized as normal weight (<85th percentile) or overweight/obese (≥85th percentile). The primary outcome was whether the prevalence of overweight/obesity among the cases exceeded national pediatric benchmarks. Formal sample size and power analyses were performed to guide future research. Results: Twenty-one patients met the inclusion criteria, with a mean age of 13.7 years; 95.2% were male. Soccer was the most common injury mechanism (52.4%), followed by athletics and running. The predominant fracture type was Ogden IVb (38.1%). Overweight/obesity was present in 52.4% of the patients, significantly higher than the national benchmarks. An open reduction and internal fixation was performed in 90.5% of the cases, with a mean follow-up of 14.6 months (range: 6–36). Complications occurred in 14.3% overall, all within the overweight/obese group (27.3%). Conclusions: This pilot retrospective study suggests a potential link between an elevated BMI and tibial tuberosity avulsion fractures, with overweight/obesity being significantly more prevalent in affected patients than in the general pediatric population. These exploratory findings warrant confirmation in larger, adequately powered studies, and emphasize the importance of weight management and tailored sports activities as potential preventive strategies. An early diagnosis, timely surgical intervention, and adequate rehabilitation are critical for achieving optimal functional recovery. Full article

Objectives: Tibial anterior cruciate ligament avulsion fractures (TAFs) are avulsions of the anterior cruciate ligament (ACL) from its insertion at the tibial intercondylar eminence that share the same trauma mechanism as ACL tears. TAFs were initially considered to be a pediatric equivalent to adult ACL ruptures due to the weaker insertion of the ACL on the immature tibial spine. Recent literature suggests that adult TAFs may be more common than previously thought. The incidence, possible concomitant injuries, and other differences between pediatric and adult TAFs remain a topic of ongoing debate in the literature. This systematic review provides a descriptive synthesis of the symptoms, biomechanics, and treatment outcomes of TAFs in pediatric and adult populations. This study highlights notable trends but avoids formal comparisons or meta-analysis due to heterogeneity in the literature. Methods: A systematic review was conducted on human-related studies involving tibial anterior cruciate ligament avulsion fractures, identified in PubMed^®® and EMBASE^®® databases between 2000 and 2024. Studies in English or German were included, while editorials, reviews, experimental studies, and papers with insufficient data were excluded. Data were extracted on patient demographics, trauma mechanisms, fracture classification, diagnostic modalities, treatment approaches, and clinical outcomes. Specific outcome parameters included: incidence and type of postoperative complications, return to sport rate, revision surgeries, hardware removal rates, and duration of follow-up. Due to heterogeneity in reporting, a descriptive synthesis approach was used rather than a meta-analysis. Results: The systematic search identified 3938 publications, with 2707 articles screened after duplicate removal. A total of 56 studies met the inclusion criteria. A total of 677 tibial avulsion fractures (TAF) were analyzed, with 208 (30.4%) pediatric and 469 (69.6%) adult patients. Type III fractures were most common in both groups (pediatric: 63.9%, adult: 63.4%). Concomitant injuries were more frequent in adults (35.6%) than children (8.2%). Arthroscopic surgery was the predominant technique (pediatric: 79.1%, adult: 87.8%). Fixation methods differed: pediatric cases more often used screws (40.5%) and sutures (38.2%), while adults favored sutures (49.7%) and suture anchors (23.1%). Complications were more frequent in pediatric patients (35.1% vs. 17.1%). Conclusions: TAFs show age-related differences in injury patterns and outcomes. Pediatric cases are mostly sports-related, while adult cases are commonly due to road traffic accidents. Concomitant injuries are more frequent in adults, whereas pediatric patients experience higher rates of arthrofibrosis and instability. Adults are more prone to malunion and non-union. These findings support the need for age-specific diagnostic and treatment strategies. Full article

Background/Objectives: The os supranaviculare (OSSN), also known as os talonaviculare dorsale, astragalo-scaphoid ossicle, or Pirie’s bone, is a small extra bone that was first described in 1921 by A.H. Pirie and is located at the top front part of the navicular bone or talonavicular joint. The knowledge regarding the epidemiology of the OSSN is scarcely established, as its prevalence remains unknown and varies significantly among multiple studies. This meta-analysis aims to clarify and systematically summarize all available data on the characteristics and prevalence of the OSSN. Methods: Four major databases (PubMed/Medline, Embase, ScienceDirect, Scopus) were thoroughly searched for studies reporting original data regarding the OSSN up until May 2025. The protocol of this study was pre-registered on PROSPERO (ID: CRD42025638111) and adhered to PRISMA guidelines. To evaluate the between-study heterogeneity, the 95% prediction intervals (95%PI) were calculated; I² statistic and Chi² test were also used. The AQUA-tool was used to assess the quality of included studies. Results: In total, 13 studies (18,745 feet) qualified for inclusion in the quantitative analysis. The pooled prevalence estimate (PPE) of the OSSN in the general population was found to be 0.88% (95%CI: 0.62–1.24%). The PPE of the OSSN was higher in males (0.87%, 95%CI: 0.58–1.32%) than in females (0.48%, 95%CI: 0.14–1.64%). The os supranaviculare was similarly prevalent in both European (1.04%, 95%CI: 0.55–1.96%) and Asian (0.87%, 95%CI: 0.66–1.13%) populations. Conclusions: the os supranaviculare is a very rare anatomical variation that is present in less than one in a hundred feet. Moreover, although usually asymptomatic, it can occasionally be associated with dorsal foot pain or navicular stress fractures. Accurate differentiation from avulsion fractures is essential to avoid unnecessary invasive treatment. Full article

Background/objectives: Falls are a leading cause of traumatic injury and hospitalization for adults over the age of 65. While common, bed-related falls are relatively understudied when compared to ambulatory falls. The aim of this study is to characterize the risk factors for the hospitalization of older adults presenting to U.S. emergency departments (EDs) after a fall from bed. Methods: This was a cross-sectional study using publicly available data from the U.S. Consumer Product Safety Commission’s National Electronic Injury Surveillance System (NEISS) from 2014 to 2023, including all adults over the age of 65 presenting to the NEISS’s participating EDs with bed-related fall injuries. We identified fall injuries using a keyword search of the NEISS narratives and determined how the fall occurred by manually reviewing a randomized 3% sample of the narratives. We summarized demographics and injury patterns with descriptive statistics. We constructed a multivariable logistic regression model to identify risk factors for hospitalization and used Poisson regression to assess temporal trends in fall incidence and hospital admissions. Results: An estimated average of 320,751 bed-related fall injuries presented to EDs annually from 2014 to 2023. ED visits increased by 2.85% per year, while hospital admissions rose by 5.67% per year (p < 0.001). The most common injury patterns were superficial injuries (contusions, abrasions, lacerations, avulsions, and punctures) (28.6%), fractures (21.7%), and internal injuries (including concussions) (21.6%). Most of the falls occurred while transitioning into or out of bed (34.4%) or falling out of bed (56.8%). Hospitalization was required in 34.1% of cases and was associated with male sex, medication use at time of injury, and fracture injuries. Conclusions: Bed-related falls and associated hospitalizations are increasing among older adults. ED providers should understand risk factors for hospitalization in these common injuries such as male sex, medication use at time of injury, and high-risk injury patterns. Additionally, prevention efforts should focus on helping older adults remain safely in bed and then assisting with transitions into or out of bed. Full article

Background: Musculoskeletal injuries are frequent in handball players due to the high-impact nature of the sport. Accurate diagnosis and tailored treatment are essential for recovery. Magnetic resonance imaging (MRI) has become the gold standard for evaluating complex sports-related injuries. This case report aims to assess the role of MRI in diagnosing trauma in professional handball players and the effectiveness of individualized treatment approaches. Methods: Four male members of the “Politehnica” Timișoara first team who sustained match- or training-related injuries between January 2023 and December 2024 underwent an 1.5 T MRI. Individualized conservative protocols included rest, NSAIDs, physiotherapy, and graded kinesitherapy. Results: The first case involved a right back with a knee hematoma and a vastus lateralis tear. Conservative treatment led to recovery. The second case was a left back with peripheral neuropathy caused by hamstring avulsion at the ischial tuberosity. Conservative therapy alleviated symptoms. The third case involved a left winger with adductor muscle tears, which recovered with conservative management. The fourth case, a goalkeeper, had a type III navicular fracture misdiagnosed on radiography, correctly identified via MRI and treated conservatively. Conclusions: MRI is invaluable in diagnosing handball-related injuries, enabling accurate assessments and effective individualized treatment, resulting in early recovery. Full article

Background: Traumatic injuries to the alveolar process and primary teeth in early childhood can have long-term consequences on the development of permanent dentition and eruption pathways. Objective: This case report aims to illustrate the impact of early orofacial trauma on the eruption and development of permanent maxillary incisors and to emphasize the importance of timely interdisciplinary management. Case Presentation: An 8-year-old female patient presented to a pediatric dentistry clinic with delayed eruption of the maxillary anterior permanent teeth. In contrast, her monozygotic twin sister exhibited complete eruption of all permanent anterior teeth, raising parental concern regarding a possible pathological delay. Her medical history revealed orofacial trauma at the age of two, resulting in an alveolar process fracture, avulsion of the primary maxillary left central incisor (tooth 61), and luxation of the primary maxillary right central incisor (tooth 51). A clinical examination demonstrated sufficient arch space without signs of eruption and enamel defects on tooth 52. Radiographic evaluations, including panoramic imaging and cone beam computed tomography (CBCT), confirmed the presence of impacted permanent teeth with structural anomalies suggestive of trauma-related developmental disturbances. Results: The patient underwent a multidisciplinary treatment over a three-year period involving pediatric dentistry, oral surgery, and orthodontics. Management included surgical exposure of the impacted teeth followed by orthodontic traction to guide the eruption and treatment of enamel hypoplasia. Conclusions: This case highlights the long-term consequences of early traumatic dental injuries on permanent dentition development. It underscores the necessity of early diagnosis and a coordinated interdisciplinary approach to optimize outcomes and enhance the long-term oral health and quality of life of affected individuals. Full article

Objectives: Tibial apophysis avulsion fracture is an unusual injury in young pediatric athletes. The mechanism of injury is often related to sports (i.e football and basketball). Fifteen patients who had this kind of fracture underwent surgical Open Reduction and Internal Fixation (ORIF) with two or three cannulated screws and tendon stripping. In this kind of injury and treatment, one of the most important concerns is the recovery of the extensor apparatus strength of the lower limb. Materials and Methods: We followed up the patients for 12 months, performing biomechanical tests and a kinetic analysis to evaluate the activation of the leg muscles such as rectus femoris, vastus medialis, vastus lateralis, and semitendinosus muscle fibers and compared them with the contralateral healthy limb. Results: The results showed that there was an almost complete recovery of muscle strength activation without any statistically significant differences compared to the healthy limb. Conclusions: This surgical treatment appears to be safe and effective in the treatment of tibial apophysis fractures in young athletes, since this type of surgical treatment does not compromise the recovery of the extensor apparatus strength and/or return to sport of the lower limb in case of tibial apophysis fractures in young athletes. Full article

Background/Objective: Tibial eminence avulsion fracture (TEAF) is a traumatic injury of the anterior cruciate ligament that occurs in children with an immature skeletal system. It has an incidence of 3 per 100,000 children, with an increasing prevalence over time. The objective of this study was to evaluate the long-term clinical and subjective outcomes of displaced TEAF requiring surgical intervention and to assess the return to sport. Methods: A retrospective cohort study was conducted, identifying all patients who underwent arthroscopic-assisted TEAF refixation at HFR-Fribourg between 2012 and 2020, performed by a single surgeon. A total of fifteen patients were included for descriptive analysis, while twelve patients underwent clinical assessment of knee joint stability and functional outcomes using patient-reported outcome measures (PROMs): Pedi-IKDC, Lysholm, Tegner, and Marx. Results: Of the fifteen patients, fourteen had type III and one had type II TEAF according to the McKeever classification. The mean age at the time of injury was 11.5 years, and the average time between surgery and long-term follow-up was 5.1 years (range: 0.9–8.9 years). For the primary outcomes of the operated knee, no significant differences were observed in muscle mass or range of motion between the operated and non-operated limbs (p > 0.05). Anterior knee stability, as assessed by the Lachman test and Rolimeter, showed no significant difference between the operated and non-operated knee (p > 0.05). Regarding secondary outcomes, the Pedi-IKDC and Lysholm scores were 98 out of 100, the Tegner score was 5.5 out of 10, and the Marx score was 14.5 out of 20 at the final follow-up. There were no significant differences in the number of hours per week or frequency of sport activity (mean three times per week) before and after surgery. Conclusions: The surgical treatment for displaced TEAF, specifically the pull-out suture technique with arthroscopic assistance, demonstrates excellent clinical and functional outcomes, with high recovery rates and restored knee stability. This technique allows patients to return to sports without significant impairment. Although no comparative analysis was performed, these findings provide a foundation for future studies to further validate and compare the effectiveness of this surgical approach. Full article