A Narrative Review on Avulsion Fractures of the Upper and Lower Limbs

Abstract

Avulsion fractures compromise function and movement at the affected joint. If left untreated, it can lead to deformity, nonunion, malunion, pain, and disability. The purpose of this review was to identify and describe the epidemiology and available treatment options for common avulsion fractures of the upper and lower extremities. Current evidence suggests that optimal treatment is dependent on the severity of the fracture. Conservative efforts generally include casting or splinting with a period of immobilization. Surgery is typically indicated for more severe cases or if nonoperative treatments fail; patient demographics or preferences and surgeon experience may also play a role in decision making. Some avulsion fractures can be surgically managed with any one of various techniques, each with their own pros and cons, and often there is no clear consensus on choosing one technique over another; however, there is some research suggesting that screw fixation, when possible, may offer the best stability and compression at the fracture site and earlier mobilization and return to function. Physicians should be mindful of the potential complications associated with each intervention.

ECRB avulsion fracture therapy management: Case report

“…In general, metacarpal fractures typically occur due to a direct injury to the hand [3] . Avulsion fractures at the second and third metacarpal typically occur as a result of the wrist being in a hyperextended position with force on the dorsal portion of the hand [4] . As a result of this positioning, the muscle can increase tension, resulting in the avulsion fracture [4] .…”

“…Avulsion fractures at the second and third metacarpal typically occur as a result of the wrist being in a hyperextended position with force on the dorsal portion of the hand [4] . As a result of this positioning, the muscle can increase tension, resulting in the avulsion fracture [4] . The mechanism of injury with avulsion fractures to this anatomy typically results in damage to the extensor carpi radial brevis (ECRB) or extensor carpi radialis longus (ECRL).…”

Management of Pediatric and Adolescent Sublime Tubercle Injuries: Isolated and Complex Patterns Demonstrate Distinct Etiologies and Radiographic Outcomes

“…1 These injuries are well described at the pelvis but can occur throughout the upper and lower extremities. 1,2 In the upper extremity, avulsion injuries commonly occur at the elbow, particularly at the medial epicondyle, where the ulnar collateral ligament (UCL) originates. 3 The UCL serves as the primary restraint against valgus stress.…”

“…Adolescents are at particular risk of avulsion injuries due to their level of activity and open growth plates 1 . These injuries are well described at the pelvis but can occur throughout the upper and lower extremities 1,2 .…”

“…Adolescents are at particular risk of avulsion injuries due to their level of activity and open growth plates 1 . These injuries are well described at the pelvis but can occur throughout the upper and lower extremities 1,2 . In the upper extremity, avulsion injuries commonly occur at the elbow, particularly at the medial epicondyle, where the ulnar collateral ligament (UCL) originates 3 .…”