Tip-of-the-Iceberg Fractures: Small Fractures That Mean Big Trouble

Pierce, Jennifer L.; McCrum, Erin; Rozas, Alexandra; Hrelic, Dawn M.; Anderson, Mark

doi:10.2214/ajr.15.14739

Cited by 12 publications

(3 citation statements)

References 63 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…On knee radiographs, a small osseous avulsion fracture on the peripheral margin of the medial patellar facet, known as the "sliver sign", may indicate avulsion of the attachment of the medial patellofemoral ligament (MPFL) and potential patellar dislocation[ 2 ].…”

Section: To the Editormentioning

confidence: 99%

Radiological evaluation of patellofemoral instability and possible causes of assessment errors: Letter to the editor

Mesregah¹

2022

WJM

View full text Add to dashboard Cite

show abstract

Section: To the Editormentioning

confidence: 99%

Radiological evaluation of patellofemoral instability and possible causes of assessment errors: Letter to the editor

Mesregah¹

2022

WJM

View full text Add to dashboard Cite

show abstract

“…11a-e). 10 Posterior cruciate ligament (PCL) avulsion is also common. Radiographically it is usually possible to distinguish ACL from PCL avulsions.…”

Section: Tip 6: Understand Anterior Cruciate Avulsion Fracturesmentioning

confidence: 99%

Top-Ten Tips for Imaging the ACL

Griffith

2019

Semin Musculoskelet Radiol

View full text Add to dashboard Cite

Tears of the anterior cruciate ligament (ACL) are common and represent a serious injury. Although diagnosis on magnetic resonance imaging (MRI) is usually straightforward, diagnostic difficulty can occasionally arise. This review provides tips for imaging the ACL in those scenarios where a confident diagnosis is not possible on standard MRI of the knee. Potential pitfalls while imaging the ACL are also discussed.

show abstract

“…10 The “arcuate sign” is demonstrated by the avulsed fibular styloid fragment, which is most frequently displaced proximal to the fibular head. 11 Arcuate fractures are associated with posterolateral instability because important PLC stabilizers that are inserted on the proximal fibula (such as the biceps femoris tendon, the popliteofibular ligament, fibular collateral ligament, fabellofibular ligament, and the arcuate ligament) can be disrupted and are no longer able to function properly. 12,13 One study found that 72% of arcuate fractures are associated with anterior cruciate ligament (ACL) injuries and 67% had concomitant posterior cruciate ligament tears.…”

Section: Introductionmentioning

confidence: 99%

Novel Spiked-Washer Repair Is Biomechanically Superior to Suture and Bone Tunnels for Arcuate Fracture Repair

Vojdani

Fernandez

Jiao

et al. 2017

Journal of Orthopaedic Trauma

View full text Add to dashboard Cite

Objectives Injuries to the posterolateral corner (PLC) of the knee can lead to chronic degenerative changes, external rotation instability, and varus instability if not repaired adequately. A proximal fibula avulsion fracture, referred to as an arcuate fracture, has been described in the literature, but a definitive repair technique has yet to be described. The objective of this study is to present a novel arcuate fracture repair technique, utilizing a spiked-washer with an intramedullary screw, and to compare its biomechanical integrity to a previously described suture and bone tunnel method. Methods Ten fresh-frozen cadaveric knees underwent a proximal fibula osteotomy to simulate a proximal fibula avulsion fracture. The lateral knee capsule and posterior cruciate ligament were also sectioned to create maximal varus instability. Five fibulas were repaired using a novel spiked-washer technique and the other five were repaired using the suture and bone tunnel method. The repaired knees were subjected to a monotonic varus load using a mechanical testing system (MTS) instrument until failure of the repair or associated PLC structures. Results Compared to the suture repair group, the spiked-washer repair group demonstrated a 100% increase in stiffness, 100% increase in yield, 110% increase in failure force, and 108% increase in energy to failure. Conclusions The spiked washer technique offers superior quasi-static biomechanical performance compared to suture repair with bone tunnels for arcuate fractures of the proximal fibula. Further clinical investigation of this technique is warranted and the results of this testing may lead to improved outcomes and patient satisfaction for proximal fibula avulsion fractures.

show abstract

Tip-of-the-Iceberg Fractures: Small Fractures That Mean Big Trouble

Cited by 12 publications

References 63 publications

Radiological evaluation of patellofemoral instability and possible causes of assessment errors: Letter to the editor

Radiological evaluation of patellofemoral instability and possible causes of assessment errors: Letter to the editor

Top-Ten Tips for Imaging the ACL

Novel Spiked-Washer Repair Is Biomechanically Superior to Suture and Bone Tunnels for Arcuate Fracture Repair

Contact Info

Product

Resources

About