N Haraguchi, H Toga, N Shiba and F Kato
Avulsion fracture often goes undetected on early radiograph and management of these injuries is less clear than management of ligament injuries. Non-operative management of avulsion fractures often does not yield satisfactory results. This cohort study took 169 consecutive patients with severe inversion injury, they were classified into a ligament injury group and an avulsion group on the basis of physical examination and XR findings. Age, sex, activity level and mechanism of injury were analysed. Patients in both groups were treated by casting. Follow-up was carried out on 152 patients. The results showed that avulsion fracture was diagnosed in 44 patients, most of these were in children and patients over 40. Sedentary activity level and low energy injury were more common in the avulsion group. Non-operative treatment yielded satisfactory results in the avulsion group that were comparable to results of non-operative treatment of the ligament group. Osseus union was achieved in 65% of patients with avulsion fracture. The authors concluded that avulsion injuries are more common than previously thought. Authors recommend a high level of suspicion when assessing sever inversion injuries due to the difficulties in identifying avulsion fractures.
Amercian Journal of Sports Medicine, 2007, 35, 1144-1152