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

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          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.

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          Most cited references102

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          The epidemiology of ankle sprains in the United States.

          Ankle sprain has been studied in athletic cohorts, but little is known of its epidemiology in the general population. A longitudinal, prospective epidemiological database was used to determine the incidence and demographic risk factors for ankle sprains presenting to emergency departments in the United States. It was our hypothesis that ankle sprain is influenced by sex, race, age, and involvement in athletics. The National Electronic Injury Surveillance System (NEISS) was queried for all ankle sprain injuries presenting to emergency departments between 2002 and 2006. Incidence rate ratios were then calculated with respect to age, sex, and race. During the study period, an estimated 3,140,132 ankle sprains occurred among an at-risk population of 1,461,379,599 person-years for an incidence rate of 2.15 per 1000 person-years in the United States. The peak incidence of ankle sprain occurred between fifteen and nineteen years of age (7.2 per 1000 person-years). Males, compared with females, did not demonstrate an overall increased incidence rate ratio for ankle sprain (incidence rate ratio, 1.04; 95% confidence interval, 1.00 to 1.09). However, males between fifteen and twenty-four years old had a substantially higher incidence of ankle sprain than their female counterparts (incidence rate ratio, 1.53; 95% confidence interval, 1.41 to 1.66), whereas females over thirty years old had a higher incidence compared with their male counterparts (incidence rate ratio, 2.03; 95% confidence interval, 1.65 to 2.65). Compared with the Hispanic race, the black and white races were associated with substantially higher rates of ankle sprain (incidence rate ratio, 3.55 [95% confidence interval, 1.01 to 6.09] and 2.49 [95% confidence interval, 1.01 to 3.97], respectively). Nearly half of all ankle sprains (49.3%) occurred during athletic activity, with basketball (41.1%), football (9.3%), and soccer (7.9%) being associated with the highest percentage of ankle sprains during athletics. An age of ten to nineteen years old is associated with higher rates of ankle sprain. Males between fifteen and twenty-four years old have higher rates of ankle sprain than their female counterparts, whereas females over thirty years old have higher rates than their male counterparts. Half of all ankle sprains occur during athletic activity.
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            Adult ankle fractures--an increasing problem?

            The epidemiology of ankle fractures is changing. Increasing longevity has resulted in the highest age-specific incidence of ankle fractures being in women between 75 and 84 years of age. The introduction of the AO classification has facilitated analysis of the commonest fracture types. This survey of 1,500 ankle fractures, seen in a 3-year period in the Edinburgh Orthopaedic Trauma Unit, shows that the commonest ankle fractures are the B1.1 and A1.2 lateral malleolar fractures. Isolated malleolar fractures accounted for two thirds of the series, with bimalleolar fractures occurring in one fourth of the patients and trimalleolar fractures in the remaining 7%. Open fractures occurred in 2%.
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              Transchondral fractures (osteochondritis dissecans) of the talus.

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                Author and article information

                Journal
                Clin Med Insights Arthritis Musculoskelet Disord
                Clin Med Insights Arthritis Musculoskelet Disord
                AMD
                spamd
                Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders
                SAGE Publications (Sage UK: London, England )
                1179-5441
                01 November 2018
                2018
                : 11
                : 1179544118809050
                Affiliations
                [1 ]OrthoEvidence Inc., Burlington, ON, Canada
                [2 ]Department of Surgery, McMaster University, Hamilton, ON, Canada
                [3 ]Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
                Author notes
                [*]Christopher Vannabouathong, OrthoEvidence Inc., 3228 South Service Road, Suite 206, Burlington, ON L7N 3H8, Canada. Email: chris.vannabouathong@ 123456myorthoevidence.com
                Author information
                https://orcid.org/0000-0002-9694-6364
                Article
                10.1177_1179544118809050
                10.1177/1179544118809050
                6236480
                30450008
                3d5a66fa-ebff-461c-80bf-6c806a1fc6f8
                © The Author(s) 2018

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 20 August 2018
                : 16 September 2018
                Categories
                Review
                Custom metadata
                January-December 2018

                Rheumatology
                review,avulsion fracture,upper extremity,lower extremity
                Rheumatology
                review, avulsion fracture, upper extremity, lower extremity

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