Avulsion fracture
An avulsion fracture , also known as an avulsion fracture, is when a piece of bone breaks off when a tendon or ligament is pulled too hard. These injuries are usually associated with relatively little pain. Mobility is often not severely restricted either. A typical avulsion fracture occurs in the area of the ankle during sporting activities. The fingers are also often affected by this injury.
What is an avulsion fracture?
Excessive strain on a muscle in turn creates a very strong pull on the corresponding tendons or ligaments. Tendons are the muscle part made of connective tissue that connects the muscle to the bone . An avulsion fracture, or avulsion fracture, occurs when a fragment of bone breaks off or splinteres from the strong pull of the tendon. Ligaments, on the other hand, connect bones to bones and can also lead to an avulsion fracture if they are stretched or pulled too much. Depending on the strength of the pull and the bone involved, the fragments torn out in avulsion fractures can vary in size and shape.
Causes
The cause of an avulsion fracture is the abrupt increase in tension on a tendon with bone anchorage as a result of heavy muscular strain, for example during sports. The bone can no longer withstand the sudden strain caused by the tension of the tendon, and a piece of bone is torn out. The same applies to excessive strain on ligaments, which can also pull fragments out of the bones. The ripped piece of bone can vary in size and shape. Sometimes only the bone cortex is affected by the fracture. In general, bone is less resistant to sudden tension than the elastic connective tissues of tendons and ligaments , which are designed to withstand such forces.
When to the doctor?
A doctor should be consulted as soon as sudden pain occurs during movements of the bones or joints. If the pain increases in intensity or extent, medical examinations must be carried out to provide information about the cause. It is advisable to consult a doctor if there is a bad posture when moving or a crooked posture of the body due to the symptoms. Permanent damage can occur that must be treated in a timely manner.
If there is a drop in performance or strength, there is damage to the tendons, ligaments or muscles that must be treated. If the affected region is stressed, the symptoms increase and can lead to further tears. Therefore, a doctor should be consulted to take treatment and protective measures.
If the symptoms are very minor and do not lead to any major impairment in everyday life, self-help measures can be taken. It is often sufficient to take care of the injured region, relieve it and cool it regularly. If the symptoms are reduced, there is usually a complete healing within a few days. A doctor’s visit is only necessary if there is no relief. Before taking painkillers , you should consult a doctor. Side effects and risks need to be discussed and ruled out.
Symptoms and course
An avulsion fracture is swelling at the junction of the bone and tendon or bone and ligament where the piece of bone was torn out. At the same time, the tendon or ligament in the affected area no longer works, muscle tension can no longer be transferred. The piece of bone and the actual bone are a little apart due to the pull of the tendon and do not rub against each other. This is also the reason why avulsion fractures usually cause little pain.
So it happens that soccer players continue to play after an avulsion fracture in the ankle. In general, younger people are more likely to be affected by avulsion fractures, since their tendons and ligaments are more elastic and show less wear. In older people, on the other hand, the tendons or ligaments are more likely to tear under heavy loads because they are less elastic and show greater wear and tear.
Diagnosis
Diagnosis of an avulsion fracture is by X-ray , as is generally the case with fractures and other bone injuries. A detailed medical history and examination are very important for this type of fracture, as those affected can often continue to move relatively painlessly for a long time. There is often only swelling. In addition, it is sometimes difficult to clearly differentiate between an avulsion fracture and a pure injury to tendons or ligaments. In contrast to a skeletal tendon tear, tendon or ligament injuries can only be seen in a computer or magnetic resonance imaging and not in the X-ray image.
Complications
Of course, an avulsion fracture can also lead to various complications if the affected person does not seek medical treatment in time. If there is an avulsion fracture, then a doctor should be consulted in any case. This is the only way to treat or rule out serious secondary diseases. In most cases, an avulsion fracture also involves a muscle or tendon injury. If it is just a case of overstretching, it is not absolutely necessary to see a doctor. No further complaints or complications are to be expected as long as the affected area is spared.
However, if the muscles continue to be strained, the injury will persist. Inflammation can also occur, which can lead to an abscess. If the first signs of an abscess can be seen, a visit to the doctor should not be delayed any longer. Blood poisoning can even occur if the bacteria and viruses in it enter the bloodstream. If a visit to the doctor is avoided, there is even an acute danger to life in such a case. For this reason, the following applies: In the case of an avulsion fracture, medical treatment is absolutely necessary. If this is not done, the above-mentioned complications can be expected. There are also other symptoms that can vary depending on the severity of the injury.
Treatment and therapy
The acute treatment of an avulsion fracture initially consists of relief, immobilization, cooling and, if necessary, the administration of painkillers . In general, the treatment of such a fracture depends primarily on its size and the position of the bone. If smaller bones are affected, such as on the fingers, and only small fragments are torn out, the injury is usually only treated with a splint. This relieves the pressure on the bone and the torn off fragment grows back on its own.
However, if larger bones are affected or if the bone is larger, surgery is usually done. With these larger fractures, the tension on the bones is too high for self-healing. There are two different surgical options for operating an avulsion fracture: connection with screws or connection with wires. In screw osteosynthesis, the piece of bone that has been torn out is attached to the affected bone with the help of a screw.
The second option is to connect the bone parts with so-called Kirschner wires. The connection of the bones by means of a screw is considered to be more stable with a lower probability of the fragment being torn out again. However, the risk of adhesions at the fracture site is higher, and removing the screw once it has healed can also be more difficult. The use of skinning wires is less invasive than screwing. At the same time, however, it is also less stable.
The additional treatment with a plaster splint, which stabilizes the wired fracture accordingly, is very important here. The use of a plaster splint is also recommended for screw osteosynthesis. During the healing of the avulsion fracture and for a few weeks afterwards, depending on the bone involved, physical therapy is important to restore full mobility and strengthen the muscles. Avoiding movements with strong pull on the fracture in the initial period is also essential for healing.
Prevention
Avulsion fractures are prevented on the one hand by avoiding sudden, heavy loads and on the other hand by exercising correctly during sport. So it’s very important to warm up and stretch thoroughly for sports that involve fast, sudden movements. With stretching, tendons and ligaments are more elastic and exert less sudden pull. Building muscle is also a key component of prevention, as trained muscles can withstand more stress.
Wearing appropriate splints, for example on the ankle, can be another useful preventive measure against avulsion fractures. Immediate immobilization is very important if an injury with swelling occurs in the bone area during sport. An avulsion fracture can already be present, despite the fact that mobility is often still present and relatively little pain. However, if further loading occurs, there is a risk of further injuries from the bone fragment.
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My passion for health and wellness started at a young age when I became interested in the connection between the food we eat and the way we feel. This fascination led me to study nutrition and dietetics in college, where I learned about the importance of a balanced diet and the impact of various nutrients on the body.