Keep an eye out for redness, swelling, or other signs of infection and see a doctor if these occur. Stitches. Successful replantation of a completely avulsed ear by microvascular anastomosis. Sometimes a dermatologist or plastic surgeon can treat the condition after the wound is healed. deSousa, J.L., Leibovitch, I., Malhotra, R., O'Donnell, B., Sullivan, T., & Selva, D. (2007, December). An avulsion injury extends through all the layers of skin. In rare cases, if the bone fragment and main bone are too far apart to fuse naturally, surgery may be necessary to reunite them. Avulsions typically occur during violent accidents. Apart from heavy bleeding, some cases of avulsions can also lead to the loss or dislocation of limbs. Do not aggressively scrub the wound. An avulsion is a forcible tearing off of skin or another part of the body, such as an ear or a finger. To minimize your risk, make sure you seek emergency medical treatment so the wound is thoroughly cleaned. After three days the bandage may be removed, except in the case of drainage. Clean the wound daily using soap and water. If left alone, it exposes the body to harmful bacteria, making it at risk of infection. Cuts in the same direction as your natural skin lines (wrinkle lines) are less visible. Microsurgical replantation of total upper eyelid avulsion. Fingertip avulsions often occur when the finger gets slammed in the door (latch side) or is caught along the edge of the door (hinge side). Avulsion may happen on your finger or toe. Accessed May 22, 2017. There are four types of open wounds, which are classified depending on their cause. See avulsion stock video clips Image type Orientation Sort by Popular Healthcare and Medical Geography and Landscapes Emotion avulsion bone avulsion fracture injury medicine stethoscope ligament Next of 4 Severe lower extremities degloving injuries medical problems and treatment results. [21] Shoulder trauma during motor vehicle collisions is another common cause of brachial plexus avulsions. With degloving injuries, you may need to take antibiotics. If you are a Mayo Clinic patient, this could All rights reserved. 8th ed. In some cases, they can cause a bruise, but this is usually the only visible symptom. DOI: Nair AV, et al. Minor cuts can be treated at home, but severe cases requireemergency services. The torn skin may be lost or too damaged to be repaired, and it must be removed. If your avulsion wound is deep but not too wide, your doctor may be able to close it up with stitches, also called sutures. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. It may seemingly be harmless, but if the wound is contaminated, antibiotics or a tetanus shot may be needed. What are common causes of an avulsion fracture? DOI: Han F, et al. This is especially true if you have thinner skin, are an older adult, or have taken steroids for long periods of time. irrigate wound and inspect for visible avulsed vessel, nerve, tendon, damaged skin edges staggered injury pattern proximal skin avulsion (from PIPJ to base of digit) distal bone fracture or dislocation (distal to PIPJ, often at DIPJ level) Imaging Radiographs recommended views avulsions might involve the eyeballs, ears or fingers. Explore. An avulsion that wraps all the way around an extremity and causes the layers of tissue to pull away is called a degloving injury. Sutures in your hand may be left in 14 or more days because of slower healing and greater tension on the wound. When deep, punctures can damage internal organs. Skin avulsion is a wound that happens when skin is torn from your body during an accident or other injury. Fresh Abrasion. A single copy of these materials may be reprinted for noncommercial personal use only. After cleaning and possibly numbing the area, your doctor may close the wound using skin glue, sutures, or stitches. In a skin avulsion injury, all layers of skin are gone from the wounded area. You may use over-the-counter medicine, such as acetaminophen, naproxen, or ibuprofen, to control pain, unless another pain medicine was given. Just like any other injury, open wounds can be classified into different categories. A common cause of degloving injury is when a ring catches on something, resulting in a degloving injury of the finger. Avulsion. doi:10.1016/j.injury.2021.04.042, Zacharia B, Roy A. Minor wounds can be treated at home. In a. This is especially true if theres a lot of bleeding or if bleeding lasts for more than 20 minutes. Nail avulsion is extremely painful and requires adequate anesthesia by digital or wing block. The hip, elbow and ankle are the most common locations for avulsion fractures in the young athlete. You should have had a tetanus booster immunization within the last 10 years if you have a simple, clean-cut, or within the last five years if you have a more complex or dirty cut. During a periosteal avulsion, the periosteum (a fibrous layer that surrounds a bone) detaches the bone's surface. Skin graft. The bottom line is to use common sense. Accessed May 22, 2017. Rod Brouhard is an emergency medical technician paramedic (EMT-P), journalist, educator, and advocate for emergency medical service providers and patients. If you have even a small puncture wound, visit your doctor to get a tetanus shot and prevent infection. (2001, August). Diviti S, et al. An avulsion fracture occurs when a small chunk of bone attached to a tendon or ligament gets pulled away from the main part of the bone. Treatment for a mild skin avulsion wound is similar to other types of at-home wound treatments. An avulsion is a partial or complete tearing away of skin and the tissue beneath. The torn skin may be lost or too damaged to be repaired, and it must be removed. Some climbers may even use super-glue to adhere the loose skin back to the finger. Treatment of an avulsion fracture typically includes resting and icing the affected area, followed by controlled exercises that help restore range of motion, improve muscle strength and promote bone healing. Clotting will ultimately help to stop the bleeding. Binder, D. K., Lu, D. C., & Barbaro, N. M. (2005, October). Eyelid avulsions are uncommon,[12] but can be caused by motor vehicle collisions,[13] dog bites,[14][15] or human bites. Theyre also often accompanied by other serious injuries, such as broken bones, that require emergency treatment. The person with the avulsion injury will need immediate medical care, but these first aid steps can be done as soon as possible, even before medical treatment is available. After taking off the dressing, wash the area gently with soap and water. Scarring is a big concern. [1] The term most commonly refers to a surface trauma where all layers of the skin have been torn away, exposing the underlying structures (i.e., subcutaneous tissue, muscle, tendons, or bone). You may be able to lift up a flap of tissue that is still connected, or the tissue could be completely detached from the body. From outside in, they are the epidermis, the dermis, and the hypodermis. What Are Symptoms and Signs of Cuts or Lacerations? Allow the wound to be open to the air. You may need to stay in the hospital for days or weeks, depending on the injury. Rinse the wound: Use water or saline solution. 1,225 puncture wound stock photos, vectors, and illustrations are available royalty-free. You may need to spend a few weeks on crutches if you have an avulsion fracture around your hip. information highlighted below and resubmit the form. A head injury is an injury to your brain, skull, or scalp. See puncture wound stock video clips Image type Orientation Color People Artists AI Generated More Sort by Popular Closed up wound of dog bite injury, dirty wound possible to cause infection 1395546479 Foot stepping on rusty metal nail outdoors 590853110 DOI: Wojcicki P, et al. Eyelid avulsion: Eyelid avulsions are the result of some or all of the eyelid being torn away. In a brachial plexus avulsion, the root of the nerve is detached from the spinal cord. Punctures may not bleed much, but these wounds can be deep enough to damage internal organs. The dressing will trap blood and hold it against the open wound, promoting clotting. Chin J Traumatol. Nearly everyone will experience an open wound at some point in their life. You may also have instructions regarding activity limitations to avoid movements that could interfere with your healing. Fracture care. Avulsions typically occur during violent accidents. Write down your questions so you remember to ask them during your visits. If tendons are affected, an incision will cause heavy bleeding and possibly cause permanent damage. exclude or treat people differently because of race, color, national origin, age, disability, sex, If we combine this information with your protected Keep your wound clean and protected to prevent infection and speed healing. Your Care Instructions. Thoroughly rinse out any dirt or debris from the wound and clean the wound with soap and water. Surgical avulsion: A surgical avulsion is a situation in which a part of the body needs to be permanently removed. Your doctor may also prescribe penicillin or another antibiotic if theres an infection or high risk for developing an infection. https://en.wikipedia.org/w/index.php?title=Avulsion_injury&oldid=1102730825, Short description is different from Wikidata, Creative Commons Attribution-ShareAlike License 3.0, This page was last edited on 6 August 2022, at 15:54. Do not be afraid to put direct pressure on raw muscle or fat tissue. Injuries typically heal from the bottom up and from the edges in. Call 612-273-3780. Nickerson TP, et al. Degloving, also called avulsion, is a type of severe injury that happens when the top layers of your skin and tissue are ripped from the underlying muscle, connective tissue, or bone. In a perfect world of preventive medicine, people would not get into fights, shoes would always be worn outside, glass doors would not exist, the left hand would not be used as a cutting board, and lawn mowers would be turned off before removing jammed material, and people would always wear seat belts. The Mayo Clinic experience with Morel-Lavalle lesions: Establishment of a practice management guideline. A 2017 review estimated that up to one-third of people with closed degloving injuries may have a delayed diagnosis. The nail bed will form a hard layer and then a new nail may grow. Philadelphia, Pa.: Saunders Elsevier; 2014. https://www.clinicalkey.com. Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Advertising and sponsorship opportunities. (2011). An avulsion is a severe wound that can result in the partial or complete tear of the skin and tissues. To know if your child has a sprain or an avulsion fracture, the doctor or health care provider will order an X-ray of the finger. Your wound is red and there are red streaks on your skin starting at your wound and moving upward. Meanwhile, deep punctures (e.g., gunshot wounds) require immediate medical intervention. Laskowski ER (expert opinion). Accidents with knives, tools, and machinery are frequent causes of lacerations. Injury. if there is a lot of bleeding or if you cannot stop minor bleeding within 20 mins. What to Do When You Bite Your Lip or Tongue, Fungating Breast Cancer: Wound Care, Relief, and Coping, Skin wound healing: An update on the current knowledge and concepts, Primary reattachment of avulsed skin flaps with negative pressure wound therapy in degloving injuries of the lower extremity, Outcomes of tibial avulsion fracture of the posterior cruciate ligament treated with a homemade hook plate, A clinicoradiological classification and a treatment algorithm for traumatic triceps tendon avulsion in adults, Proximal adductor avulsions are rarely isolated but usually involve injury to the PLAC and pectineus: descriptive MRI findings in 145 athletes, Traumatic choroidal injuries - classification, incidence, diagnosis and prognosis twenty-year results of Eye Injury Vitrectomy Study, Avulsion fracture, such as tibial avulsion fracture, Tendon avulsion, such as triceps tendon avulsion, Muscle avulsion, such as proximal adductor avulsion, Eye injury, such as choroidal (a layer in the back of the eye) avulsion. Written by Stephanie Chandler. Avulsions and degloving injuries will almost always need surgical intervention to heal properly. Use direct pressure and elevation to control bleeding and swelling. We do not discriminate against, A wound generically refers to a tissue injury caused by physical means. When changing dressings, be very careful to avoid tearing delicate skin. More tears can occur when trying to remove a bandage that is stuck on. They create and support wound healing. Degloving injuries of the hand. Puncture. Krishnamoorthy R, et al. You have painful swelling, redness, or warmth around your wound. You can learn more about how we ensure our content is accurate and current by reading our. DOI: ncbi.nlm.nih.gov/pmc/articles/PMC4753839/, symbiosisonlinepublishing.com/surgery/surgery01.php, ijri.org/article.asp?issn=0971-3026;year=2014;volume=24;issue=3;spage=288;epage=290;aulast=Nair, Achilles Tendon Rupture: Symptoms to Look For, Debra Sullivan, Ph.D., MSN, R.N., CNE, COI, Ruptured Spleen: Symptoms and Treatment in Adults and Children, accidents with industrial or farm equipment, draining any built-up fluid from the lesion, sclerotherapy, which involves injecting blood vessels with medication to make them shrink, oozing around the wound, especially if its yellow or smells bad. Patterns and management of degloving injuries: A single national level 1 trauma center experience. A wound of this type cannot be stitched closed because there is tissue missing. The most common type of avulsion injury is a skin avulsion wound. Early treatment is key to prevent infections. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Infections should not be ignored as they can spread to other parts of your body. Open degloving injuries are serious. Be very careful when removing tape or other dressings, or you may cause more skin tears. Always follow your healthcare professional's instructions. An avulsion wound refers to a wound in which a part of the body has been torn off or removed through either surgery or trauma. Your wound splits open or does not seem to be healing. Skin wound healing: An update on the current knowledge and concepts. Puncture wounds: First aid. [20] It occurs in 1 to 2 out of every 1,000 births. 2017;58(1-2):81-94. doi:10.1159/000454919, Sakai G, Suzuki T, Hishikawa T, Shirai Y, Kurozumi T, Shindo M. Primary reattachment of avulsed skin flaps with negative pressure wound therapy in degloving injuries of the lower extremity. But don't soak the area in water (no baths or swimming) until the stitches or staples are taken out and your provider says it's OK. These wounds often require surgery to repair. McCord, C.D. Your toe or finger may be sore after treatment. Road rash is an example of an abrasion. Amputation health.vic.gov.au/edfactsheets/downloads/care-of-open-wounds-cuts-and-grazes.pdf, mayoclinic.org/first-aid/first-aid-puncture-wounds/basics/art-20056665, Do I Need Stitches? To fix this injury and to be able to continue climbing, many climbers will apply sports tape to the flapped finger to cover up the sensitive area of broken skin. Your doctor will decide the best way to repair your wound. DOI: Hakim S, et al. Avoid tourniquets unless bleeding cannot be controlled and medical care will not be available for several hours. If skin glue was used, don't put any creams, lotions, or antibiotic ointments on it. [23] A completely avulsed tooth that is replaced within one hour of the injury can be permanently retained. Although you can treat some wounds at home, you should see a doctor if: Your doctor may use different techniques to treat your open wound. You have trouble moving the injured body area. The five types of wounds are abrasion, avulsion, incision, laceration, and puncture. All rights reserved. The graft was meshed 1.5:1 and secured to the forearm with staples. Doctor hand healing bloody area. Microvascular surgery in avulsive trauma to the external ear. Nail avulsion: In a nail avulsion, some or all of the nail is torn or removed from the nail bed. Another treatment for an open wound includes pain medication. DOI: Jones M, et al. If the bleeding was very difficult to stop and you are concerned that it will be out of control if you rinse the wound, then skip this step while you are waiting for professional help. An example of a periosteal avulsion is an ALPSA (anterior labral periosteal sleeve avulsion). This is similar to an abrasion but more severe, as body parts such as an eyelid or an ear can be partially or fully detached from the body. Copyright Merative 2022 Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. An abrasion is a wound caused by friction when a body scrapes across a rough surface. Some materials are better because they won't stick to your cut (Telfa or Vaseline gauze). as they are your bodys natural way of protecting the wound from germs and are a good sign you are growing new skin beneath your wound. Jeng, S.F., & Wei, F.C. The doctor who placed the stitches will often recommend the number of days before this follow-up. Treatment for degloving injuries depends on the type, severity, and location of the injury. [23] Primary (baby) teeth are not replaced because they tend to become infected and to interfere with the growth of the secondary teeth. For more minor cases, you may just need a combination of compression bandages, physical therapy, and rest. information submitted for this request. If your wound is oozing, put ointment and a nonstick dressing over it. Skin scrapes and abrasions, often called raspberries, are usually bright red and painful and are sometimes difficult to treat. Upload Join. Infection prevention will depend on the type of injury. Some open wounds can be treated at home, but this isnt always the case. Pennington, D. G., Lai, M. F., & Pelly, A.D. (1980, June). National Institute of Neurological Disorders and Stroke. First, wash and disinfect the wound to remove all dirt and debris. An amputation refers to the loss of an extremity such as an arm, finger, or leg. When you have experienced an avulsion or degloving injury, you might also have other injuries as well, such as laceration. 18 December, 2018. Treating open degloving injuries depends on both the extent of the injury and hospital resources. This is known as healing by secondary intention, meaning from the base of the wound to the superficial epidermis. The term gash can be used for more dramatic effect because it implies a longer or deeper cut. If you think you might have an infection, see a doctor. Your doctor may have removed the nail, put part of it back into place, or repaired the nail bed. All rights reserved. Degloving can affect any part of the body, such as the fingers, feet, or hands. Anomalies and curiosities of medicine: Being an Encyclopedic Collection of by George Milbry Gould, Walter . A cut, or laceration, is a tear or opening in the skin that occurs due to an external injury. Hydrocolloid bandages are used to treat open, superficial wounds and open pimples. We avoid using tertiary references. A wound of this type cannot be stitched closed because there is tissue missing. If there is still a skin flap attached to the wound, and the flap is healthy, your doctor may be able to reattach the skin into its original place. A wound check without suture removal may be recommended after one or two days, especially if the chance of infection is thought to be higher than the usual 5%, or if changing the bandage may be difficult. is a small hole caused by a pointy object like a nail, needle, or bullet (bullet puncture). Techniques and outcomes of total upper and lower eyelid reconstruction. 8 First Aid Kit Essentials for Scrapes, Cuts, Bug Bites, and More. Isolated nail bed injury typically occurs as a result of direct blunt trauma (eg, crush in a door jamb) [ 1 ]. Minor lacerations are cuts to the skin that often cause a burst of bleeding. Flapper - n. a superficial injury resulting in a loose flap of skin. Ring avulsion injuries. The nail may be completely or partially torn off after a trauma to the area. Subscrible to MakatiMeds online newsletter to get notified on latest updates, and amazing deals and promos. Infection is the biggest medical concern in the first few weeks. Mayo Clinic is a nonprofit organization and proceeds from Web advertising help support our mission. Avulsions are devastating injuries, and they come with a high degree of infection risksimilar to burns. Indian J Plast Surg. before caring for the wound to reduce the likelihood of a bacteria infection. [3] This is usually the result of friction forces between the climber's fingers and the holds, arising when the climber slips off a hold. Here's what you need to know. Children injury. [2] Small suprafascial avulsions can be repaired by suturing, but most avulsions require skin grafts or reconstructive surgery. Losing a toenail or fingernail because of an injury is called avulsion. If surgical tape was used, keep the area clean and dry. In medicine, an avulsion is an injury in which a body structure is torn off by either trauma or surgery (from the Latin avellere, meaning "to tear off"). [4] A partially avulsed ear can be reattached through suturing or microvascular surgery, depending on the severity of the injury. Hand embracing injured leg with painful place. We comply with the HONcode standard for trustworthy health information. This can happen with either the top or bottom eyelid. See Additional Information. If a body part is severed, it should be brought to the hospital for possible reattachment. Degloving injuries are often life threatening. An avulsion fracture occurs when a small chunk of bone attached to a tendon or ligament gets pulled away from the main part of the bone. the unsubscribe link in the e-mail. A blunt trauma injury can cause your spleen to rupture. information is beneficial, we may combine your email and website usage information with Eur Surg Res. In: Pfenninger and Fowler's Procedures for Primary Care. Mayo Clinic does not endorse companies or products. Replace the flap or bring separated tissue to the hospital: If the tissue (skin, fat, and muscle) is not completely torn away, replace the flap and cover the wound. Depending on the amount of skin left and the type of injury, treatment options include: All of these options usually require multiple surgeries. Not all emergency centers may have the expertise for complex skin repair. It is not intended as medical advice for individual conditions or treatments. You may need to use crutches if the wound is on your leg. Try to remove the bandage again; this may take several attempts. In case a loved one is wounded or hurt, identifying the wound type can be helpful when administering first-aid. Know the symptoms and what to do if you experience them. You should know the following facts: A physical exam will include the following: An x-ray may be ordered if foreign objects or an underlying broken bone is suspected. Your skin is made up of three tissue layers. The ear is particularly vulnerable to avulsion injuries because of its position on the side of the head. Your skin is made up of three tissue layers. You have heavy bleeding or bleeding that does not stop after 10 minutes of holding firm, direct pressure over the wound. Review/update the WebMD does not provide medical advice, diagnosis or treatment. Theyre known as open degloving and closed degloving. Verywell Health's content is for informational and educational purposes only. Most bleeding can be stopped with direct pressure and time (rest and elevation are also helpful). In some cases, a small degloving injury will only need a thorough cleaning and some bandaging to help it heal. A laceration is a deep cut or tearing of your skin. Not all emergency rooms are equipped to handle complex skin repair. Blepharospasm: A review of 264 patients. Every person most likely had an open wound in the past, whether it is a small scratch from the playground or a freak accident at work. Acta Ophthalmol. If your avulsion wound is mild, you may be able to take care of it at home. Your doctor may have removed the nail, put part of it back into place, or repaired the nail bed. Please see our Nondiscrimination 2017;48(1):137-141. doi:10.1016/j.injury.2016.10.026, Liu H, Liu J, Wu Y, et al. You might be able to drive while you are healing from an avulsion fracture if your healthcare provider says that it would be safe to do so. (2011). In the case of a severe wound, you should seek immediate medical care. Some people faint at the sight of their own blood (this is a neurological reaction in which a reflex slowing of the heart causes a. Stitches to the skin surface can help to stop bleeding, protect underlying tissues, and lessen scarring. This does not include baby teeth that fall out naturally. In an avulsion fracture, your bone moves one way and your tendon or ligament moves in the opposite direction with a broken chunk of bone in tow. After cleaning, reapply petroleum jelly and bandage. Avulsion royalty-free images 334 avulsion stock photos, vectors, and illustrations are available royalty-free. Thousands of new images every day Completely Free to Use High-quality videos and images from Pexels. Stay safe: If you are not the person who was injured, practice universal precautions and wear personal protective equipment if available. Always see a doctor if you have neck pain following an injury. Language assistance services are availablefree of charge. With a volar plate injury, the joint will have: Pain right away and with slight movement; Bruising; Swelling; Diagnosis. Copyright 2022 | Catawba Valley Healthcare | ALL RIGHTS RESERVED.Website by Precision Marketing Partners. Trauma to the nail can cause the nail plate to be torn from the nail bed. Keep a thin layer of antibiotic ointment on the cut. An avulsion is a serious skin trauma. A decubitus ulcer is also called a bedsore. Call your healthcare provider right away if any of these occur: Redness, swelling, or pus coming from the wound, Fever of 100.4F (38C) or higher, or as directed by your provider, Stitches or staples come apart or fall out before your next appointment, and the wound edges look as if they will reopen, Surgical tape closures fall off before 7 days, and the wound edges look as if they will reopen, Bleeding not controlled by direct pressure. An avulsion injury will usually cause severe pain and bleeding. Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. If this happens, don't wait for your scheduled visit. A laceration is a deep and jagged cut that results in skin tears and heavy bleeding. In the case of an accident, it comes with severe bleeding, which requires emergency medical management. An open wound is a type of injury that causes an external or internal break in the bodys tissue. If stitches or staples were used, check the wound every day. Always follow your doctors instructions for wound care. These injuries are much more extensive than lacerations (cuts), but they are less substantial than traumatic amputations (a finger or limb is completely cut from the body). Doctors usually make incisions when performing surgery, but it can be lethal when suffered during an accident. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press. The nail may be completely or partially torn off after a trauma to the area. Degloving injuries of trunk and limbs: Comparison of outcomes of early versus delayed assessment by the plastic surgery team. Most avulsion fractures heal very well without surgical intervention. [19] In the average person, fingernails require 3 to 6 months to regrow completely, while toenails require 12 to 18 months. [27][28] However, it often requires additional surgeries to retain function[27] and botulinum toxin injections have been shown to be more effective than surgical avulsions in treating benign essential blepharospasm, while causing fewer complications.[28]. However, if you notice a rash or redness due to the antibiotic ointment, stop use. How to Tell If You Need Medical Care, Treating a Cut Finger Injury, and When to See a Doctor, Bedsores: What You Should Know About Decubitus Ulcers, bleeding doesnt stop with direct pressure, bleeding is the result of a serious accident. (2017). Falls, accidents with a sharp object, and car accidents are the most common causes of open wounds. In children, avulsion fractures that involve the growth plates also might require surgery. Ingrown & Infected Toenails Treatment & Removal. If youre spending time outdoors, use a sunscreen thats sun protection factor (SPF) 30 on the area until its completely healed. From outside in, they are the epidermis, the dermis, and the hypodermis. Multiple root avulsions from the brachial plexus. Degloving injuries are serious and sometimes fatal. Avram, D.R., Hurwitz, J.J., & Kratky, V. (1991, October). 2000-2022 The StayWell Company, LLC. An avulsion fracture is when a tendon or ligament pulls so hard on a bone that a piece of bone breaks off.
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