Avulsies

Avulsies, or avulsions, are injuries in which tissue is forcibly detached from its normal attachments. The term applies to a range of injuries, including dental avulsions, soft tissue avulsions, and avulsion fractures. In dental avulsion, a tooth is completely displaced from its socket. In soft tissue avulsions, skin or mucosa is torn away, sometimes with underlying structures. Avulsion fractures involve a bone fragment pulled away by a ligament or tendon.

Causes include high-energy trauma such as falls, sports injuries, motor vehicle accidents, and crush injuries. Mechanisms involve traction, shearing, or direct impact. Diagnosis relies on clinical examination and imaging to assess tissue loss, bleeding, and underlying bone or dental involvement.

Management varies by tissue type. For dental avulsion in a patient with a permanent tooth, immediate reimplantation is best; if immediate reimplantation is not possible, store the tooth in milk, saline, or the patient’s saliva and seek urgent dental care. Do not reimplant a primary tooth. For soft tissue avulsions, control bleeding, irrigate wound, and approximate and suture edges if feasible, with tetanus vaccination as indicated. For avulsion fractures, immobilize the affected area with a splint and arrange orthopedic or oral-maxillofacial consultation as appropriate.

Prognosis depends on tissue type, contamination, time out of the body, and quality of management. Dental avulsions have varying survival and risk of resorption or ankylosis; soft tissue injuries heal with scarring; fractures may require prolonged immobilization or surgery. Prevention includes protective gear and safety measures in activities.