Open treatment of transscaphoid perilunate fracture dislocations

Background: Large cystic osteochondral lesions of the talus (OLT) are challenging pathological conditions to treat, but particulated juvenile cartilage allografts (PJCAs) supplemented with bone grafts are a promising therapeutic option. The purpose of this project was to further elucidate the role of PJCA with concomitant bone autografts for treating large cystic OLTs with extensive subchondral bone involvement (greater than 150 mm2 in area and/or deeper than 5 mm). Methods: We identified 6 patients with a mean OLT area of 307.2 ± 252.4 mm2 and a mean lesion depth of 10.85 ± 6.10 mm who underwent DeNovo PJCA with bone autografting between 2013 and 2017. Postoperative outcomes were assessed with radiographs, Foot and Ankle Outcome Scores (FAOS), and visual pain scale scores. Results: At final follow-up (27.0 ± 12.59 weeks), all patients had symptomatic improvement and incorporation of the graft on radiographs. At an average of 62 ± 20.88 months postoperatively, no patients required a revision surgery. All patients contacted by phone in 2018 and 2020 reported they would do the procedure again in retrospect and reported an improvement in their symptoms relative to their preoperative state, especially with pain and in the FAOS activities of daily living subsection (91.93 ± 9.04 in 2018, 74.63 ± 26.86 in 2020). Conclusion: PJCA with concomitant bone autograft is a viable treatment option for patients with large cystic OLTs. Levels of Evidence: Level IV

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Splinting vs temporary external fixation in the initial treatment of ankle fracture-dislocations

Foot and Ankle Surgery ◽

10.1016/j.fas.2021.03.018 ◽

2021 ◽

Author(s):

Mehmet Ozbey Buyukkuscu ◽

Seckin Basilgan ◽

Ali Mollaomeroglu ◽

Abdulhamit Misir ◽

Hakan Basar

Keyword(s):

External Fixation ◽

Initial Treatment ◽

Ankle Fracture ◽

Fracture Dislocations

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An Alternative Approach Using Circummandibular Wiring for Treatment of Dentoalveolar Fractures in Children: A Case Report

Craniomaxillofacial Trauma & Reconstruction ◽

10.1177/1943387521990283 ◽

2021 ◽

pp. 194338752199028

Author(s):

José Henrique Santana Quinto ◽

Andressa Bolognesi Bachesk ◽

Lucas Costa Nogueira ◽

Liogi Iwaki Filho

Keyword(s):

Case Report ◽

Surgical Technique ◽

Bone Fracture ◽

Closed Reduction ◽

Alternative Methods ◽

Alveolar Process ◽

Fractures In Children ◽

Alternative Approach ◽

Open Treatment ◽

Segmental Fractures

The prevalence of dentoalveolar injuries in children is approximately 25%, with falls from own height being one of the main etiologies. Diagnosis is based on the clinical evaluation associated with complementary imaging tests. The treatment of choice depends on the type of damage and structure affected. For alveolar process fractures, closed reduction and semi-rigid dental splinting for 4 to 6 weeks is generally satisfactory. However, some cases, such as severe segmental fractures, require open treatment to ensure adequate reduction and stabilization of the displaced alveolar segment, which is usually achieved by titanium miniplates and screws. Nevertheless, there are situations where this type of fixation is not possible, requiring alternative methods. Therefore, this article describes a surgical technique performed by open reduction, associating semi-rigid dental splint and circummandibular wiring in pediatric patient diagnosed with dentoalveolar fracture through clinical examination (with bone fracture displacement) and tomography. The technique promoted a good prognostic to the patient, proving to be a viable alternative for treating dentoalveolar fractures.

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Hemi-hamate Arthroplasty for Base of Middle Phalanx Fracture: A Systematic Review

Hand ◽

10.1177/15589447211014623 ◽

2021 ◽

pp. 155894472110146

Author(s):

Harrison Faulkner ◽

David J. Graham ◽

Mark Hile ◽

Richard D. Lawson ◽

Brahman S. Sivakumar

Keyword(s):

Systematic Review ◽

Symptomatic Relief ◽

Donor Site ◽

Functional Restoration ◽

Interphalangeal Joint ◽

Posttraumatic Arthritis ◽

Middle Phalanx ◽

Weighted Mean ◽

True Incidence ◽

Fracture Dislocations

Intra-articular fracture dislocations of the base of the middle phalanx are complex and debilitating injuries that present a management conundrum when nonreconstructable. Hemi-hamate arthroplasty (HHA) is a treatment modality of particular use in the setting of highly comminuted fractures. This systematic review aims to summarize the reported outcomes of HHA in this context. A literature search was conducted using MEDLINE, Embase, and PubMed, yielding 22 studies with 235 patients for inclusion. The weighted mean postoperative range of movement at the proximal interphalangeal joint was 74.3° (range, 62.0°-96.0°) and at the distal interphalangeal joint was 57.0° (range, 14.0°-80.4°). The weighted mean postoperative pain Visual Analog Scale was 1.0 (range, 0.0-2.0). The weighted mean postoperative grip strength was 87.1% (range, 74.5%-95.0%) of the strength on the contralateral side. Posttraumatic arthritis was reported in 18% of cases, graft collapse in 4.2%, and donor site morbidity in 3.0%, with a mean follow-up period of 28.4 months (range, 1-87 months). Hemi-hamate arthroplasty is a reliable and effective technique for the reconstruction of intra-articular base of middle phalangeal fracture dislocations, affording symptomatic relief and functional restoration. Further research is required to assess the true incidence of long-term complications.

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Post-Reduction Stability of the Proximal Interphalangeal Joint after Dorsal Fracture Dislocation—A Cadaveric Study

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835516500387 ◽

2016 ◽

Vol 21 (03) ◽

pp. 382-387 ◽

Cited By ~ 1

Author(s):

Andre Eu-Jin Cheah ◽

Tun-Lin Foo ◽

Janice Chin-Yi Liao ◽

Min He ◽

Alphonsus Khin-Sze Chong

Keyword(s):

Traction Force ◽

Proximal Interphalangeal Joint ◽

Interphalangeal Joint ◽

Fracture Dislocation ◽

Treatment Modalities ◽

Full Extension ◽

Early Motion ◽

Fracture Dislocations ◽

Reduction Stability ◽

The One

Background: Proximal interphalangeal joint (PIPJ) dorsal fracture dislocations (DFD) are challenging injuries. Treatment aims to achieve stability of the PIPJ after reduction so that early motion can be initiated. We studied how increasing articular destruction would affect post reduction stability and investigate the amount of traction and PIPJ flexion needed to maintain the reduction. Methods: Increasing amounts (20%, 40% and 60%) of damage to the volar lip of the middle phalanx in cadaveric specimens were created to represent PIPJ DFD that were stable, of tenuous stability and frankly unstable. Traction forces and PIPJ flexion needed to maintain the reduction were then measured. Results: The PIPJ DFD with 20% damage were stable and did not subluxe while the one with 40% articular involvement was stable after reduction. For unstable the PIPJ with 60% involvement, the more the PIPJ was flexed, the less traction force was needed to hold the joint in reduction. For PIPJ flexion of 20 degrees, a minimum 4.4N of force is needed to maintain reduction while PIPJ flexion of 10 degrees required a minimum 5.0N of force. No amount of force could maintain PIPJ reduction if traction was performed in full extension. Conclusions: In our model, PIPJ DFD with less than 30% articular damage are stable while those with 30% to 50% of involvement have tenuous stability. For the unstable PIPJ DFD, traction obviates the need for excessive flexion of the PIPJ to maintain joint reduction. This information should be considered in treatment modalities for PIPJ DFD, as well in the design of external traction devices for the treatment of PIPJ DFD.

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