Surgical Treatment for Delayed Ulnar Carpometacarpal Fracture–Dislocations

Background Fracture and dislocations of the carpometacarpal (CMC) joints except the thumb are relatively rare. Herein, we report the case of a delayed fracture–dislocation of fourth and fifth carpometacarpal joints. Case Description The patient is a 41-year-old, right-handed male. To improve the complaints, such as decreased motion, reduced grip strength, and cosmetic appearance, surgical treatment surgically performed with resection of scar tissues and fixation using suture button at 11 weeks after injury. Movement began at 2 weeks after the surgery, which resulted in satisfactory appearance and good function of 92 and 101% of the motion of the unaffected side of the fifth CMC joint and grip strength, respectively. Literature Review Missed diagnosis can cause impairment of function including grip strength and range of motion. Nevertheless, a few previous studies reported that patients with delayed diagnosis did not need further treatment because of less functional loss and less improvement. Clinical Relevance The surgical treatment using the implant allowed early motion from 2 weeks after surgery which resulted in good motion of the ulnar CMC joints as well as increased hand grip.

Download Full-text

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.

Download Full-text

An Uncommon Presentation of Fracture-dislocation of the 4th and 5th Carpometacarpal Joints with Volar Displacement and its Management

Journal of Orthopaedic Case Reports ◽

10.13107/jocr.2021.v11.i09.2400 ◽

2021 ◽

Vol 11 (9) ◽

Author(s):

Nikhil Jawaharlal ◽

Vasanthakumar Ramsingh ◽

Vijaya Bhalaik

Keyword(s):

Kirschner Wire ◽

Fracture Dislocation ◽

Carpometacarpal Joint ◽

Carpometacarpal Joints ◽

Kirschner Wire Fixation ◽

Joint Fracture ◽

Satisfactory Outcome ◽

Uncommon Presentation ◽

Fracture Dislocations ◽

Poor Outcomes

Introduction: Carpo-metacarpal joint fracture-dislocations are rare injuries. They constitute less than 1% of all hand injuries [1]. They often go unnoticed [2]. Of these, dorsal fracture-dislocations on the ulnar side are more commonly seen [3] because of the greater stabilizing dorsal structures. Volar fracture-dislocations are very rare and difficult to diagnose for which, one should have a keen eye on. Case Report: This is a case of a 51-year-old female with a closed injury to her wrist. With clinical suspicion and appropriate radiographs fracture-dislocation of the 4th and 5th carpometacarpal joints with volar displacement was diagnosed. She underwent closed reduction and percutaneous Kirschner wire fixation, followed by 6 weeks of immobilization. At the final follow-up in 4 months, the patient was noted to have a satisfactory outcome following intense physiotherapy. Conclusion: Fourth and fifth carpometacarpal joint fracture-dislocations of the fingers are unique; their diagnosis can be challenging and often overlooked [4], which if missed can have very poor outcomes. The functional prognosis depends on the precocity of diagnosis and appropriate reduction and vigorous rehabilitation. Keywords: Carpometacarpal joint, fracture-dislocation, volar displacement, wrist injury.

Download Full-text

Dorsal fracture-dislocation of the radiocarpal joint: a new classification and implications in surgical treatment

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193420926801 ◽

2020 ◽

Vol 45 (7) ◽

pp. 700-708

Author(s):

Marco Biondi ◽

Giulio Lauri

Keyword(s):

Surgical Treatment ◽

Soft Tissue Injuries ◽

Fracture Dislocation ◽

Type I ◽

New Classification ◽

Level Of Evidence ◽

Type Iv ◽

Radiocarpal Joint ◽

Fracture Dislocations ◽

Preoperative Ct

Dorsal dislocations and fracture-dislocations of the radiocarpal joint are a spectrum of pathology involving both the bony and ligamentous structures that stabilize the radiocarpal joint. We retrospectively reviewed 63 dorsal radiocarpal dislocations treated in our Institute in order to propose a new classification and define surgical treatment. Preoperative CT-scan findings together with clinical and radiological outcomes were recorded. We identified four main types of lesions: Type I, pure dorsal radiocarpal dislocation; Type IIA, dorsal wall impaction and radial styloid avulsion; Type IIB, as IIA with additional intra-articular die punch; Type III, volar and dorsal marginal fragments; Type IV, larger volar and dorsal fragments. For each type of lesion, we propose specific options for treatment that are progressively more invasive. We believe that this classification adequately addresses the whole spectrum of bony and soft tissue injuries that occurs in dorsal radiocarpal fracture-dislocations giving a practical guide for surgical treatment. Level of evidence: IV

Download Full-text

Promising Mid-Term Outcomes after Humeral Head Preserving Surgery of Posterior Fracture Dislocations of the Proximal Humerus

Journal of Clinical Medicine ◽

10.3390/jcm10173841 ◽

2021 ◽

Vol 10 (17) ◽

pp. 3841

Author(s):

Lukas F. Heilmann ◽

J. Christoph Katthagen ◽

Michael J. Raschke ◽

Benedikt Schliemann ◽

Helmut Lill ◽

...

Keyword(s):

Surgical Treatment ◽

Humeral Head ◽

Proximal Humerus ◽

Clinical Results ◽

Fracture Dislocation ◽

Simple Shoulder Test ◽

Locked Plating ◽

Significant Difference ◽

Fracture Dislocations

Background: The aim of this study was to evaluate the clinical outcome after humeral head preserving surgical treatment of posterior fracture dislocations of the proximal humerus. Methods: Patients with a posterior fracture dislocation of the proximal humerus that were operatively treated in two level-1 trauma centers within a timeframe of 8 years were identified. With a minimum follow-up of 2 years, patients with humeral head preserving surgical treatment were invited for examination. Results: 19/24 fractures (79.2%; mean age 43 years) were examined with a mean follow-up of 4.1 ± 2.1 years. Of these, 12 fractures were categorized as posteriorly dislocated impression type fractures, and 7 fractures as posteriorly dislocated surgical neck fractures. Most impression type fractures were treated by open reduction, allo- or autograft impaction and screw fixation (n = 11), while most surgical neck fractures were treated with locked plating (n = 6). Patients with impression type fractures showed significantly better ASES scores (p = 0.041), Simple Shoulder Test scores (p = 0.003), Rowe scores (p = 0.013) and WOSI scores (p = 0.023), when compared to posteriorly dislocated surgical neck fractures. Range of motion was good to excellent for both groups with no significant difference. Conclusions: This mid-term follow-up study reports good to very good clinical results for humeral head preserving treatment.

Download Full-text

TREATMENT OF THORACIC AND LUMBAR SPINE AND SPINAL CORD INJURY IN CHILDREN

Hirurgiâ pozvonočnika ◽

10.14531/ss2006.1.13-19 ◽

2006 ◽

pp. 013-019

Author(s):

Eduard Vladimirovich Ulrikh ◽

Sergey Valentinivich Vissarionov ◽

Aleksandr Yuryevich Mushkin

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Surgical Treatment ◽

Neurological Deficit ◽

Neurological Disorders ◽

Seat Belt ◽

Fracture Dislocation ◽

Burst Fractures ◽

Cord Injury ◽

Fracture Dislocations

Objective. To assess results of surgical treatment and to develop an optimal management regiment of patients with spine and spinal cord injury. Material and methods. Twenty patients, age 9 to 17 years, with complicated unstable spinal injuries were operated on. Out of them 13patients had severe Frankel grades A, B, C neurological disorders, 7 patients – grades D and Er. Seventeen patients had burst fractures, one – seat-belt injury, and two – fracture-dislocations. Surgery was performed in the first hours following the trauma in 9 patients, within two weeks – in 9, and after 15 days – in two. Burst fractures with grades A, B, C were treated by simultaneous posterior reposition and fixation of the injured segment, and anterior decompression and fusion. Grade D and Er was treated initially by indirect posterior reduction and fixation of the involved segment. If neurological disorders still remained decompression and body fusion were performed. Posterior-lateral decompression and instrumental fixation were performed in cases of seat-belt injuries. Fracture-dislocation was treated by decompression laminoplasty, spinal canal revision, followed by posterior reposition and fixation. Results. Two patients with burst fractures and grade A neurological disorders have shown a regression to the grade D. Dynamics of neurological restoration to grades B and C was observed in 4patients. The patient with grade B has not shown any regression. A positive dynamics with motor function improvement was observed in 4 patients with grade C. Seven patients (6 with burst fractures, 1 with seat-belt trauma) with grade D and Er were operated on within first hours and day after the trauma. First stage of surgical treatment provided elimination of neurological deficit in 5 cases. Two patients with grade D required the second stage. Regression of neurological deficit was not achieved in patients with fracture-dislocations. Conclusion. Surgical treatment of patients with complicated spine and spinal cord injury should be performed within first 6–8 hours after the trauma.

Download Full-text

Esophageal Atresia and Associated Duodenal Atresia: A Cohort Study and Review of the Literature

European Journal of Pediatric Surgery ◽

10.1055/s-0040-1716884 ◽

2020 ◽

Author(s):

Maria Enrica Miscia ◽

Giuseppe Lauriti ◽

Dacia Di Renzo ◽

Angela Riccio ◽

Gabriele Lisi ◽

...

Keyword(s):

Cohort Study ◽

Esophageal Atresia ◽

Primary Repair ◽

English Literature ◽

Delayed Diagnosis ◽

Case Series ◽

Primary Treatment ◽

Duodenal Atresia ◽

Staged Approach ◽

Missed Diagnosis

Abstract Introduction Esophageal atresia (EA) is associated with duodenal atresia (DA) in 3 to 6% of cases. The management of this association is controversial and literature is scarce on the topic. Materials and Methods We aimed to (1) review the patients with EA + DA treated at our institution and (2) systematically review the English literature, including case series of three or more patients. Results Cohort study: Five of seventy-four patients with EA had an associated DA (6.8%). Four of five cases (80%) underwent primary repair of both atresia, one of them with gastrostomy placement (25%). One of five cases (20%) had a delayed diagnosis of DA. No mortality has occurred. Systematic Review: Six of six-hundred forty-five abstract screened were included (78 patients). Twenty-four of sixty-eight (35.3%) underwent primary correction of EA + DA, and 36/68 (52.9%) underwent staged correction. Nine of thirty-six (25%) had a missed diagnosis of DA. Thirty-six of sixty-eight underwent gastrostomy placement. Complications were observed in 14/36 patients (38.9 ± 8.2%). Overall mortality reported was 41.0 ± 30.1% (32/78 patients), in particular its incidence was 41.7 ± 27.0% after a primary treatment and 37.0 ± 44.1% following a staged approach. Conclusion The management of associated EA and DA remains controversial. It seems that the staged or primary correction does not affect the mortality. Surgeons should not overlook DA when correcting an EA.

Download Full-text

Open Reduction for Dorsal Dislocation of Second to Fifth Carpometacarpal Joints: A Case Report

Journal of Wrist Surgery ◽

10.1055/s-0040-1715802 ◽

2020 ◽

Author(s):

Hiroo Kimura ◽

Akira Toga ◽

Taku Suzuki ◽

Takuji Iwamoto

Keyword(s):

Closed Reduction ◽

Open Reduction ◽

Delayed Diagnosis ◽

Preoperative Assessment ◽

Radiographic Examination ◽

Clinical Images ◽

Left Hand ◽

Carpometacarpal Joints ◽

Joint Deformity ◽

Poor Outcomes

Abstract Background Fracture-dislocations of all four ulnar (second to fifth) carpometacarpal (CMC) joints are rare hand injuries and frequently overlooked or missed. These injuries can be treated conservatively when closed reduction is successfully achieved, though they are sometimes irreducible and unstable. Case Description We report the case of a 17-year-old boy involved in a vehicular accident. Clinical images showed dorsal dislocation of all four ulnar CMC joints of the left hand associated with a fracture of the base of the fourth metacarpal. Although closed reduction was attempted immediately, the affected joints remained unstable and easily redislocated. Therefore, we performed open reduction and percutaneous fixation of all ulnar CMCs. He showed excellent recovery after 1 year postoperatively, reported no pain, and demonstrated complete grip strength and range of motion of the affected wrist and fingers. Literature Review Accurate clinical diagnosis of this lesion is difficult because of polytrauma, severe swelling masking the dislocated CMC joint deformity, and overlapping of adjacent metacarpals and carpal bones on radiographic examination. As for the treatment strategy, it has yet to obtain a consensus. Some reports value open reduction to guarantee anatomical reduction, and it is definitely needed in the patients with interposed tissues to be removed or with subacute and chronic injuries. Clinical Relevance Delayed diagnosis or treatment could lead to poor outcomes. Therefore, surgeons must be aware that precise preoperative assessment is critical, and anatomical open reduction of interposed bony fragments, like our case, may be required even in an acute phase.

Download Full-text

Physical Activity in Aging Population

European Journal of Interdisciplinary Studies ◽

10.26417/ejis.v5i3.p74-80 ◽

2019 ◽

Vol 5 (3) ◽

pp. 74

Author(s):

Rezarta Stena ◽

Klara Hysenaj ◽

Mitilda Gugu Karoli ◽

Armelda Teta ◽

Gjergji Doka

Keyword(s):

Physical Activity ◽

Older Adults ◽

Heart Rate ◽

Pain Intensity ◽

Range Of Motion ◽

Training Program ◽

Grip Strength ◽

Upper Limb ◽

Hand Grip ◽

Trunk Flexibility

It is known that worldwide populations are aging, and also that physical activity can play an important role in minimizing impairments characteristic of old age. Adopting a more active lifestyle and doing regular physical activity, including aerobic and resistance exercises, daily walking etc. have been demonstrated to improve cardiovascular, respiratory, and musculoskeletal parameters in older adults. We assessed a potential participant from Elbasan (Albania), 67 years, for eligibility to participate in a 5 month training program. The subject gave written informed consent before inclusion.The following parameters were measured at the beginning (baseline) and end of the training period: BMI, body fat percentage, hand grip strength, lower/upper limb and trunk flexibility and range of motion, heart rate, balance, pain intensity, as well as VO2 max, directly and/or an estimate using the Rockport fitness test estimate. An initial evaluation was carried out just before starting the training (baseline). A second evaluation was made 5 months after starting the program of physical exercise (post training). Each evaluation included the recording of health related events, such as any changes in previous symptoms, as well as measurements of balance, flexibility, body composition, coordination, muscle strength, and aerobic capacity, to detect any changes that might have been induced specifically by physical activity. The subject’s attendance and participation in the program was also recorded. Range of motion for each part evaluated (trunk, hip, cervical region and shoulder) is improved about 15-20° degree. BMI, hand grip strength, lower/upper limb and trunk flexibility, heart rate, balance, pain intensity, VO2 max are also improved after training program. Following a training program or a regular physical activity in older adults minimise impairments characteristics in this age and cardiovascular, respiratory, and musculoskeletal parameters. According to the low importance shown in my country for the physical activity in older adults, I want to emphasize the importance of state structures involvement and the sensibilization of this group of age to stimulate an actively participation in physical training programs followed by professionals for bests life parameters. A higher investment for this age group, building as many facilities as possible for activation and spending quality free time, hiring more physiotherapists in nursing homes will increase life motivation and improve the quality and the parameters of living.

Download Full-text