IN SITU ROTATIONAL DISLOCATION OF THE TRAPEZOID ASSOCIATED WITH CARPAL-METACARPAL DISLOCATIONS

Hand Surgery ◽  
2009 ◽  
Vol 14 (01) ◽  
pp. 31-33 ◽  
Author(s):  
M. R. Broadbent ◽  
O. S. Bach ◽  
A. J. Johnstone
Keyword(s):  
Internal Fixation ◽  
Ct Scan ◽  
Open Reduction ◽  
Rare Case ◽  
High Energy ◽  
Plain Radiographs ◽  
Full Extent ◽  
Open Fixation

A rare case of in situ rotational dislocation of the trapezoid was described after dislocation of the index and long carpal-metacarpal joints. Due to the difficulty in visualising the trapezoid on plain radiographs, there was a delay in assessing the full extent of the injury. However, after further imaging, the case required open reduction and internal fixation. Therefore, in cases involving high energy dislocations of the second and third metacarpal CMC joints, injury to the peri-trapezoid ligaments should be considered. A pre-operative CT scan or, if not available, open fixation of the CMC joints and trapezoid, is recommended.

scholarly journals Management of Severely Displaced Fronto-Zygomatico-Orbital Fracture in a Child

2014 ◽  
Vol 48 (2) ◽  
pp. 103-104
Author(s):  
S Shanthanam ◽  
Sachin Rai ◽  
Satnam Singh ◽  
Akshat Gupta
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Rare Case ◽  
Multidisciplinary Approach ◽  
Orbital Fracture

ABSTRACT The paper presents a rare case of severely fractured and displaced fronto-zygomatico-orbital fracture in a 4-year-old child. The case was managed with open reduction and internal fixation. The paper highlights the importance of early and multidisciplinary approach to such craniofacial injuries. How to cite this article Singh S, Shanthanam S, Gupta A Rai S. Management of Severely Displaced Fronto-Zygomatico-Orbital Fracture in a Child. J Postgrad Med Edu Res 2014; 48(2):103-104.

scholarly journals Findings of Routine Diagnostic Ankle Arthroscopy for Management of AO 44-C Fibular Fractures

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Daniel Dean ◽  
Francis McGuigan ◽  
Nicholas Casscells
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Case Series ◽  
High Energy ◽  
Ankle Arthroscopy ◽  
Ankle Fractures ◽  
Mechanism Of Injury ◽  
Loose Bodies ◽  
Therapeutic Benefits ◽  
Articular Damage

Category: Ankle, Arthroscopy, Trauma Introduction/Purpose: High fibula fractures, including Maisonneuve and Weber type C fractures are commonly associated with syndesmotic injuries resulting in subluxation and dislocation of the ankle. These injuries to the joint are rarely evaluated or addressed during operative fixation, which generally consists of open reduction internal fixation of the fibula with or without fixation of the syndesmosis. Chondral lesions and loose bodies in ankle fractures may predict a poor result and can be addressed using arthroscopy to avoid exacerbating articular damage. The purpose of this study is to identify the frequency and severity of articular pathology in Weber C and Maisonneuve fibula fractures. Methods: A single surgeon case series of operatively managed ankle fractures with arthroscopic assessment from 2011-2015 was retrospectively reviewed. Inclusion criteria were patients with AO 44-C ankle fractures who were aged >17 and underwent arthroscopic assessment of the ankle joint prior to open reduction and internal fixation. Patients were excluded from the series if they presented <2 weeks from the time of injury, had a pilon variant, or had incomplete medical records available. Demographic information on the patients including age, sex, and BMI were collected. Information on mechanism of injury was recorded. Operative reports were reviewed and the presence of chondral injury and loose bodies was recorded. Descriptive statistics were performed on the collected data. Results: 18 patients (12 male, 6 female) with a mean age of 38.3 years (range 17-61; SD 13.9) were included in the case series. The average BMI 29.6 (SD 6.92). Five of the included fractures were Maisonneuve fractures while the remaining 13 were Weber C ankle fractures. The mechanism of injury of the fracture was low energy in 12, high energy in 1, and unknown in 5. On arthroscopic examination, 12 (66.7%) of the fractures were associated with full thickness articular cartilage injury requiring formal chondroplasty, 16 (88.9%) were associated with a minimum of partial articular damage, and only 2 (11.1%) had no articular damage identified on arthroscopy. Additionally, 12 (66.7%) had loose bodies that were removed during ankle arthroscopy. Conclusion: This study adds to a growing collection of literature concerning chondral injuries during ankle fractures. The data from this study suggest that AO 44-C fibular fractures are associated with a high rate of intraarticular pathology that can be effectively identified and managed during arthroscopy. Prospective studies are required to determine if there are therapeutic benefits to routine ankle arthroscopy in AO 44-C ankle fractures.

Predictors of Time to Union After Operative Fixation of Closed Ankle Fractures

2016 ◽  
Vol 10 (4) ◽  
pp. 308-314 ◽  
Author(s):  
Andrew P. Matson ◽  
Kamran S. Hamid ◽  
Samuel B. Adams
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Case Series ◽  
Patient Characteristics ◽  
High Energy ◽  
Delayed Union ◽  
Ankle Fractures ◽  
Patient Counseling ◽  
Chi Square ◽  
Energy Mechanism

Background. Ankle fractures are common and represent a significant burden to society. We aim to report the rate of union as determined by clinical and radiographic data, and to identify factors that predict time to union. Methods. A cohort of 112 consecutive patients with isolated, closed, operative malleolar ankle fractures treated with open reduction and internal fixation was retrospectively reviewed for time to clinical union. Clinical union was defined based on radiographic and clinical parameters, and delayed union was defined by time to union >12 weeks. Injury characteristics, patient factors and treatment variables were recorded, and statistical techniques employed included the Chi-square test, the Student’s T-test, and multivariate linear regression modeling. Results. Forty-two (37.5%) of patients who achieved union did so in less than 12 weeks, and 69 (61.6%) of these patients demonstrated delayed union at a mean of 16.7 weeks (range, 12.1-26.7 weeks), and the remaining patient required revision surgery. Factors associated with higher rates of delayed union or increased time to union included tobacco use, bimalleolar fixation, and high energy mechanism (all p<0.05). In regression analysis, statistically significant negative predictors of time to union were BMI, dislocation of the tibiotalar joint, external fixation for initial stabilization and delay of definitive management (all p<0.05). Conclusion. Patient characteristics, injury factors and treatment variables are predictive of time to union following open reduction and internal fixation of closed ankle fractures. These findings should assist with patient counseling, and help guide the provider when considering adjunctive therapies that promote bone healing. Levels of Evidence: Prognostic, Level IV: Case series

scholarly journals Open Reduction Internal Fixation versus External Fixation with Limited Internal Fixation for Displaced Comminuted Closed Pilon Fractures: A Randomised Prospective Study

2018 ◽  
Vol 24 (1) ◽  
pp. 84-89
Author(s):  
Rayan Ahmed ◽  
Kotb Ahmed ◽  
M. Elmoatasem Elhussein ◽  
Samir Shady ◽  
Tamer A. El-Sobky ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Prospective Study ◽  
Internal Fixation ◽  
External Fixation ◽  
Functional Outcomes ◽  
Open Reduction ◽  
Articular Surface ◽  
High Energy ◽  
Complication Rates ◽  
Pilon Fractures

Background Pilon fractures involve the dome of the distal tibial articular surface. The optimal treatment for high-energy pilon fractures remains controversial. Some authors advocate the use of open reduction and internal fixation (ORIF) to avoid articular incongruence. Others advocate the use of bridging external fixation with limited internal fixation (EFLIF) to reduce soft tissue complications. Literature reports of prospective studies comparing the radioclinical outcomes of ORIF and EFLIF in high-energy fractures are scarce. Retrospective studies have their limitations because of insufficient randomisation. The objective of this randomised prospective study is to compare the clinical, radiologic and functional outcomes of displaced and comminuted closed pilon fractures, Rüedi and Allgöwer type II and III, treated by either ORIF or EFLIF. Materials and Methods Forty-two patients were selected for the study. Twenty-two patients were subjected to ORIF and 20 patients were subjected to EFLIF. We used the American Orthopaedic Foot and Ankle Society score as a standard method of reporting clinical status of the ankle. Patients were followed-up clinically and radiologically for over 2 years after the surgical treatment. Results The results of ORIF and EFLIF in treatment of high-energy pilon fractures are equally effective in terms of functional outcomes and complication rates on the short term. Conclusion Soft tissue integrity and fracture comminution seem to have a significant influence on outcomes of intervention. A prospective multicentre study with a larger sample size that controls for other associated variables and comorbidities is warranted. Level of evidence Level II.

Palmar Lunate Trans-Scaphoid, Trans-Triquetral Fracture-Dislocation

1999 ◽  
Vol 24 (4) ◽  
pp. 493-496 ◽  
Author(s):  
P. HARRINGTON ◽  
W. B. QUINLAN
Keyword(s):  
Internal Fixation ◽  
Axial Compression ◽  
Open Reduction ◽  
Avulsion Fracture ◽  
High Energy ◽  
Fracture Dislocation ◽  
Compression Force ◽  
Emergency Procedure ◽  
Radial Styloid

A palmar lunate dislocation associated with fractures of the scaphoid and triquetrum and an avulsion fracture of the radial styloid is described. The injury resulted from a high energy dorsiflexion/axial compression force. Open reduction of the dislocated lunate and internal fixation of the scaphoid were done as an emergency procedure. A second operation was required to internally fix the displaced triquetral fracture and reduce the lunotriquetral dissociation. A good result was documented at 6 months.

scholarly journals Functional outcome after open reduction and internal fixation for traumatic diastasis of the pubic symphysis a one year follow-up study

2016 ◽  
Vol 2 (4) ◽  
pp. 256
Author(s):  
B. L. S. Kumar Babu ◽  
Biju Ravindran
Keyword(s):  
Internal Fixation ◽  
Functional Outcome ◽  
Open Reduction ◽  
High Energy ◽  
Walking Distance ◽  
Early Weight Bearing ◽  
Dual Plating ◽  
Pubic Diastasis ◽  
One Year

<p class="abstract"><strong>Background:</strong> Pubic diastasis often results in anteroposterior compression (APC) injuries based on Young and Burgess classification. It is caused due to high-energy trauma and of much clinical importance is given when coexists with urogenital and neurological complications with hemodynamic instability. Open reduction and internal fixation with plating facilitates early mobilisation with better results and is the preferable mode of stabilisation. We evaluated the clinical and functional outcome of such patients in a one-year follow-up period.</p><p class="abstract"><strong>Methods:</strong> In our study, we included 20 patients with APC II injuries who underwent an open reduction by single or dual plating technique by the Pfannenstiel approach, were followed for one year.<strong></strong></p><p class="abstract"><strong>Results:</strong> Among 20 patients, 14 patients (70%) were operated with single superior plating, six patients (30%) were performed with dual plating, i.e., both superior and anterior plating. Among 20 patients, two patients (10%) were operated for primary arthrodesis with double plating. Only one among 20 (5%) had implant failure due to early weight bearing and were re-operated with primary arthrodesis with plating. Results were analysed based on a scoring system which includes five criteria such as anterior pelvic pain, dyspareunia and sexual dysfunction, ability to sit, gait abnormalities and walking distance. Among 20 patients ten patients (50%) had excellent results, six patients (30%) had good results, two patients (10%) had fair results, two patients (10%) had poor results.</p><p><strong>Conclusions:</strong> Open reduction and internal fixation of traumatic pubic diastasis in type II APC injuries with single or dual plating had given better results and early functional recovery.</p>

Palmar Dislocation of the Trans-Scaphoid-Lunate Unit

1995 ◽  
Vol 20 (4) ◽  
pp. 557-560 ◽  
Author(s):  
L. EKEROT
Keyword(s):  
Internal Fixation ◽  
Bone Grafting ◽  
Open Reduction ◽  
Rare Case ◽  
Wrist Function

A rare case of total palmar trans-scaphoid-lunate dislocation is reported. Open reduction, bone grafting and internal fixation were followed by uneventful healing. At follow-up 70 months after injury there is no osteonecrosis and the wrist function is almost normal.

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