A Fixed, Unreducible, Unstable Medial Swivel Dislocation of the Talonavicular Joint with Associated Navicular Fracture

A 32-year-old white male was on a second-story balcony when he fell off and landed on the cement below. With initial X-rays being read as negative on the radiology report due to the subtle nature of the injury, the patient was promptly diagnosed with a medial swivel dislocation by the orthopaedic team, which ended up being fixed, unstable, and irreducible. The patient also had acute skin compromise and needed to be taken to the operating room prior to progression of skin breakdown. This dislocation pattern is a rare variant, especially when paired with the fixed nature of the dislocation and the soft tissue compromise. In the end, open treatment was necessary in order to reduce the talonavicular joint. Because of early recognition and prompt treatment, skin breakdown was avoided. Internal screw fixation of the fractured navicular bone was needed along with K-wire insertion to hold the normal anatomy of the talonavicular joint reduced. All hardware was ultimately removed after healing, and anatomy was restored with excellent patient function. This case report highlights the orthopaedic knowledge needed to not only recognize this rare fracture-dislocation pattern but to also treat it promptly when encountered.

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Faculty Opinions recommendation of Internal screw fixation compared with bipolar hemiarthroplasty for treatment of displaced femoral neck fractures in elderly patients.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.3001957.2680056 ◽

2010 ◽

Author(s):

Nicola Maffulli ◽

Nikolaos Gougoulias

Keyword(s):

Femoral Neck ◽

Elderly Patients ◽

Screw Fixation ◽

Femoral Neck Fractures ◽

Bipolar Hemiarthroplasty ◽

Displaced Femoral Neck Fractures ◽

Internal Screw

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AB0771 Osteoporosis as A Prognostic Factor for Surgery Treatment Failure in Hip Fracture Patients Treated with Internal Screw Fixation:

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2016-eular.4444 ◽

2016 ◽

Vol 75 (Suppl 2) ◽

pp. 1168.2-1168

Author(s):

Ø. Berg ◽

G. Haugeberg ◽

A. Diamantopoulos

Keyword(s):

Hip Fracture ◽

Prognostic Factor ◽

Treatment Failure ◽

Screw Fixation ◽

Internal Screw

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Rehabilitation Strategies in Management of Complex Case of Cervical Burst Fracture- A Case Report

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i59a34265 ◽

2021 ◽

pp. 205-208

Author(s):

Rishika H. Gabada ◽

Pooja Kasatwar ◽

Chaitanya A. Kulkarni

Keyword(s):

Ct Scan ◽

Vertebral Body ◽

Motor Vehicle ◽

Burst Fracture ◽

Compression Fracture ◽

Complex Case ◽

Fracture Dislocation ◽

X Rays ◽

Spinal Compression ◽

Spinal Compression Fracture

A burst fracture is a descriptive term for an injury to the spine in which the vertebral body is severely compressed. They typically occur from severe trauma, such as a motor vehicle accident or a fall from a height. With a great deal of force vertically onto the spine, a vertebra may be crushed .If it is only crushed in the front part of the spine, it becomes wedge shaped and is called a compression fracture. However, if the vertebral body is crushed in all directions it is called a burst fracture. Burst fractures cause severe pain. The diagnosis of a burst fracture is usually made by x-rays and a CT scan. Occasionally, an MRI scan may be ordered as well, in order to assess the amount of soft tissue trauma, bleeding or ligament disruption. The review of the CT scan and x-rays allows the treating physician to make a determination as to the level of the fracture, whether it is a compression fracture, burst fracture or fracture dislocation. A spinal compression fracture also may be caused by trauma to the spine. Events that may cause trauma to the spine can include: A car accident, a hard fall or a fall from a height of more than 15 feet, landing on the feet, and a blow to the head. Any fall from a standing height that results in a spinal compression fracture or any other fracture most likely indicates weak bones due to osteoporosis. The physical exam should be performed to document both spinal deformity, that is, angulation of the spine or tenderness of the spine at the level of fracture, as well as, a neurologic exam. Neurologic exam should include testing of the muscle strength, sensation, and reflexes of the lower extremities, as well as, testing of bowel and bladder sphincter control. A 36 year old man was brought to the hospital as he had a fall from electric pole approximately 20 feet height. He had sustaining injury to the neck. Surgery was done as patient was diagnosed with C6 burst fracture with fracture dislocation of C5-C7. Therapeutic Interventions includes exercises, strengthening exercises, cervical fracture fixation, and traction.

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Radiostereometric Analysis Of Biceps Tenodesis: A Comparison Of Techniques

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00122 ◽

2020 ◽

Vol 8 (3_suppl2) ◽

pp. 2325967120S0012

Author(s):

Kelechi Okoroha ◽

Brandon J. Manderle ◽

Alexander Beletsky ◽

Adam Blair Yanke ◽

Brian J. Cole ◽

...

Keyword(s):

Screw Fixation ◽

Biceps Tendon ◽

Similar Amount ◽

X Rays ◽

Biceps Tenodesis ◽

Radiostereometric Analysis ◽

Arthroscopic Technique ◽

Distal Migration ◽

Long Head ◽

Anchor Fixation

Objectives: Arthroscopic biceps tenodesis (BT) is a common surgical procedure for treatment of anterior shoulder pain due to long head of the biceps pathology. BT can be accomplished via several different techniques. There continues to be a paucity of literature comparing the different techniques and fixation devices. The purpose of this study was to compare 4 different techniques for accomplishing a BT utilizing radiostereometric analysis. Methods: This study was a prospectively enrolled non-randomized trial of patients undergoing BT. All patients were treated at a single institution by 1 of 4 surgeons. Four different techniques were analyzed, 1) open BT with screw fixation, 2) open BT with single anchor fixation, 3) arthroscopic BT with screw fixation, and 4) arthroscopic BT with two suture anchor fixation. After the BT was completed a tantalum bead was sewn to the long head of the biceps tendon. This bead acted as a marker of the position of the biceps tendon. X-rays were taken during surgery while the patient remained sedated to establish time zero bead position. Follow up x-rays were completed at the patients 1st post-operative visit and 12 week post-operative visit. Position of the bead was measured at each time point in mm from the proximal most point of the humerus to its position distally. Results: A total of 60 patients were included in the analysis, with 15 patients in each of the 4 groups. Final bead position differed significantly for the open and arthroscopic techniques (107.35±20.39mm, 65.64±23.69mm, p<0.001), but did not differ significantly between the two open techniques and the two arthroscopic technique (p>0.05). The open technique resulted in 7.69±5.98mm of distal migration while the arthroscopic technique resulted in a similar amount of distal migration, 8.93±2.71mm. Conclusion: Short-term radiographic outcomes following open and arthroscopic biceps tenodesis revealed that each technique results in stable fixation of the tendon with minimal migration. Although a statistically significant migration occurred, this is likely clinically insignificant. This initial migration observed could be due to increased tensioning of the tendon when the patient is awake versus sedated.

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COMPARISON OF PROPHYLACTIC IN-SITU SCREW FIXATION VERSUS OBSERVATION OF THE ASYMPTOMATIC CONTRALATERAL HIP IN SLIPPED CAPITAL FEMORAL EPIPHYSIS (SCFE)

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00140 ◽

2019 ◽

Vol 7 (3_suppl) ◽

pp. 2325967119S0014

Author(s):

Brian Haus ◽

Lauren Agatstein ◽

Akash R. Patel ◽

Alton W. Skaggs ◽

Jennette Boakes

Keyword(s):

Operative Time ◽

Screw Fixation ◽

Treatment Options ◽

Hip Pain ◽

X Rays ◽

Estimated Blood Loss ◽

Significant Difference ◽

Length Of Hospitalization ◽

Unilateral Group

BACKGROUND: Prophylactic fixation of the asymptomatic, radiographically-normal contralateral hip after unilateral (SCFE) is controversial. Children with unilateral SCFE whose contralateral hip is observed are at risk for having a contralateral slip and associated complications such as avascular necrosis (AVN). On the other hand, prophylactic pinning may be an unnecessary surgery that may also result in substantial complications. A comparison of the two treatment options has not been performed. This study seeks to compare the outcomes and nature of complications of patients whose contralateral hip was observed with those whose hip underwent prophylactic in-situ screw fixation. METHODS: We retrospectively reviewed 197 patients treated for a unilateral SCFE over 20 years between the 1997 and 2017 at two hospitals. Medical records and x-rays were reviewed, and variables of interest included age, sex, body mass index (BMI), Modified Oxford Bone Age Score (MOBA) at presentation, length of operation, estimated blood loss (EBL), and length of hospitalization. Additionally, postoperative complications/outcomes such as reoperation in the unaffected hip, pain in the unaffected hip, AVN, chondrolysis, infection. abnormal gait (limp), reslipped epiphysis (growth off of the implanted screw), degenerative joint disease, and development of a limb length discrepancy were recorded. RESULTS: Of the 197 total patients (mean age 11.8) treated for unilateral SCFE, 100 (51%) received prophylactic fixation of their unaffected, contralateral hip and 97 (49%) were observed. Average follow up was 24.5 months. A statistically significant difference was found between groups for age, MOBA Score, EBL, and operative time. No difference was found between groups for BMI, BMI %ile, and length of hospitalization. The unilateral group was older (p<0.001) and had a greater MOBA Score (p=0.006) compared to the prophylactic group (Table 1). Patients in the prophylactic group had greater EBL during surgery (p=0.004) and longer operative time (p<0.001) compared to the unilateral group. In those patients whose contralateral hip was observed, 19% developed a contralateral SCFE which required later in-situ fixation. Amongst those, 2/19 (10%) developed AVN or chondrolysis of the contralateral hip (2% overall). For the contralateral hip, 17/97 (17%) developed hip pain, 10/97 (10%) developed a leg length difference and 24/97 (24%) developed a limp. In those patients who had prophylactic fixation, for the contralateral hip 2/100 (2%) developed AVN, (3/100) 3% required reoperation, 1/100 (1%) developed an infection, 10/100 (10%) developed contralateral hip pain, 4/100 (4%) developed a LLD, and 26/100 (26%) developed a limp. CONCLUSIONS: Surgeons and patients should be able to compare outcomes when deciding whether or not to prophylactically fix the asymptomatic contralateral hip in SCFE. For patients with unilateral SCFE, there are similar rates of AVN (2%) of the asymptomatic contralateral hip whether the hip is prophylactically pinned or observed. Between the two treatment options, there are similar outcomes for length of hospital stay, EBL, rate of infection and development of a limp. There is a higher rate of a LLD and the need for another operation in patients whose contralateral asymptomatic hip is observed, rather than prophylactically pinned. [Table: see text]

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Invasive Group A Streptococcal Infections Among People Who Inject Drugs and People Experiencing Homelessness in the United States, 2010–2017

Clinical Infectious Diseases ◽

10.1093/cid/ciaa787 ◽

2020 ◽

Author(s):

Sandra J Valenciano ◽

Jennifer Onukwube ◽

Michael W Spiller ◽

Ann Thomas ◽

Kathryn Como-Sabetti ◽

...

Keyword(s):

Risk Factors ◽

People Who Inject Drugs ◽

Early Recognition ◽

The United States ◽

Streptococcal Toxic Shock Syndrome ◽

Infection Rates ◽

Invasive Group ◽

Average Percentage ◽

Skin Breakdown ◽

Group A

Abstract Background Reported outbreaks of invasive group A Streptococcus (iGAS) infections among people who inject drugs (PWID) and people experiencing homelessness (PEH) have increased, concurrent with rising US iGAS rates. We describe epidemiology among iGAS patients with these risk factors. Methods We analyzed iGAS infections from population-based Active Bacterial Core surveillance (ABCs) at 10 US sites from 2010 to 2017. Cases were defined as GAS isolated from a normally sterile site or from a wound in patients with necrotizing fasciitis or streptococcal toxic shock syndrome. GAS isolates were emm typed. We categorized iGAS patients into four categories: injection drug use (IDU) only, homelessness only, both, and neither. We calculated annual change in prevalence of these risk factors using log binomial regression models. We estimated national iGAS infection rates among PWID and PEH. Results We identified 12 386 iGAS cases; IDU, homelessness, or both were documented in ~13%. Skin infections and acute skin breakdown were common among iGAS patients with documented IDU or homelessness. Endocarditis was 10-fold more frequent among iGAS patients with documented IDU only versus those with neither risk factor. Average percentage yearly increase in prevalence of IDU and homelessness among iGAS patients was 17.5% and 20.0%, respectively. iGAS infection rates among people with documented IDU or homelessness were ~14-fold and 17- to 80-fold higher, respectively, than among people without those risks. Conclusions IDU and homelessness likely contribute to increases in US incidence of iGAS infections. Improving management of skin breakdown and early recognition of skin infection could prevent iGAS infections in these patients.

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