Case report of an unusual extra-articular scapular malunion: Rare indication for surgery

2020 ◽  
pp. 175857322090655
Author(s):  
Bhanu Mishra ◽  
N Grocott ◽  
K Smith ◽  
D McClelland
Keyword(s):  
Surgical Intervention ◽  
Polar Angle ◽  
High Energy ◽  
Dorsal Side ◽  
Concomitant Injuries ◽  
Multiple Rib Fractures ◽  
Poor Outcome ◽  
Scapular Fractures ◽  
Body Fracture ◽  
Scapular Body

Introduction Scapular fractures are relatively rare injuries usually associated with high-energy trauma and multiple concomitant injuries. Most of scapular fractures do not require surgical intervention. Patient and clinical history A 42-year-old male sustained an extra-articular scapular body fracture along with multiple rib fractures with flail segments and right pneumothorax treated with intercostal drain. The scapula fracture was treated non-operatively initially, which resulted in very poor outcome. Operative intervention was planned following scans which showed a bony spike from the ventral surface impinging on the chest wall. Surgical technique Bony spur was approached from dorsal side using a three-dimensional anatomical model as a guide for accurate localization. Results The patient’s symptoms including shoulder stiffness and pain on deep inspiration settled down completely following removal of the spur. Discussion This case presents a new indication for surgical intervention in scapular body fracture which has not been published before. All the relevant measurements related to the fracture namely gleno-polar angle, lateral border offset and angulation were within published limits of indications for conservative treatment. Despite this, it resulted in poor outcome necessitating surgical intervention.

scholarly journals Fractures of the Scapula

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Pramod B. Voleti ◽  
Surena Namdari ◽  
Samir Mehta
Keyword(s):  
Surgical Treatment ◽  
Critical Role ◽  
Operative Management ◽  
Axial Skeleton ◽  
High Energy ◽  
Glenoid Fossa ◽  
Traumatic Injuries ◽  
Scapular Fractures ◽  
Force Mechanism ◽  
Scapular Body

The scapula plays a critical role in the association between the upper extremity and the axial skeleton. Fractures of the scapula account for 0.4% to 1% of all fractures and have an annual incidence of approximately 10 per 100,000 inhabitants. Scapular fractures typically result from a high-energy blunt-force mechanism and are often associated with other traumatic injuries. The present review focuses on the presentation, diagnosis, and treatment of fractures of the scapula. Indications for surgical treatment of glenoid fossa, scapular neck, and scapular body fractures are presented in detail. Finally, the authors’ preferred surgical technique, including positioning, approach, reduction, fixation, and post-operative management, is described.

scholarly journals Patterns of orthopaedic injury among hospitalised personal mobility device users and bicycle riders: a comparative study

2021 ◽  
Author(s):  
TSD Koh ◽  
YL Woo ◽  
TH Wong ◽  
MH Tan
Keyword(s):  
Orthopaedic Surgery ◽  
Surgical Intervention ◽  
High Energy ◽  
Open Fractures ◽  
Inpatient Stay ◽  
Injury Patterns ◽  
Prolonged Hospitalisation ◽  
Personal Mobility ◽  
Mobility Devices ◽  
Mobility Device

Introduction: Personal mobility devices (PMDs), such as electronic scooters or motorised bicycles, are efficient modes of transportation. Their recent popularity has also resulted in an increase in PMD-related injuries. We aimed to characterise and compare the nature of injuries sustained by PMD users and bicycle riders. Methods: This retrospective study compared injury patterns among PMD and bicycle users. 140 patients were admitted between November 2013 and September 2018. Parameters studied included patients’ demographics (e.g. age, gender and body mass index), type of PMD, nature of injury, surgical intervention required, duration of hospitalisation and time off work. Results: Of 140 patients, 46 (32.9%) patients required treatment at the department of orthopaedic surgery. 19 patients were PMD users while 27 were bicycle riders. 16 (84.2%) patients with PMD-related injuries were men. PMD users were significantly younger (mean age 45 ± 15 years) when compared to bicycle riders (mean age 56 ±17 years; p < 0.05). A quarter (n = 5, 26.3%) of PMD users sustained open fractures and over half (n = 10, 52.6%) required surgical intervention. Among 27 bicycle users, 7.4% (n = 2) of patients sustained open fractures and 70.4% (n = 19) required surgical intervention. Both groups had comparable inpatient stay duration and time off work. Conclusion: PMD-related orthopaedic traumas are high-energy injuries, with higher rates of open fractures, when compared to bicycle injuries. In addition, PMD users are significantly younger and of economically viable age. Prolonged hospitalisation and time off work have socioeconomic implications. Caution should be exercised when using PMDs.

Rib Fracture Patterns Predict Thoracic Chest Wall and Abdominal Solid Organ Injury

2010 ◽  
Vol 76 (8) ◽  
pp. 888-891 ◽  
Author(s):  
Ammar Al-Hassani ◽  
Husham Abdulrahman ◽  
Ibrahim Afifi ◽  
Ammar Almadani ◽  
Ahmed Al-Den ◽  
...  
Keyword(s):  
Chest Wall ◽  
Rib Fractures ◽  
Organ Injury ◽  
Trauma Patients ◽  
Solid Organ ◽  
Solid Organ Injury ◽  
High Association ◽  
Multiple Rib Fractures ◽  
Scapular Fractures ◽  
Sternal Fractures

Blunt trauma patients with rib fractures were studied to determine whether the number of rib fractures or their patterns were more predictive of abdominal solid organ injury and/or other thoracic trauma. Rib fractures were characterized as upper zone (ribs 1 to 4), midzone (ribs 5 to 8), and lower zone (ribs 9 to 12). Findings of sternal and scapular fractures, pulmonary contusions, and solid organ injures (liver, spleen, kidney) were characterized by the total number and predominant zone of ribs fractured. There were 296 men and 14 women. There were 38 patients with scapular fracture and 19 patients with sternal fractures. There were 90 patients with 116 solid organ injuries: liver (n = 42), kidney (n = 27), and spleen (n = 47). Lower rib fractures, whether zone-limited or overlapping, were highly predictive of solid organ injury when compared with upper and midzones. Scapular and sternal fractures were more common with upper zone fractures and pulmonary contusions increased with the number of fractured ribs. Multiple rib fractures involving the lower ribs have a high association with solid organ injury, 51 per cent in this series. The increasing number of rib fractures enhanced the likelihood of other chest wall and pulmonary injuries but did not affect the incidence of solid organ injury.

Open patellar fractures: High energy injuries with a poor outcome?

Injury ◽  
2008 ◽  
Vol 39 (4) ◽  
pp. 480-484 ◽  
Author(s):  
Sanjeev Anand ◽  
James Charles Romaine Hahnel ◽  
P.V. Giannoudis
Keyword(s):  
High Energy ◽  
Poor Outcome ◽  
Patellar Fractures

scholarly journals Fractures of the femoral head: a narrative review

2021 ◽  
Vol 6 (11) ◽  
pp. 1122-1131
Author(s):  
Maximilian M. Menger ◽  
Benedikt J. Braun ◽  
Steven C. Herath ◽  
Markus A. Küper ◽  
Mika F. Rollmann ◽  
...  
Keyword(s):  
Femoral Head ◽  
Surgical Approach ◽  
Motor Vehicle ◽  
Hip Dislocation ◽  
High Energy ◽  
Femoral Head Fracture ◽  
Concomitant Injuries ◽  
Vehicle Accidents ◽  
Joint Congruity

Fractures of the femoral head are rare injuries, which typically occur after posterior hip dislocation. The Pipkin classification, developed in 1957, is the most commonly used classification scheme to date. The injury is mostly caused by high-energy trauma, such as motor vehicle accidents or falls from a significant height. Emergency treatment consists of urgent closed reduction of the hip joint, followed by non-operative or operative treatment of the femoral head fracture and any associated injuries. There is an ongoing controversy about the suitable surgical approach (anterior vs. posterior) for addressing fractures of the femoral head. Fracture location, degree of displacement, joint congruity and the presence of loose fragments, as well as concomitant injuries are crucial factors in choosing the adequate surgical approach. Long-term complications such as osteonecrosis of the femoral head, posttraumatic osteoarthritis and heterotopic ossification can lead to a relatively poor functional outcome. Cite this article: EFORT Open Rev 2021;6:1122-1131. DOI: 10.1302/2058-5241.6.210034

scholarly journals Outcome of traumatic Extradural Hematoma (EDH) using Glasgow Outcome Scale (GOS)

2018 ◽  
Vol 5 (10) ◽  
pp. 3327
Author(s):  
Dixit V. Prajapati ◽  
Nimish J. Shah
Keyword(s):  
Traffic Accident ◽  
Surgical Intervention ◽  
Road Traffic ◽  
Extradural Hematoma ◽  
Factors Affecting ◽  
Poor Outcome ◽  
Ct Head ◽  
Lost To Follow Up ◽  
Time Of Intervention

Background: Outcome in patient with EDH depends on various factors like GCS at presentation, Volume of hematoma, time of intervention, age, location of hematoma, etc. This study was carried out to find out correlation (if any) between outcome and various factors affecting it. Aim and objectives of this study were to study outcome of patients with traumatic EDH in terms of poor outcome (GOS score 1,2,3), Good outcome (GOS Score 4,5)Methods: This study was carried out in 91 patients having positive CT Head for EDH. Follow up was done every monthly up to 3 months. GOS was recorded at each follow up. Results: Road traffic accident was the most common mode of trauma. 16 patients were operated. Four patients died immediately after diagnosis of traumatic EDH, before doing any intervention. One patient died on 1st post-operative day. After one month, two patients were lost to follow up, 80 patients had GOS 5, four patients had GOS 4. At 2nd and 3rd month, 83 patients had GOS 5, one patient had GOS 4. 17 patients had GCS 3-8, among them, 11 patients had GOS 5, one patient had GOS 4 and five patients died (GOS 1). 15 patients had GCS 9-12, among them, 15 patients had GOS 5. 57 patients had GCS 13-15, among them, 54 patients had GOS 5. 69 patients had EDH volume <30 ml and all patients had GOS 5. 20 patients had EDH volume ≥30 ml, among them, 14 patients had GOS 5, one patient had GOS 4 and five patients died. Conclusions: GOS in EDH patient is affected by GCS and EDH volume at presentation. Lower GCS and larger EDH volume have poor outcome. Surgical intervention in larger EDH volume improves outcome.

scholarly journals Talus Fractures and Concomitant Injuries Patterns

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0022
Author(s):  
Ishaq Ibrahim ◽  
Michael Ye ◽  
Jeremy Smith ◽  
John Y. Kwon ◽  
Christopher P. Miller
Keyword(s):  
Lumbar Spine ◽  
Motor Vehicle ◽  
Sports Injuries ◽  
High Energy ◽  
Associated Injuries ◽  
Concomitant Injuries ◽  
Final Study ◽  
Open Versus ◽  
Injured Patients ◽  
Serious Injuries

Category: Trauma Introduction/Purpose: Fractures of the talus are rare, but serious injuries to the hindfoot associated with high-energy mechanisms in often polytraumatized patients. The collective knowledge regarding talus injuries is lacking in many regards. Limited effort has been previously made to identify and characterize associated injuries ordinarily occurring in conjunction with fractures of the talus. The purpose of the current study was to [1] determine what associated injuries occur in high incidence in patients presenting with major fractures of the talus, and to [2] identify clinical injury patterns that warrant special attention in patients presenting with talus fractures. Methods: A retrospective review was conducted for patients with talar body or neck fractures at three level-1 academic trauma centers in Boston, MA between June 1, 2004 and June 30, 2018. Patient charts were reviewed for demographic details, injury mechanism, open versus closed injury status, and all associated orthopaedic and non-orthopaedic injuries identified during the initial patient encounter and hospitalization. Results: 253 patients met criteria for inclusion. The final study population included 158 (61%) talar neck fractures, 82 (32%) body fractures, and 18 (7%) head fractures. Falls from height, MVC/MCC, low energy falls and sports injuries were the most common mechanisms of injury in declining order. 64% of patients presenting with a talus fracture had at least one other concomitant injury. The table demonstrates the breakdown of associated injuries rates by body area. Conclusion: Talus fractures are commonly associated with injuries to different anatomic sites and systems. Trauma to the ipsilateral foot is most common necessitating complete imaging of the foot and ankle in all patients presenting with talus fractures. Trauma to the chest, abdomen, and pelvis occurred most commonly following motor vehicle trauma. Talar fractures and lumbar spine injuries was also observed frequently and underscores the importance of lumbar spine evaluation in patients presenting with major talus fractures, particularly those occurring after falls from height. This study presents valuable information to surgeons when evaluating and assessing injured patients to optimize care for patients.

scholarly journals Displaced scapular body fracture treated with operative closed reduction

2019 ◽  
Vol 47 ◽  
pp. 101234 ◽  
Author(s):  
Michael Ghassibi ◽  
Dhanunjay Sarma Boyalakuntla ◽  
Sheryl Handler-Matasar
Keyword(s):  
Closed Reduction ◽  
Body Fracture ◽  
Scapular Body

Surgical intervention and patient factors associated with poor outcomes in patients with traumatic brain injury at a tertiary care hospital in Uganda

2021 ◽  
pp. 1-10
Author(s):  
Charis A. Spears ◽  
Syed M. Adil ◽  
Brad J. Kolls ◽  
Michael E. Muhumza ◽  
Michael M. Haglund ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Low Income ◽  
Surgical Intervention ◽  
Tertiary Care ◽  
Care Hospital ◽  
Treatment Variable ◽  
Patient Factors ◽  
Poor Outcome ◽  
Poor Outcomes

OBJECTIVE The purpose of this study was to investigate whether neurosurgical intervention for traumatic brain injury (TBI) is associated with reduced risks of death and clinical deterioration in a low-income country with a relatively high neurosurgical capacity. The authors further aimed to assess whether the association between surgical intervention and acute poor outcomes differs according to TBI severity and various patient factors. METHODS Using TBI registry data collected from a national referral hospital in Uganda between July 2016 and April 2020, the authors performed Cox regression analyses of poor outcomes in admitted patients who did and did not undergo surgery for TBI, with surgery as a time-varying treatment variable. Patients were further stratified by TBI severity using the admission Glasgow Coma Scale (GCS) score: mild TBI (mTBI; GCS scores 13–15), moderate TBI (moTBI; GCS scores 9–12), and severe TBI (sTBI; GCS scores 3–8). Poor outcomes constituted Glasgow Outcome Scale scores 2–3, deterioration in TBI severity between admission and discharge (e.g., mTBI to sTBI), and death. Several clinical and demographic variables were included as covariates. Patients were observed for outcomes from admission through hospital day 10. RESULTS Of 1544 patients included in the cohort, 369 (24%) had undergone surgery. Rates of poor outcomes were 4% (n = 13) for surgical patients and 12% (n = 144) among nonsurgical patients (n = 1175). Surgery was associated with a 59% reduction in the hazard for a poor outcome (HR 0.41, 95% CI 0.23–0.72). Age, pupillary nonreactivity, fall injury, and TBI severity at admission were significant covariates. In models stratifying by TBI severity at admission, patients with mTBI had an 80% reduction in the hazard for a poor outcome with surgery (HR 0.20, 95% CI 0.04–0.90), whereas those with sTBI had a 65% reduction (HR 0.35, 95% CI 0.14–0.89). Patients with moTBI had a statistically nonsignificant 56% reduction in hazard (HR 0.44, 95% CI 0.17–1.17). CONCLUSIONS In this setting, the association between surgery and rates of poor outcomes varied with TBI severity and was influenced by several factors. Patients presenting with mTBI had the greatest reduction in the hazard for a poor outcome, followed by those presenting with sTBI. However, patients with moTBI had a nonsignificant reduction in the hazard, indicating greater variability in outcomes and underscoring the need for closer monitoring of this population. These results highlight the importance of accurate, timely clinical evaluation throughout a patient’s admission and can inform decisions about whether and when to perform surgery for TBI when resources are limited.

Sonographic visualization of a scapular body fracture: A case report

2011 ◽  
Vol 39 (8) ◽  
pp. 466-468 ◽  
Author(s):  
Bradley M. McCrady ◽  
Michael P. Schaefer
Keyword(s):  
Case Report ◽  
Body Fracture ◽  
Scapular Body
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