scholarly journals Pilon Fracture: A Case Report of a 45-Year-Old Dental Technician

2014 ◽  
Vol 8 (1) ◽  
pp. 433-436 ◽  
Author(s):  
Pouya Mafi ◽  
James Stanley ◽  
Sandip Hindocha ◽  
Reza Mafi
Keyword(s):  
Lower Extremity ◽  
External Fixation ◽  
Motor Vehicle ◽  
High Energy ◽  
Tibial Fractures ◽  
Pilon Fracture ◽  
Distal Tibial Fractures ◽  
Vehicle Accidents ◽  
Dental Technician ◽  
Fall From Height

Pilon fractures are complex and difficult-to-treat fractures of the lower extremity that account for about 1% of all lower extremity fractures and up to 10% of tibial fractures. The injury is caused by high energy axial load either from motor vehicle accidents or a fall from height. The treatment of these fractures has caused controversy among surgeons due to mixed outcomes. Here we report a case of pilon fracture in a 45 year old male patient who has sustained the injury as a result of a fall from a height of approximately 12 feet. We describe why it is absolutely crucial that the patient is treated with external fixation initially and evaluate its merits and drawbacks as well as ways to minimize the complications associated with external fixation of open intra-articular distal tibial fractures.

scholarly journals Using External Fixation in distal tibial fractures- good principle, debatable application- Case presentation

2018 ◽  
Vol 1 (2) ◽  
pp. 60-66
Author(s):  
Olivera Lupescu ◽  
Mihail Nagea ◽  
Alina Grosu ◽  
Alexandru Dimitriu ◽  
Gheorghe Ion Popescu ◽  
...  
Keyword(s):  
Soft Tissue ◽  
External Fixation ◽  
Recovery Period ◽  
Soft Tissue Injuries ◽  
High Energy ◽  
Tibial Fractures ◽  
Distal Tibial Fractures ◽  
Definitive Method ◽  
Tissue Injuries

Abstract Distal tibial fractures usually result from high-energy trauma, affecting young, active people, producing long-term disability and numerous complications. Their treatment is difficult, especially in type C fractures, which affect both the articular surface and the metaphysis, are quite frequent comminuted fractures, and are accompanied by soft tissue injuries. In these situations, External Fixation (EF) is used as a temporary bridging method, either for treating concomitant soft tissue injuries (in open fractures) or for achieving and maintaining reduction in order to prevent blisters or compartment syndrome, possibly resulting from severe displacement, bleeding or oedema. It must be however underlined that EF is rarely a definitive method for these fractures, especially when the ankle is splinted, and it must be followed by definitive Internal Fixation (IF) - the so-called “sequential method”, otherwise restoration of a normal ankle anatomy and function is improbable, resulting in ankle stiffness or even osteoarthritis. This paper presents a case in which this principle was only partially applied, thus requiring corrective surgery followed by a long-term recovery period.

scholarly journals Low-Energy Multiligament Knee Injuries Are Associated With Higher Postoperative Activity Scores Compared With High-Energy Multiligament Knee Injuries: A Systematic Review and Meta-analysis of the Literature

2020 ◽  
pp. 036354652096208
Author(s):  
Robert S. Dean ◽  
Nicholas N. DePhillipo ◽  
David H. Kahat ◽  
Nathan R. Graden ◽  
Christopher M. Larson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Motor Vehicle ◽  
Meta Analysis ◽  
Knee Injuries ◽  
High Energy ◽  
Low Energy ◽  
Vehicle Accidents ◽  
Injury Mechanisms ◽  
Outcome Scores ◽  
Multiligament Knee Injuries

Background: Multiligament knee injuries (MLKIs) can result from high-energy injury mechanisms such as motor vehicle accidents or low-energy injury mechanisms such as activities of daily living or sports. Purpose/Hypothesis: The purpose was to conduct a systematic review on postoperative patient-reported outcomes after MLKIs and to conduct a meta-analysis of comparable outcome variables based upon high- versus low-energy injury mechanisms. It was hypothesized that MLKIs with low-energy injury mechanisms would demonstrate significantly improved subjective clinical outcome scores compared with high-energy injuries. Study design: Meta-analysis and systematic review. Methods: A systematic review was performed with the inclusion criteria of postoperative MLKI outcomes based upon high-versus low-energy mechanisms of injury with a minimum 2-year follow-up. Outcome scores included were the Lysholm knee scoring scale, Tegner activity scale, and the International Knee Documentation Committee (IKDC) score. High-energy mechanisms included motor vehicle accidents or falls from a height >5 feet; low-energy mechanisms included sports-related injuries, activities of daily living, or falls from <5 feet. A meta-analysis was performed comparing the outcome scores of high- versus low-energy mechanisms of MLKIs. Results: Overall, 1214 studies were identified, 15 of which were included in the systematic review and meta-analysis. Thirteen studies included surgical reconstructions of all injured ligaments. A total of 641 patients with 275 high-energy and 366 low-energy injuries were grouped for comparison in the meta-analysis. No significant differences in Lysholm scale (78.6 vs 78.0) or IKDC scores (69.0 vs 68.4) were found between high- and low-energy groups at a minimum of 2 years (range, 2-10 years) postoperatively ( P > .05). The low-energy injury group demonstrated significantly higher Tegner activity scale scores (5.0 vs 3.9; P = .03). There was no significant difference in failure rates between groups (3.5% vs 2.0%; P = .23). Conclusion: We found in this systematic review and meta-analysis that patients with low-energy mechanisms of MLKI surgery had improved postoperative Tegner activity scores compared with those patients with high-energy mechanisms after MLKI surgery. However, there were no differences in Lysholm score, IKDC score, or failure rates between high- and low-energy MLKI patients at an average of 5.3 years postoperatively.

RhBMP-7 accelerates the healing in distal tibial fractures treated by external fixation

2007 ◽  
Vol 89-B (2) ◽  
pp. 265-272 ◽  
Author(s):  
J. Ristiniemi ◽  
T. Flinkkilä ◽  
P. Hyvönen ◽  
M. Lakovaara ◽  
H. Pakarinen ◽  
...  
Keyword(s):  
External Fixation ◽  
Tibial Fractures ◽  
Distal Tibial Fractures

scholarly journals Surgical treatment of disloced fracture of the scapula column and glenoid: A 22-year follow-up

2015 ◽  
Vol 72 (2) ◽  
pp. 181-184 ◽  
Author(s):  
Desimir Mladenovic ◽  
Marko Mladenovic ◽  
Predrag Stojiljkovic ◽  
Ivan Micic ◽  
Sasa Karalejic
Keyword(s):  
Surgical Treatment ◽  
Motor Vehicle ◽  
Clavicle Fracture ◽  
Humeral Fracture ◽  
Lateral Part ◽  
Scapular Fracture ◽  
Vehicle Accidents ◽  
Scapular Fractures ◽  
Intraarticular Fractures ◽  
Fall From Height

Introduction. Most scapular fractures are caused by highimpact blunt injuries, often as the result of motor vehicle accidents, fall from height, etc. In 80% to 90% of cases, scapula fractures are associated with multiple injuries (clavicle fracture, rib fractures, humeral fracture, pulmonary injury, brachial plexus injury). Case report. We presented scapular fracture in a 27-years-old male who had sustained a workrelated injury when a ground soil brick machine pressed him. Fracture line was identified on radiotherapy and computed tomography scan from the distal scapular angle enclosing scapular neck. The whole lateral part of the scapula was dislocated laterally from the scapular body. Scapular fracture was treated operatively. The posterior approach was used for reposition, while for fixation after reposition we used two Blunt clamps. We presented functional outcome 22 years after the injury and the surgical treatment. The patient can perform all physical activities, still works, and there is no need to remove the ostheosynthetic material as it causes no discomfort nor problems. The strength of the shoulder muscles is estimated as physician as the grade 5. Conclusion. Displaced intraarticular fractures of the scapula should be treated operatively, with open reduction and internal fixation.

scholarly journals Distal tibial fracture treated by minimally invasive plate osteosynthesis after external fixation Retrospective clinical and radiographic assessment

2014 ◽  
Vol 20 (1) ◽  
pp. 44-49
Author(s):  
Șerban Al. ◽  
Obadă B. ◽  
Turcu R. ◽  
Anderlik St. ◽  
Botnaru V.
Keyword(s):  
Internal Fixation ◽  
External Fixation ◽  
Ankle Joint ◽  
Plate Osteosynthesis ◽  
Weight Bearing ◽  
Distal Tibia ◽  
Tibial Fractures ◽  
Minimally Invasive Plate Osteosynthesis ◽  
Surgical Trauma ◽  
Distal Tibial Fractures

ABSTRACT Fractures of the horizontal surface of the distal tibia are known commonly as pylon or plafond fractures, and represent 1-5% of lower extremity fractures, 7-10% of all tibial fractures. The protocol consisted of immediate (within eight to 24 hours) open reduction and internal fixation of the fibula, using a fibular plate or one third tubular plate and application of an external fixator spanning the ankle joint. In the second stage, the treatment of proximal and distal tibial fractures with close reduction and MIPPO technique can preserve soft tissue, simplify operative procedure and decrease wound, obtain rigid internal fixation and guarantee early function exercises of ankle joint. In this study we evaluated 22 patients treated in Clinical Emergency Hospital Constanta between April 2012 - July 2013 diagnosed with multifragmentary fractures of the distal tibia. This study evaluates the treatment of complex fractures of distal tibia with locked plate after external fixation. There were 17 males and 5 females of mean age 51,7 years (31-68). The mean follow-up period was 14 weeks. (Ranging from 9-16 weeks). All patients were fully weight bearing at 16 weeks (ranging 9-16 weeks) showing radiological union. There were no cases of failures of fixation, or rotational misalignment. No significant complication was observed in our patients. MIPO is an effective method of treatment for distal tibial fractures, reduce surgical trauma and maintain a more biologically favorable environment for fracture healing, reducing risks of infection and nonunion.

Ankle spanning external fixator with limited internal fixation for distal tibial extra-articular fractures

2017 ◽  
Vol 5 (10) ◽  
pp. 4355
Author(s):  
Siddharth Goel ◽  
Abhay Elhence
Keyword(s):  
Soft Tissue ◽  
Internal Fixation ◽  
External Fixation ◽  
External Fixator ◽  
Tibial Fractures ◽  
Fixation Method ◽  
Ankle Pain ◽  
Distal Tibial Fractures ◽  
Tract Infections

Background: Fractures of the distal tibia are among the most difficult fractures to treat. The short distal segment presents difficulty in choosing the appropriate fixation method. The greatest challenge lies in the relatively tight soft tissue around the ankle. As a result, it has been a recent interest in treating these fractures with external fixation and limited internal fixation. The external stable fixation methods used are tubular or ring fixators, with or without immobilising the ankle. This minimally invasive nature of the surgery can avoid catastrophic wound complications like dehiscence, implant exposure and infection.Methods: 18 patients with extra-articular distal tibial fractures (AO Type 43A) were treated with the technique of ankle spanning external fixation. Lag screws or K-wires were supplemented for limited internal fixation when required. Fibula was stabilised in all cases. Intra- articular and Compound fractures were excluded. In addition to union at fracture site, ankle pain and motion was noted in each follow-up.Results: The mean follow-up was 25 months. Of the 18 patients included all but one fractures united with an average healing time of 16 to 18 weeks. Ankle pain and motion was graded according to Mazur modified by Teeny and Wiss clinical scoring system. 15 of them had excellent or good results, 2 had fair results. One patient had poor result. Five pin tract infections occurred. 17 patients had no evidence of osteoarthritis after completing follow up of at least 2 years.Conclusions: Distal tibial fractures are complex injuries, not only regarding the bony component, but also in terms of the management of the soft tissue problem. Ankle Spanning External Fixator with Limited Internal fixation is a relatively simple and cost-effective method for treating these fractures, achieving union and also maintaining ankle function.

scholarly journals Renal trauma: the current best practice

2018 ◽  
Vol 10 (10) ◽  
pp. 295-303 ◽  
Author(s):  
Tomer Erlich ◽  
Noam D. Kitrey
Keyword(s):  
Renal Injury ◽  
Best Practice ◽  
Motor Vehicle ◽  
Penetrating Trauma ◽  
High Energy ◽  
Renal Trauma ◽  
Common Mechanism ◽  
Trauma Patients ◽  
Vehicle Accidents ◽  
Enhanced Computed Tomography

The kidneys are the most vulnerable genitourinary organ in trauma, as they are involved in up to 3.25% of trauma patients. The most common mechanism for renal injury is blunt trauma (predominantly by motor vehicle accidents and falls), while penetrating trauma (mainly caused by firearms and stab wound) comprise the rest. High-velocity weapons impose specifically problematic damage because of the high energy and collateral effect. The mainstay of renal trauma diagnosis is based on contrast-enhanced computed tomography (CT), which is indicated in all stable patients with gross hematuria and in patients presenting with microscopic hematuria and hypotension. Additionally, CT should be performed when the mechanism of injury or physical examination findings are suggestive of renal injury (e.g. rapid deceleration, rib fractures, flank ecchymosis, and every penetrating injury of the abdomen, flank or lower chest). Renal trauma management has evolved during the last decades, with a distinct evolution toward a nonoperative approach. The lion’s share of renal trauma patients are managed nonoperatively with careful monitoring, reimaging when there is any deterioration, and the use of minimally invasive procedures. These procedures include angioembolization in cases of active bleeding and endourological stenting in cases of urine extravasation.

Two-ring Hybrid External Fixation of Distal Tibial Fractures: A Review of 47 Cases

2007 ◽  
Vol 62 (1) ◽  
pp. 174-183 ◽  
Author(s):  
Jukka Ristiniemi ◽  
Tapio Flinkkil?? ◽  
Pekka Hyv??nen ◽  
Martti Lakovaara ◽  
Harri Pakarinen ◽  
...  
Keyword(s):  
External Fixation ◽  
Tibial Fractures ◽  
Distal Tibial Fractures ◽  
Hybrid External Fixation

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

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