Rarely seen radial nerve total injury with humerus supracondylar type IIIA open fracture in a child: Our five-year follow-up results

The clinical presentation of a proximal femoral fracture is completely different between young and adult patients. Unlike closed proximal femoral fractures, the incidence of exposed fractures is found in the young population between 15 and 30 years of age. Osteonecrosis of the femoral head is one the complications we can find in this type of fractures. Avascular necrosis (AVN or osteonecrosis) is defined as the interruption of blood supply to the femoral head due to trauma, infectionalcohol or steroid use, resulting in bone necrosis, joint collapse and osteoarthrosis. The treatment will depend on the clinical presentation, age of the patient and when the diagnosis is made. This is a case report of a 16-year-old patient with a gunshot wound on the hip. Surgical cleansing and closed reduction plus internal fixation with a nail in the center of the spine were performed. A 3-year clinical and radiographic follow up was made, observing the evolution of the fracture and the subsequent avascular necrosis that the patient presented. Key words: Proximal femoral fracture; hip; avascular necrosis (AVN, osteonecrosis); open fracture; osteoarthritis.

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Radial Nerve Palsy following Endovascular Embolization of an Arteriovenous Malformation

Journal of Wrist Surgery ◽

10.1055/s-0037-1607422 ◽

2017 ◽

Vol 07 (03) ◽

pp. 258-261

Author(s):

Ram Alluri ◽

Anuj Mahajan ◽

Alidad Ghiassi ◽

Venus Vakhshori

Keyword(s):

Peripheral Nerve ◽

Radial Nerve ◽

Nerve Palsy ◽

Case Reports ◽

Endovascular Embolization ◽

Careful Consideration ◽

Radial Nerve Palsy ◽

Direct Compression ◽

Endovascular Techniques

Background Arteriovenous malformations (AVMs) are commonly treated using endovascular techniques. Previous nerve palsies after embolization have been reported as isolated case reports, none of which affected the forearm. Case Description A case of acute, transient neuropathy of the radial nerve following embolization of a forearm AVM is described. The patient, an otherwise healthy 27-year-old man, began having symptoms of superficial radial nerve (SRN) and posterior interosseous nerve (PIN) palsies immediately following endovascular embolization. He underwent decompression of the radial nerve within 5 days and was found to have direct compression of the PIN and SRN. The patient recovered completely at the time of his 7-month follow-up. Literature Review Few cases of nerve palsy after endovascular embolization have been reported in the literature. Many are intracranial, but rare instances of peripheral nerve palsy have been reported, including two sciatic nerve and four digital nerve palsies after endovascular embolization. No cases of peripheral nerve palsy in the forearm have been reported. Clinical Relevance We recommend careful consideration of surrounding neural elements at risk for palsy prior to endovascular embolization and detailed discussion with the patient during the informed consent process.

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Internal Trauma, Humeral Fracture, and Radial Nerve Paralysis: How Could it Occur in the Sport Setting? A Case Report and Review of the Literature

Advances in Bioscience and Clinical Medicine ◽

10.7575/aiac.abcmed.v.8n.1p.1 ◽

2020 ◽

Vol 8 (1) ◽

pp. 1

Author(s):

Elghoul Naoufal ◽

Elantri Ismail ◽

Bouya Ayoub ◽

Bennis Azzelarab ◽

Zaddoug Omar ◽

...

Keyword(s):

Radial Nerve ◽

Full Range ◽

Humeral Fracture ◽

Imaging Findings ◽

Review Of The Literature ◽

Significant Morbidity ◽

Nerve Paralysis ◽

Pathologic Fractures ◽

Type Of Fracture

Thrower’s fractures are Spiral fractures of the humerus in the ball. They represent very uncommon clinical entities that can simulate pathologic fractures. Moreover, the concomitant neurologic deficient is rare. Herein we report a 27 years old muscular man presented a spiral fracture of the humerus following a forceful throw of the ball during an amateur throwing challenge. Clinical and imaging findings showed a displaced Thrower fracture with radial nerve neurapraxia (known as Holstein Lewis fracture) prompting the patient to undergo surgery. The intraoperative aspect found that the nerve was near to the beveled distal humeral fragment with no incarceration. We performed an internal fixation using the Leicester plate and the nerve was kept away from the plate by the interposition of a soft tissue sheet. At the last follow up, the fracture united and radial nerve neurapraxia resolved and the patient regained the full range of motion of his right upper limb with no pain. In conclusion, although this type of fracture is rare, given their significant morbidity, we emphasize that the reactional throwers should undergo appropriate preseason training before practicing a throwing challenge or generally a throwing sport.

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Simultaneous Symmetrical Bilateral Bimalleolar Open Fracture with Ankle Dislocation by Indirect Injury – Case Study

Ortopedia Traumatologia Rehabilitacja ◽

10.5604/01.3001.0011.5880 ◽

2018 ◽

Vol 20 (1) ◽

pp. 51-55

Author(s):

Asif Sultan ◽

Maajid Shabir ◽

Mufti Mehmood ◽

Qazi Waris Manzoor

Keyword(s):

Coming Out ◽

Open Fracture ◽

Operative Management ◽

Probable Mechanism ◽

Distal Fibula ◽

Indirect Trauma ◽

Free Function ◽

Indirect Injury

A rare case of symmetrical open bimalleolar fractures with bilateral dislocation of ankles is described. A 30-year-old man sustained indirect trauma working in squatting position with a heavy log of wood falling on his knees with ankles in inversion, and sustained symmetrical open III B bimalleolar fractures with dislocation of bilateral ankles with the distal fibula coming out of the skin. The patient underwent operative management on bilateral ankles and the post-operative course was uneventful. The patient had no complaints at 4 years’ follow-up and had a full, pain-free function. The probable mechanism of the fracture is discussed.

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Eighteen-year follow-up after rotationplasty for a grade IIIC open fracture of the distal femur

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-012-1671-8 ◽

2012 ◽

Vol 133 (3) ◽

pp. 351-355 ◽

Cited By ~ 1

Author(s):

M. Petri ◽

M. Omar ◽

H. Horstmann ◽

S. Brand ◽

C. Krettek

Keyword(s):

Open Fracture ◽

Distal Femur

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Biceps-to-Triceps Transfer in Tetraplegia

Journal of Hand Surgery (European Volume) ◽

10.1054/jhsb.1998.0184 ◽

1999 ◽

Vol 24 (2) ◽

pp. 235-237 ◽

Cited By ~ 53

Author(s):

M. REVOL ◽

E. BRIAND ◽

J. M. SERVANT

Keyword(s):

Range Of Motion ◽

Nerve Injury ◽

Radial Nerve ◽

Elbow Flexion ◽

Active Range Of Motion ◽

The Mean ◽

Radial Nerve Injury

Eight tetraplegic patients (13 elbows) were treated by biceps-to-triceps transfer. To avoid the risk of radial nerve injury, we chose a medial routing of the biceps. The mean follow-up after surgery was 17.8 months (range, 4–47 months). No complications were encountered. Active extension of the elbow was achieved in each case. The mean postoperative active range of motion of the elbow was 6° extension and 137° flexion. After the biceps-to-triceps transfer mean extension torque of the elbow was 3.7 Nm and mean flexion torque was 10 Nm. In eight elbows in which it was measured, there was a 47% reduction in elbow flexion power. Nevertheless no patient complained about that reduction, and all of them were satisfied.

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Radical treatment of severe open fractures of extremities by orthoplastic surgery: a 10-year retrospective study

10.21203/rs.3.rs-114827/v1 ◽

2020 ◽

Author(s):

Zhao Yang ◽

Chao Xu ◽

Yong-Gang Zhu ◽

Jun Li ◽

Zi-Xiang Wu ◽

...

Keyword(s):

Soft Tissue ◽

Open Fracture ◽

Aesthetic Surgery ◽

Open Fractures ◽

Soft Tissue Reconstruction ◽

Central Unit ◽

Chinese Characteristics ◽

Tissue Reconstruction ◽

The Mean

Abstract Orthoplastic treatment based on the collaboration of orthopedic and plastic surgeons in an “orthoplastic” central unit has been recommended by the British Association of Plastic Reconstructive and Aesthetic Surgery. However, this approach is not used worldwide especially in most developing countries. Based on the aggressive orthoplastic management, orthoplastic experience with Chinese characteristics has been carried out in last 10 years. The clinical data of 41 consecutive patients with severe open fracture (Gustilo IIIb or IIIc) of the limb, who underwent successful surgical debridement, fixation, and soft tissue reconstruction in one stage between January 2008 and April 2019, were retrospectively reviewed. Postoperative indicators, including infection rate and union time, were acquired by a regular follow-up and analyzed. The mean (±SD) age of the patients was 38±16 years. The soft tissue cover was achieved within 72 h. The overall rate of infection was 14.6% (6/41). Sex and the Mangled Extremity Severity Score were associated with infection. The median union time of 40 patients (one amputation) was 32 weeks. The overall rate of infection exhibited a lower tendency in this study. These results indicated that the single-stage radical orthoplastic treatment was an effective and reliable option for reconstructing severe open fractures.

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Treatment of open fracture of shaft of tibia-fibula Gustilo type III-B by SIGN interlocking nail and wound coverage by muscle flap within 72 hours of injury

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20173931 ◽

2017 ◽

Vol 3 (5) ◽

pp. 898

Author(s):

Ayub Ali ◽

Mizanur Rahman ◽

Sajedur Reza Faruquee ◽

Tazul Islam ◽

Zamil Zaidur Rahim ◽

...

Keyword(s):

Open Fracture ◽

Young Patients ◽

Muscle Flap ◽

Tibial Shaft Fracture ◽

Bacteriological Study ◽

Wound Coverage ◽

Wound Debridement ◽

Interlocking Nail ◽

Type Iii

Background: The open fracture of tibia-fibula Gustilo type III-B may threaten the survival of the injured leg. The objective of the study purpose was to see the effect of early coverage following fixation of open tibial shaft fracture.Methods: This clinical trial was carried out in National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka from July 2004 to June 2006 for a period of two (2) years. Patients at age group of 18 years or above with both sexes presented with open fracture shaft of tibia-fibula Gustilo type III-B were selected as study population. The patients were surgically managed by SIGN Interlocking nail and wound coverage by muscle flap within 72 hours of injury. Bacteriological study of the wound was done in all cases. All fixation and coverage were performed within 72 hours of injury. Patients grading improved on subsequent follow up. Evaluation of results was done at every post-operative follow up.Results: A total number of 12 young patients with open fracture tibia-fibula Gustilo III-B were recruited for this study. Their age varies from 18 years to 48 years. A total number of 83.33% cases wound debridement was done within 12 hours of injury. Most of the soft tissue healed (91.67%) within 0 to 20 days. There were no cases developed limb length discrepancy angulations or rotation. Superficial infections were occurred in 1(8.33%) case but no evidence of deep infection. In this study excellent result were obtained from 9 cases (75%), good results were found in 2 cases (16.67%), fair results from 1 case (8.33%). Conclusions: In conclusion early intramedullary fixation and exposed bone coverage by muscle flap is very important for prevention of infection, minimizing bone death simultaneously enhances bone healing.

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Irreparable Radial Nerve Palsy Due to Delayed Diagnostic Management of a Giant Lipoma at the Proximal Forearm Resulting in a Triple Tendon Transfer Procedure: Case report and Brief Review of Literature

The Open Orthopaedics Journal ◽

10.2174/1874325001711010794 ◽

2017 ◽

Vol 11 (1) ◽

pp. 794-803 ◽

Cited By ~ 2

Author(s):

Ingo Schmidt

Keyword(s):

Functional Recovery ◽

Radial Nerve ◽

Tendon Transfer ◽

Nerve Palsy ◽

Radial Nerve Palsy ◽

Patient Reported ◽

Diagnostic Management ◽

Giant Lipoma ◽

Proximal Forearm

Background: Non-traumatic radial nerve palsy (RNP) caused by local tumors is a rare and uncommon entity. Methods: A 62-year-old female presented with a left non-traumatic RNP, initially starting with weakness only. It was caused by a benign giant lipoma at the proximal forearm that was misdiagnosed over a period of 2 years. The slowly growth of the tumor led to an irreparable overstretching-related partial nerve disruption. For functional recovery of the patient, a triple tendon transfer procedure had to be performed. Results: Four months after surgery, the patient was completely able to perform her activities of daily living again. At the 10-months follow-up, strength of wrist extension, thumb's extension and abduction, and long fingers II-V extension had all improved to grade 4 in Medical Research Council scale (0-5). In order to restore motion, the patient reported that she would undergo the same triple tendon transfer procedure a second time where necessary. Due to the initially misdiagnosed tumor, there was an overall delayed duration of time for functional recovery of the patient. Conclusion: The triple tendon transfer procedure offers a useful and reliable method to restore functionality for patients sustaining irreparable RNP. However, it must be noted critically with our patient that this procedure probably would have been avoided. Initially, there was weakness only by entrapment of the radial nerve. RNP caused by local tumors are uncommon but known from the literature, and so it should be considered generally in differential diagnosis of non-traumatic RNP.

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Efficacy of Antibiotic Laden Collagen Sponge In Treating Open Fracture

IIUM Medical Journal Malaysia ◽

10.31436/imjm.v17i1.842 ◽

2018 ◽

Vol 17 (1) ◽

Author(s):

Kularaj Subramaniam ◽

Aminuddin Che Ahmad

Keyword(s):

Internal Fixation ◽

Open Fracture ◽

Female Gender ◽

Blood Parameters ◽

Collagen Sponge ◽

Open Fractures ◽

Predisposing Factor ◽

Observational Cohort ◽

Grade 3

Introduction: Open fractures are known as a major predisposing factor for a higher incidence of infection. The aim of this study was to assess the efficacy of antibiotic impregnated collagen sponge in reducing the risk of infection in open fractures Grade 3. Materials and Methods: This was an observational cohort study, evaluating the incidence of infection in open fractures of the femur Grade 3A/3B following insertion of gentamicin impregnated collagen sponge (Collatamp®) during definitive fracture fixation. Eryhtrocyte Sedimentation Rate (ESR) and total white count (TWC) were used as blood parameters to observe for the possibility of infection from pre-operatively up to follow up visits at the clinic. Results: A total number of 36 patients, whom had sustained open fracture of the femur Grade 3A/B, underwent internal fixation with antibiotic impregnated collagen sponge insertion. Overall, ESR and TWC in both male and female gender were downgoing trend, with p values of <0.001, and clinically there was no evidence of infection. No infection was identified in 97.2% of patients, following the internal fixation and antibiotic impregnated collagen sponge insertion. There was only one patient (2.8%) who developed infection following the definitive internal fixation and antibiotics impregnated collagen sponge insertion. Conclusion: The use of antibiotic impregnated collagen sponge in open fractures reduced the occurrence of infection. Furthermore, this allows for an uncomplicated union of the bone following definitive fixation.

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