Inveterate elbow dislocation: surgical reduction with triceps lengthening

Inveterate elbow dislocations remain common in developing countries. We report the case of a 17-year-old child who consulted us after six months of trauma to the left elbow. Clinical examination revealed a deformed elbow, locked in extension with a mobility sector of 5°. The Mayo Clinic Elbow performance score was sixty-six; the downstream vasculo-nervous examination was normal. The face and profile X-ray of the elbow showed a pure posterolateral elbow dislocation. We used the posterior medial para-tricipital and lateral approach, a first stage of arthrolysis was performed. A complete reduction was achieved by progressive and non-traumatic gentle maneuvers. Intraoperative elbow flexion was less than 80°, indicating a retraction of the triceps muscle, so a Z-lengthening plasty was necessary. This reduction was then fixed with two olecranon-humeral K-wires. At the third week, the plaster cast and K-wires were removed. The patient was subsequently referred to a physical therapist. After a ten-month follow-up, an undistorted and functional elbow with a gain of twenty-one points according to the Mayo Clinic score was obtained. Surgical reduction of a neglected elbow dislocation with triceps lengthening plasty, followed by a codified physical therapy program, results in a remarkable restoration of elbow function and stability. Keyword : elbow, dislocation, inveterate, reduction, triceps.

Factors influencing surgical outcomes in orbital trapdoor fracture

This study is aimed to determine the appropriate timing of performing surgical reduction on trapdoor fractures for bringing out better visual outcomes and the factors influencing surgical outcomes in this special subgroup of fracture victims. Data for 72 patients of orbital trapdoor fracture were analyzed retrospectively. Post-operative diplopia is the main posttreatment outcome of orbital bone fracture reduction. The receiver-operating characteristic (ROC) analysis indicated the cut-off point of surgical reduction timing at day 10 post-fracture. The rate of postoperative diplopia showed a significant difference between patients who underwent surgical reduction within 10 days and those who did after 10 days of injury (5.3% vs. 38.2%). Multivariate analysis revealed that preoperative infra-duction limitation (p = 0.02), muscle incarceration (p = 0.01), duration from injury to surgical reduction (p = 0.004), and postoperative supra-duction limitation (p = 0.004) were independent factors for poor surgical outcomes. In younger patients with head injury, the diagnosis of orbital trapdoor fracture should be kept in mind. Timely recognition and surgical reduction, especially within 10 days, can result in better visual outcomes without the occurrence of postoperative diplopia.

A virtual reality simulator for training the surgical reduction of patient-specific supracondylar humerus fractures

Purpose Virtual reality has been used as a training platform in medicine, allowing the repetition of a situation/scenario as many times as needed and making it patient-specific prior to an operation. Of special interest is the minimally invasive plate osteosynthesis (MIPO). It represents a novel technique for orthopedic trauma surgery, but requires intensive training to acquire the required skills. In this paper, we propose a virtual reality platform for training the surgical reduction of supracondylar fractures of the humerus using MIPO. The system presents a detailed surgical theater where the surgeon has to place the bone fragments properly. Methods Seven experienced users were selected to perform a surgical reduction using our proposal. Two paired humeri were scanned from a dataset obtained from the Complejo Hospitalario de Jaén. A virtual fracture was performed in one side of the pair, using the other as contralateral part. Users have to simulate a reduction for each case and fill out a survey about usability, using a five-option Likert scale. Results The subjects have obtained excellent scores in both simulations. The users have notably reduced the time employed in the second experiment, being 60% less in average. Subjects have valued the usability (5.0), the intuitiveness (4.6), comfort (4.5), and realism (4.9) in a 1–5 Likert scale. The mean score of the usability survey was 4.66. Conclusion The system has shown a high learning rate, and it is expected that the trainees will reach an expert level after additional runs. By focusing on the movement of bone fragments, specialists acquire motor skills to avoid the malrotation of MIPO-treated fractures. A future study can fulfill the requirements needed to include this training system into the protocol of real surgeries. Therefore, we expect the system to increase the confidence of the trainees as well as to improve their decision making.

Intussusception Presenting as Rectal Prolapse

Intussusception is the invagination of a segment of the intestine into the lumen of the distal or proximal segment. It is one of the commonest causes of intestinal obstruction in the toddlers. Ileo-colic intussusception is the most common type. At times the inussusceptum may protrude through the anal canal and mimic a rectal prolapse. The diagnosis may be delayed in such cases leading to increase morbidity as well as mortality. Therefore, a high index of suspicion is required in such cases. In this case where a colo-colic intussusception presented like rectal prolapse. Emergency surgical reduction was carried out under general anaesthesia and the baby had a smooth recovery.

Jejunojejunal Intussusception as Initial Presentation of Coeliac Disease: A Case Report and Review of Literature

Intussusception as the initial presentation of coeliac disease has been rarely reported, with an incidence of 1% in all coeliac disease presentations. Furthermore, intussusception requiring surgical reduction as the primary presentation for coeliac disease in adults is even rarer. Presented here is a case of a 37-year-old female Asian patient who presented with abdominal pain and distension; she was diagnosed with small bowel obstruction due to jejunojejunal intussusception and required surgical reduction as the initial presentation of coeliac disease.

Acromial Fracture Associated with Coracoid Fracture Not Belong to Floating Shoulder : A Case Report

Floating shoulder is no osseoligamentous connection between the humeral shoulder joint with the axial skeleton. The osseoligamentous of shoulder joint connection compose a ring, including clavicle,acromion, coracoid, glenoid fossa, surgical or anatomical scapula neck, acromioclavicular ligament and coracolclavicular ligament. This ring is known as superior shoulder suspensory complex (SSSC). The double disruptions of this ring are recognized to create a potentially unstable anatomical situation. Thus, floating shoulder is also characterized as double or more disruptions of SSSC. Surgical reduction and fixation for the displacement of those fractures at one or more sites is recommended in previous reports. We present 2 cases of patients with acromial and coracoid displaced fractures which belong to a type of the double disruptions of SSSC, there were still osseoligamentous connection between the humeral shoulder joint with the axial skeleton. The patient’s shoulder function after nonoperative management was satisfactory.