Unusual and nondescript type of distal clavicular fracture

Displaced fracture of the distal third of the clavicle usually occurs after direct trauma to the shoulder and typically results in superior displacement of the proximal fragment. We report a previously undescribed case of downward displacement of the clavicle caused by a fall on an outstretched hand, and we suggest the mechanism of injury.

728 Histomorphology Of the Subregions of The Scapholunate Interosseous Ligament and Its Enthesis

Introduction The scapholunate interosseous ligament (SLIL) is commonly ruptured following a fall onto the outstretched hand. This ligament has three subregions: dorsal, proximal, and volar. The SLIL enthesis, a specialised region where this ligament attaches to the scaphoid and lunate, has not previously been studied despite its important mechanical function in the wrist joint biomechanics. This study therefore aims to compare the histomorphological differences between the three SLIL subregions, including at their entheses, to inform subregion prioritisation during surgical reconstruction. Method Twelve fresh-frozen human cadaveric wrists were dissected and the gross dimensions of the SLIL subregions measured. Subregions were histologically processed for analysis, including quantification of enthesis calcified fibrocartilage (CF) area. Results From the gross measurements, the dorsal subregion was the thickest (dorsal=3.04 ± 0.26mm, volar=1.69 ± 0.08mm, proximal=1.51 ± 0.06mm). The dorsal and volar subregions had fibrocartilaginous entheses while the proximal subregion was attached to articular cartilage. The dorsal subregion had significantly more CF than the volar subregion. Conclusions The dorsal subregion is the thickest and has the greatest CF area, which is consistent with the greatest biomechanical force subjected to this subregion. These results confirm that the dorsal subregion is the strongest subregion, suggesting important implications in the study of graft incorporation during SLIL reconstruction.

Changes in Scaphoid and Lunate Position and Loading at Two Wrist Pushup Positions

Background: Scapholunate interosseous ligament (SLIL) injury following a fall on an outstretched hand may lead to carpal instability and in some cases require long-term rehabilitation following repair. Rehabilitation, especially in athletes, may include pushups, but little is known as to what type of pushup may be safer. Objective: To determine biomechanical differences between two pushup positions (neutral or extended). Methods: Six fresh cadaver wrists with pre-existing SLIL damage were uni-axially loaded in neutral and extension in order to simulate two different pushup styles. The motions of the scaphoid and lunate in relation to the radius were measured. The dorsal, proximal, and volar insertion sites of the SLIL were identified and, using the collected kinematic data, gap distances were calculated for each site. Conclusion: The larger gap distances between the scaphoid and lunate in neutral suggest that a neutral style pushup could put higher forces on a wrist with pre-existing SLIL damage and may thus hinder recovery for a person with a repaired SLIL. A pushup in extension, in these injured wrists, may be less detrimental.

Middle third clavicle fractures are the most common fractures in head injuries: a biomechanical and epidemiological study in 1000 patients

<p class="abstract">A consecutive series of 1000 cases of head injury, out of which 385 patients presented with fractures. In the 385 patients with fractures, 179 patients presented with clavicle fractures, among that, 127 are middle third fractures. Out of the 189 patients who had clavicle fractures, 90% of them had direct blow to shoulders and 10% had fallen on the outstretched hand. This variation with the mechanism of injury was further investigated by biomechanical analysis of the forces involved in clavicular fractures.</p><p class="abstract"> </p>

Bilateral Supracondylar Humerus Fracture in Pediatric after a Fall on an Outstretched Hand

Background. Supracondylar humerus fracture (SCH) is common in the pediatric age group 5-7 years, mostly due to a fall on an outstretched hand. However, a bilateral SCH is rarely observed in this age group. Management of SCH is either surgical or conservative based on the following factors: patient age, fracture pattern and neurovascular involvement. Complications of a displaced SCH can be dramatically reduced by early surgical fixation. Acute complications include: neurovascular injury and compartment syndrome, and long term complications include: stiffness, infections and angular deformities. In this article, we present a rare case of bilateral supracondylar humerus fractures with a six-months follow-up.