A novel technique for stabilising sacroiliac joint dislocation using spinal instrumentation: technical notes and clinical outcomes

Purpose Currently, sacroiliac joint dislocations, including crescent fracture–dislocations, are treated using several techniques that have certain issues. We present the technical details and clinical outcomes of a new technique, anterior sacroiliac stabilisation (ASIS), performed using spinal instrumentation. Methods ASIS is performed with the patient in a supine position via the ilioinguinal approach. The displacements are reduced and fixed by inserting cancellous screws from the sacral ala and iliac brim; the screw heads are bridged using a rod and locked. We performed a retrospective review of patients with iliosacral disruption who underwent ASIS between May 2012 and December 2020 at two medical facilities. The patients were assessed for age, sex, injury type, associated injuries, complications, functional outcome by evaluating the Majeed pelvic score after excluding the sexual intercourse score and fracture union. Results We enrolled 11 patients (median age: 63 years). The median operative time was 195 min, median blood loss was 570 g, and eight patients (72.3%) required blood transfusion. The sacral and iliac screws had a diameter of 6.0–8.0 mm and 6.2–8.0 mm, and a length of 50–70 mm and 40–80 mm, respectively. Bone union was achieved with no marked loss of reduction in the median follow-up period of 12 months in all cases. The median Majeed score at the final follow-up was 85/96. Conclusion ASIS is a rigid internal fixation method that provides angular stability. Despite invasiveness issues compared to iliosacral screw fixation, this method is easy to confirm and achieves precise reduction.

Extension-Block Pinning for Unstable Dorsal Proximal Interphalangeal Joint Fracture-Dislocations: A Simple, Percutaneous Technique With Reproducible Outcomes

Background: Proximal interphalangeal (PIP) joint fracture-dislocations can be technically challenging injuries to treat, and no technique has proven to be superior nor lead to predictably good outcomes. We describe our experience of treating unstable dorsal fracture-dislocations of the PIP joint with extension-block pinning (EBP) at our institution over a 22-year period. Methods: In all, 23 patients with 24 unstable dorsal fracture-dislocations of the PIP joint treated with EBP between January 1998 and October 2020 were identified. All patients underwent closed reduction of the PIP joint and insertion of a Kirschner wire into the proximal phalanx, creating a mechanical block. Range of motion and joint congruity were assessed at final clinic follow-up. Long-term function was assessed via completion of a Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire. Spearman’s correlation coefficient was utilized to assess if any association existed between treatment delay, pin-in-body days, or amount of articular surface involved and QuickDASH score. Results: Mean range of motion at final follow-up was 83.3° and 22 of 24 PIP joints demonstrated a congruent reduction. In all, 15 of the 23 patients completed the QuickDASH questionnaire at a median long-term follow-up of 57.5 months (range: 3-157 months). Average QuickDASH score was 18.8, indicating minimal long-term disability. No statistically significant associations were found between treatment delay, pin-in-body days, or amount of articular surface involved and QuickDASH score. Conclusions: EBP offers a simple and innovative method to treat a complex injury of the PIP joint. It is technically straightforward and cheap, and produces excellent functional outcomes with minimal long-term disability.

Restoration of neglected fracture dislocation hip in elderly: a case report

<p class="abstract">Neglected traumatic fracture dislocation of the hip is a challenging problem due to soft tissue contractures, adhesions, fibro fatty tissue filling acetabulum, avascular necrosis, arthritis and myositis ossificans. These types of injury often get missed at initial evaluation in the presence of distracting injuries and in poly trauma patients. Femoral head fractures account for only 7-16% of all hip fracture dislocations, with combined femoral head and acetabular fractures in elderly being even lower. Literature favours primary hip replacement as compared to hip salvage in age above 60 years and in patients with neglected hip fracture dislocations of more than 3 months duration due to high chances of afore mentioned complications. Here, we report a case of 69 years old male with neglected hip fracture dislocation associated with posterior acetabular wall and femoral head fracture for the challenges in management with a total hip replacement.</p>

Volar plating versus external fixation for unstable dorsal fracture-dislocations of the proximal interphalangeal joint

We retrospectively compared the results of volar plating and dynamic external fixation for acute unstable dorsal fracture-dislocations of the proximal interphalangeal joint with a depressed fragment. We treated 31 patients (31 fingers), 12 with volar buttress plating and 19 with dynamic external fixation. Follow-up averaged 35 and 40 months in the two groups, with a minimal 6-month follow-up. Average active flexion of the proximal interphalangeal joint was 95° after plate fixation and 87° after external fixation, with an active extension lag of –6° and –9°, respectively. Active flexion at the distal interphalangeal joint averaged 67° in the plate group and 58° in the external fixation group, with active extension lags of 0° and –5°, respectively. We conclude that both methods can obtain a good range of motion at the proximal interphalangeal joint. A limitation of the extension of the distal interphalangeal joint occurred with dynamic external fixation but not with volar buttress plating. Level of evidence: IV

Neglected acetabular fracture with hip dislocation in a 34-year-old subject treated with total hip arthroplasty: our experience

Neglected hip fracture-dislocations are rare but still possible clinical situations, especially in developing countries. Some authors described skeletal traction and open reduction with internal fixation as a treatment for the abovementioned conditions. Despite the poor literature about this topic, total hip arthroplasty (THA) may be a feasible option in the treatment of neglected hip fracture-dislocations. We present a case of a 34-year-old Moroccan man reporting a 1-year neglected acetabular fracture with hip dislocation successfully treated with THA. The patient showed a significant improvement of pain, range of motion and his quality of life at 45 days. Our experience shows how a neglected acetabular fracture with hip dislocation can be successfully treated with THA. Considering the complexity of these cases, an accurate preoperative planning is mandatory and the prosthetic components’ choice must be customised to the patient.

Coracoid Osteotomy, Greater Tuberosity Take Down and Latarjet Procedure for Missed Bilateral Locked Anterior Shoulder Fracture-Dislocations in a Young Man

Introduction:It is rare to see chronic bilateral anterior fracture-dislocations as a result of seizure, and we present a case of this type and review of the literature. Despite the signs and symptoms of shoulder dislocation being well documented, and X-ray imaging being good at identifying such pathology, there are a few cases in the literature of missed or chronic shoulder dislocation (a shoulder that has been dislocated for more than 3 weeks) but these are extremely rare. Our case represents the first example of chronic bilateral locked anterior fracture-dislocations requiring open reduction and coracoid osteotomy with GT takedown to gain adequate exposure and allow soft tissue release to facilitate joint reduction. No other case has used anchors to achieve GT fixation, and our patient is the youngest published case with such pathology. Case Report: A 16-year-old boy presented to the emergency department with reduced range of movements in both shoulders. Six weeks prior he had suffered an epileptic seizure. X-rays confirmed bilateral anterior shoulder dislocations with displaced greater tuberosity (GT) fractures. Staged open reduction was performed in the right and then left shoulder. Coracoid osteotomy with takedown of the malunited GT fracture was needed to assist with gradual soft tissue contracture release and a successful relocation. Latarjet procedure was then performed and the GTs were fixed using rotator cuff anchors. At 6 months post-operation, on the right side, he achieved forward flexion to 150o and abduction to 120o. On the left side, forward flexion was 110o and abduction was 90o. X rays showed satisfactory maintenance of the reduction without signs of avascular necrosis of the humeral head. Conclusions: Surgical management of this injury in this way is effective and achieves good results in the first 6 months of follow up. A high index of suspicion should be employed for this injury in post-ictal patients with shoulder pain. Early mobilization and