Case report: A complete lower cervical fracture dislocation without permanent neurological impairment.

BACKGROUND: Complete fractures and dislocations of the lower cervical spine are usually associated with severe spinal cord injury. However, a very small number of patients do not have severe spinal cord injury symptoms, patients with normal muscle strength or only partial nerve root symptoms, known as "lucky fracture dislocation". The diagnosis and treatment of such patients is very difficult. Recently, we successfully treated one such patient. CASE PRESENTATION: A 73-year-old male patient had multiple neck and body aches after trauma, but there was sensory movement in his limbs. However, preoperative cervical radiographs showed no significant abnormalities, and computed tomography (CT) and magnetic resonance imaging (MRI) confirmed complete fracture and dislocation of C7. Before operation, the halo frame was fixed traction, but the reduction was not successful. Finally, the fracture reduction and internal fixation were successfully performed by surgery. The postoperative pain of the patient was significantly relieved, and the sensory movement of the limbs was the same as before. Two years after surgery, the patient's left little finger and ulnar forearm shallow sensation recovered, and the right flexion muscle strength basically returned to normal. CONCLUSION: This case suggests that when patients with trauma are encountered in the clinic, they should be carefully examined, and the presence of cervical fracture and dislocation should not be ignored because of the absence of neurological symptoms or mild symptoms. In addition, positioning during handling and surgery should be particularly avoided to increase the risk of paralysis.

[Trans-scapho-perilunar fracture-dislocation: a case report]. / Fractura-luxación transescafo-perilunar: reporte de un caso clínico.

Trans-scaphoid perilunate fractures-dislocations are rare injuries caused by high-energy trauma of the wrist. Diagnosis is based on medical history, physical examination, and tools such as radiographs, computed tomography scan, and magnetic resonance imaging. Early treatment consists of closed reduction and casting to stabilize the limb. Definitive treatment is surgical and includes bone and soft tissue repair. A case of trans-scaphoid perilunate fracture-dislocation is presented, along with diagnosis, management and outcome.

Las fracturas-luxaciones transescafo-perilunares son lesiones infrecuentes causadas por impactos de alta energía hacia la muñeca. El diagnóstico se basa en la historia clínica, exploración física y herramientas como la radiografía, la tomografía computarizada y la resonancia magnética. El manejo inmediato consiste en una reducción cerrada e inmovilización para estabilizar la extremidad. El tratamiento definitivo es de carácter quirúrgico e incluye la reparación ósea y de tejidos blandos. Se presenta un caso de fractura-luxación transescafo-perilunar, su diagnóstico, manejo y evolución.

A Review on Volar Fracture-Dislocations of the Proximal Interphalangeal Joint.

Volar fracture-dislocations of the proximal interphalangeal joint are rare injuries caused by an axial force on a flexed digit resulting in an avulsion fracture of the dorsal lip of the middle phalanx with volar dislocation of the joint. This volar subtype is analogous to the more common dorsal subtype with a mirror image fracture on the dorsal lip of the middle phalanx. The main significance in this type of injury lies in the disruption of the extensor mechanism at the central slip. The goals of treatment, apart from restoring a congruent and stable joint, is to restore the extensor mechanism to prevent a boutonnière deformity. In this article, we summarise the current literature and discuss the principles for treatment of this uncommon injury. Level of Evidence: Level V (Therapeutic).

The Safety of Volar to Dorsal Percutaneous Screw Fixation of Bennett Fracture-Dislocation - A Cadaveric Study.

Background: Bennett fractures are traditionally fixed with percutaneous K-wires from dorsal to volar, or with a volar to dorsal screw via a volar open approach. While volar to dorsal screw fixation is biomechanically advantageous, an open approach requires extensive soft tissue dissection, thus increasing morbidity. This study aims to investigate the practicality and safety of Bennett fracture fixation using a percutaneous, volar to dorsal screw, particularly with regard to the median nerve and its motor branch during wire and screw insertion. Methods: Fifteen fresh frozen forearm and hand specimens were obtained from the University of Auckland human cadaver laboratory. A guidewire is placed under image intensifier from volar to dorsal with the thumb held in traction, abduction and pronation. The wire is passed through the skin volarly under image intensifier, then the median nerve is dissected from the carpal tunnel and the motor branch of the median nerve (MBMN) is dissected from its origin to where it supplies the thenar musculature. The distance between the K-wire to the MBMN is measured. Results: In 14 of 15 specimens, the wire was superficial and radial to the carpal tunnel. The mean distance to the origin of the MBMN is 6.2 mm (95% CI 4.1-8.3) with the closest specimen 1 mm away. The mean closest distance the wire gets to any part of the MBMN is 3.7 mm (95% CI 1.6-5.8); in two specimens, the wire was through the MBMN. Conclusions: Wire placement, although done under image intensifier, is subject to significant variation in exiting location. While research has shown the thenar portal in arthroscopic thumb surgery is safe, our guidewire needs to exit further ulnar to capture the Bennett fracture fragment, placing the MBMN at risk. This cadaveric study has demonstrated the proposed technique is unsafe for use.

Fracture Dislocation of the Pisiform Bone in 14-Year-Old Boy-A Case Report.

We present the case of a 14-year-old patient who suffered fracture dislocation of the pisiform bone (PB) along with fractures of the scaphoid, proximal radius, and proximal phalanx of the thumb due to high-energy trauma directly to the extended wrist. This combination of fractures has not been previously reported in the literature. Currently, there is no consensus in the literature regarding the optimal treatment approach for such cases. In our management, initial attempts at closed and open reduction were unsuccessful, leading to the decision for primary pisiformectomy. Our report includes a follow-up of 3.5 years, demonstrating a very good outcome. Based on this case and a few similar published cases, primary pisiformectomy appears to be a viable and well-accepted option, particularly among young patients. Additionally, we conducted a review of radiographic criteria and management strategies for this specific injury and related conditions.

Primary Arthrodesis versus Open Reduction and Internal Fixation for Lisfranc Joint Fracture-Dislocations in Adults: A Systematic Review.

BACKGROUND: The Lisfranc joint is an intricate podiatric medical structure that when injured can prove difficult to treat. No consensus has been established on optimal surgical management for this injury. It is widely debated whether open reduction and internal fixation or primary arthrodesis provides better outcomes for patients. Although literature has been published on this subject, no generalized guidelines have been created. The goal of this study was to analyze high-level meta-analyses to draw conclusions about surgical interventions for Lisfranc joint injuries. METHODS: A literature review was conducted to analyze outcomes of meta-analyses from January 1, 2016, to August 31, 2021. Only high-level evidence that reported at least one of the following outcomes was included: American Orthopaedic Foot and Ankle Society scale score, visual analog scale score, total complication rate, hardware removal rate, revision surgery rate, and secondary procedure rate. RESULTS: Six articles met the inclusion and exclusion criteria and were then analyzed. For all of the outcome measures, primary arthrodesis was equal or superior to open reduction and internal fixation. CONCLUSIONS: We recommend primary arthrodesis over open reduction and internal fixation for adult Lisfranc injuries.

Primary total talus arthroplasty for Hawkins type IV talar neck fracture dislocation.

A woman in her 40s was involved in a motor vehicle collision and sustained a closed Hawkins type IV talar neck fracture dislocation. The injury was treated with reduction, percutaneous pinning and spanning external fixation, followed by definitive treatment with total talus arthroplasty (TTA) 2 months following injury. This is a unique example of definitive management for a severe talar neck fracture dislocation with arthroplasty in the subacute setting. TTA is perhaps a primary option for these injuries at high risk for avascular necrosis, non-union, malunion and post-traumatic arthritis.

Tripolar Dislocation: Elbow Terrible Triad-Essex-Lopresti Injury-Trans-scaphoid Perilunate Dislocation: A Case Report.

CASE: A 23-year-old man presented with a right upper limb injury after a 10-m fall. Initial evaluation demonstrated a terrible triad elbow injury associated with a trans-scaphoid perilunate dislocation. Elbow stabilization with radial head replacement and carpal fixation was performed. Radiographs on postoperative day 7 demonstrated an ipsilateral Essex-Lopresti injury, which had been initially missed, and revision surgery was performed to reconstruct the interosseous membrane. CONCLUSION: Surgeons should maintain a high degree of suspicion for an ipsilateral Essex-Lopresti injury in patients with a terrible triad elbow fracture-dislocation in combination with a trans-scaphoid perilunate dislocation. Both preoperative imaging, including the contralateral side, and intraoperative evaluation are recommended to rule out longitudinal instability of the forearm in the setting of combined wrist and elbow fracture-dislocations.

Chopart dislocations: a review of diagnosis, treatment and outcomes.

INTRODUCTION: Chopart injuries can be allocated into 4 broad groups, ligamentous injury with or without dislocation and fracture with or without dislocation, which must occur at the talonavicular joint (TNJ) and/or calcaneocuboid joint (CCJ). Chopart dislocations are comprised of pure-dislocations and fracture-dislocations. We aim to review the literature, to enable evidence-based recommendations. METHODS: A literature search was conducted to identify relevant articles from the electronic databases, PubMed, Medline and Scopus. The PRISMA flow chart was used to scrutinise the search results. Articles were screened by title, abstract and full text to confirm relevance. RESULTS: We identified 58 papers for analysis, 36 case reports, 4 cohort studies, 4 case series and 14 other articles related to the epidemiology, diagnosis, treatment and outcomes of Chopart dislocations. Diagnostic recommendations included routine imaging to contain computed tomography (CT) and routine examination for compartment syndrome. Treatment recommendations included early anatomical reduction, with restoration and maintenance of column length and joint congruency. For both pure-dislocations and fracture-dislocations urgent open reduction and internal fixation (ORIF) provided the most favourable long-term outcomes. CONCLUSIONS: Chopart dislocations are a complex heterogenous midfoot injury with historically poor outcomes. There is a relative paucity of research discussing these injuries. We have offered evidence-based recommendations related to the clinical and surgical management of these rare pathologies.

Comparison of temporary external and percutaneous k-wire fixations for treatment of ankle fracture-dislocations.

PURPOSE: Ankle fracture-dislocations are among the most severe injuries, and the use of an external fixator as a recommended fixation method has some disadvantages. The aim of this study was to compare the clinical outcomes and complication rates of external and K-wire fixations in the treatment of ankle fracture dislocations. METHODS: A total of 67 patients with ankle fracture-dislocations requiring temporary external or percutaneous K-wire fixation were included. The exclusion criteria were pilon fractures, open fractures, and those who required acute open reduction internal fixation (ORIF). The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, a 10-point visual analog scale (VAS) score (range 0-10), and complications before and after the definitive surgery were recorded. RESULTS: A significant difference between the two groups was not observed for age, sex, affected side, fracture type, smoking status, or diabetes. The average AOFAS scores were 83.2 and 83.3, the median VAS scores were 3 and 3, and the complication rates were 32.4% and 6.7% in the external and K-wire fixation groups, respectively (p = 0.010). However, skin necrosis, re-dislocation of the ankle, surgical wound infection, and posttraumatic ankle osteoarthritis frequency were not significantly different between the groups, except for pin-sites infection (p = 0.036). CONCLUSION: Ankle fracture-dislocations using percutaneous k-wire fixation showed a low rate of complications and favorable clinical outcomes. This method could be a good alternative treatment option for ankle fracture-dislocations.

Variable Adjustment Methods for Hemihamate Autograft Arthroplasty in Proximal Interphalangeal Joint Fracture/Dislocations: A Surgical Technique Revisited and Case Series.

ABSTRACT: Proximal interphalangeal joint fracture/dislocations, even after surgical correction, often lead to long-term complications including posttraumatic arthritis, prolonged joint stiffness, and chronic joint instability. A wide range of surgical techniques has been devised to resolve this issue, but none has been promising enough. Despite this circumstance, arthroplasty using a hemihamate autograft of size and contour that match the middle phalangeal base has progressed into one of more acceptable methods that provide both articular congruency and osseous stability. In this article, we introduce various types of proximal interphalangeal joint fracture/dislocations and individualized surgical approach using hemihamate autograft and lag screw and/or hook plate as fixation methods.

Proximal interphalangeal joint dislocations and fracture-dislocations.

Although proximal interphalangeal joint dislocations are generally straightforward to treat, fracture-dislocations are among the most difficult hand injuries to manage. Fracture patterns range from simple to treat palmar plate avulsion fractures to complex, unstable pilon fractures of the base of the middle phalanx, where achieving adequate reduction and fixation can be extremely difficult. Moreover, these fractures may present sub-acutely or chronically, which greatly adds to the complexity of the case. It is therefore no surprise that clinical results vary and are often difficult to predict. We will discuss the clinical presentations, the various dislocation and fracture-dislocation patterns, treatment options and the complications of these injuries.

[Radiocarpal dislocations and fracture dislocations]. / Radiokarpale Luxationen und Luxationsfrakturen.

Radiocarpal dislocations and fracture dislocations are rare but always severe and complex injuries. They occur frequently in young and active patients as a result of high energy accidents. A detailed clinical and imaging examination and an accurate classification leads to a suitable and mostly surgical treatment strategy. The strategy should consider the most important components of the injury, the bony, the ligamentous and the intracarpal lesions. Delayed sequelae, residual pain and functional impairment are frequent after these severe injuries, but with adequate treatment, good, even long-term functional results are possible.

A coronoid-centric classification system of proximal trans-ulnar fracture-dislocations has almost perfect intraobserver and interobserver agreement.

BACKGROUND: Fracture-dislocations of the elbow, particularly those that involve a fracture through the proximal ulna, are complex and can be difficult to manage. Moreover, current classification systems often cannot discriminate between Monteggia-variant injury patterns and trans-olecranon fracture-dislocations, particularly when the fracture involves the coronoid. The Mayo classification of proximal trans-ulnar fracture-dislocations categorizes these fractures into 3 types according to what the coronoid is still attached to: trans-olecranon fracture-dislocations (the coronoid is still attached to the ulnar metaphysis); Monteggia-variant fracture-dislocations (the coronoid is still attached to the olecranon); and ulnar basal coronoid fracture-dislocations (the coronoid is not attached to either the olecranon or the ulnar metaphysis). The purpose of this study was to evaluate the intraobserver and interobserver agreement of the Mayo classification system when assessing elbow fracture-dislocations involving the proximal ulna based on radiographs and computed tomography scans. METHODS: Three fellowship-trained shoulder and elbow surgeons and 2 fellowship-trained orthopedic trauma surgeons blindly and independently evaluated the radiographs and computed tomography scans of 90 consecutive proximal trans-ulnar fracture-dislocations treated at a level I trauma center. The inclusion criteria included subluxation or dislocation of the elbow and/or radioulnar joint with a complete fracture through the proximal ulna. Each surgeon classified all fractures according to the Mayo classification, which is based on what the coronoid remains attached to (ulnar metaphysis, olecranon, or neither). Intraobserver reliability was determined by scrambling the order of the fractures and having each observer classify all the fractures again after a washout period ≥ 6 weeks. Interobserver reliability was obtained to assess the overall agreement between observers. κ Values were calculated for both intraobserver reliability and interobserver reliability. RESULTS: The average intraobserver agreement was 0.87 (almost perfect agreement; range, 0.76-0.91). Interobserver agreement was 0.80 (substantial agreement; range, 0.70-0.90) for the first reading session and 0.89 (almost perfect agreement; range, 0.85-0.93) for the second reading session. The overall average interobserver agreement was 0.85 (almost perfect agreement; range, 0.79-0.91). CONCLUSION: Classifying proximal trans-ulnar fracture-dislocations based on what the coronoid remains attached to (olecranon, ulnar metaphysis, or neither) was associated with almost perfect intraobserver and interobserver agreement, regardless of trauma vs. shoulder and elbow fellowship training. Further research is needed to determine whether the use of this classification system leads to the application of principles specific to the management of these injuries and translates into better outcomes.

Comparison of plaster cast and open reduction internal fixation in delayed fourth and fifth carpometacarpal fracture-dislocations.

OBJECTIVES: This study aims to compare the clinical, radiological, and functional outcomes of the late-presenting ulnar carpometacarpal (CMC) joint injuries treated conservatively with plaster cast versus treated surgically with open reduction internal fixation (ORIF). PATIENTS AND METHODS: Between May 2019 - October 2021, a total of 28 patients (26 males, 2 females; mean age: 32.2±10.3 years; range, 20 to 59 years) who were treated conservatively or surgically were retrospectively analyzed. Fourteen patients operated with ORIF were included in the first group (surgery group), and 14 patients followed conservatively with a plaster cast were included in the second group (conservative group). The patients were classified according to Cain's classification and the AO Foundation and Orthopedic Trauma Association (AO/OTA) classification. The patients were evaluated in terms of pulp palm distance (PPD), Visual Analog Scale (VAS), Disabilities of the Arm, Shoulder and Hand (DASH) score, grip strength, time to return to work, follow-up time, and presence of complications. RESULTS: No significant difference was found in terms of the pain and functional scores. In the conservative group, the grip strength of the injured side was significantly lower than the healthy side (p=0.0093). The patients with and without metacarpal fracture subluxation/dislocation were evaluated separately, and the grip strength of the fractured side in the subluxation/dislocation group was found to be significantly higher in the surgery group than the conservative group (p=0.0237). In the group with subluxation/dislocation, the recovery time increased, as the time to treatment increased. In three patients in the conservative group, the PPD values were 2, 3, and 4 mm, respectively while it was 0 mm for all in the surgery group. CONCLUSION: The non-bridging dorsal buttress plate technique with or without a Kirschner wire is effective in patients with delayed ulnar CMC fracture-dislocations. Although surgery is associated with longer time to return to work, long-term results obtained with anatomical reduction of the joint are satisfactory for manual workers.

Reverse Hemi-Hamate Autograft for Volar Proximal Interphalangeal Joint Fracture-Dislocations.

Volar proximal interphalangeal joint fracture-dislocations are rare injuries. Treatment is challenging when they are not identified acutely, with poor outcomes reported. We report a surgical technique to treat chronic volar proximal interphalangeal joint fracture-dislocations: a reverse hemi-hamate autograft.

Two-staged management of ankle fracture-dislocations with a posterior fragment: computer-tomography-based classification, treatment and its outcome.

INTRODUCTION: Trimalleolar fractures are difficult to treat and malreduction can lead to functional impairment. Involvement of the posterior malleolus has a poor predictive value. Current computed-tomography (CT)-based fracture classifications led to an increase in fixation of the posterior malleolus. The aim of this study was to describe the functional outcome after a two-stage stabilisation with direct fixation of the posterior fragment in trimalleolar dislocation fractures. MATERIALS AND METHODS: In a retrospective study, all patients presenting with a trimalleolar dislocation fracture, an available CT scan, and a two-stage operative stabilisation including the posterior malleolus by a posterior approach were included. All fractures were treated with initial external fixator and delayed definitive stabilisation including fixation of the posterior malleolus. Next to clinical and radiological follow-up, outcome measures (Foot and Ankle Outcome Score (FAOS), Numeric Rating Scale (NRS), Activity of Daily Living (ADL), Hulsmans implant removal score) and complications were analysed. RESULTS: Between 2008 and 2019, of 320 trimalleolar dislocation fractures, 39 patients were included. Mean follow-up was 49 months (standard deviation (SD) 29.7, range 16-148). Mean age was 60 years (SD 15.3, 17-84) with 69% female patients. The mean FAOS was 93/100 (SD 9.7, 57-100), NRS 2 (interquartile range (IQR) 0-3) and ADL 2 (IQR 1-2). Four patients showed a postoperative infection, three re-operations had to be performed and implants were removed in 24 individuals. CONCLUSION: A two-stage procedure of trimalleolar dislocation fractures with in-direct reduction and fixation of the posterior tibial fragment through a posterior approach leads to good functional outcome scores with a low rate of complications.

Establishing a Consensus Definition of a Knee Fracture-Dislocation (Schenck Knee Dislocation V) Using a Global Modified Delphi Method.

BACKGROUND: Knee fracture-dislocations are complex injuries; however, there is no universally accepted definition of what constitutes a fracture-dislocation within the Schenck Knee Dislocation (KD) V subcategory. The purpose of this study was to establish a more precise definition for fracture patterns included within the Schenck KD V subcategory. METHODS: A series of clinical scenarios encompassing various fracture patterns in association with a bicruciate knee ligament injury was created by a working group of 8 surgeons. Utilizing a modified Delphi technique, 46 surgeons from 18 countries and 6 continents with clinical and academic expertise in multiligamentous knee injuries undertook 3 rounds of online surveys to establish consensus. Consensus was defined as ≥70% agreement with responses of either "strongly agree" or "agree" for a positive consensus or "strongly disagree" or "disagree" for a negative consensus. RESULTS: There was a 100% response rate for Rounds 1 and 2 and a 96% response rate for Round 3. A total of 11 fracture patterns reached consensus for inclusion: (1) nondisplaced articular fracture of the femur; (2) displaced articular fracture of the femur; (3) tibial plateau fracture involving the weight-bearing surface (with or without tibial spine involvement); (4) tibial plateau peripheral rim compression fracture; (5) posterolateral tibial plateau compression fracture, Bernholt type IIB; (6) posterolateral tibial plateau compression fracture, Bernholt type IIIA; (7) posterolateral tibial plateau compression fracture, Bernholt type IIIB; (8) Gerdy's tubercle avulsion fracture with weight-bearing surface involvement; (9) displaced tibial tubercle fracture; (10) displaced patellar body fracture; and (11) displaced patellar inferior pole fracture. Fourteen fracture patterns reached consensus for exclusion from the definition. Two fracture patterns failed to reach consensus for either inclusion or exclusion from the definition. CONCLUSIONS: Using a modified Delphi technique, this study established consensus for specific fracture patterns to include within or exclude from the Schenck KD V subcategory. LEVEL OF EVIDENCE: Prognostic Level V . See Instructions for Authors for a complete description of levels of evidence.

Fracture-dislocation of the radiocarpal joint: bony and capsulo-ligamentar management, outcomes and long-term complications.

PURPOSE: Radiocarpal dislocation fractures (RCDF) are rare injuries that usually occur in a violent trauma setting. Our work aimed to analyze our patients' functional and radiological results after surgery and identify potential medium- and long-term complications while reviewing other series previously reported in the literature. METHODS: We have performed a retrospective study over five years at our university hospital, eleven patients were selected, and the mean follow-up was about 33 months. We used Dumontier's and Moneim's classifications for classifying the injuries. All the patients underwent surgery followed by cast immobilization. The QuickDash score and Green O'Brien score modified by Cooney were used to assess the functional result, while the radiological result was judged on standard wrist radiographs. RESULTS: Out of the eleven patients, only one described a Dumontier type I radiocarpal dislocation; all the others were type II. Following the Moneim classification, two patients were type II. Most cases showed posterior displacement. In 80% of cases, the radiocarpal fracture-dislocation was combined with other bone or ligament injuries. All patients received surgical treatment followed by cast immobilization for 45 days. The mean loss of range of motion at the last follow-up was about 39%, keeping the arch intact in most cases. Quick dash score was 29.54, and Green O'Brien's score was 71.1. Three of the patients showed osteoarthritic remodeling. CONCLUSION: A careful clinical and radiological evaluation, followed by an anatomic surgical reduction of the articulating surface of the distal radius, as well as the handling of the associated lesions, are major conditions for a satisfactory clinical result.