Open Galeazzi fracture with concomitant radial head dislocation.

Galeazzi fractures are uncommon, but a combination of open Galeazzi fracture and radial head dislocation has not been described. This article reports on a variant of an open Galeazzi fracture in which concomitant radial head dislocation and coronoid process fracture occurred. Thorough understanding of the mechanisms and influences of pronation injuries of the forearm is essential in order to properly treat this fracture-dislocation. Our evaluation of the individual elements of this composite injury has allowed us to propose a mechanism of injury.

Percutaneous screw fixation or cast immobilization for nondisplaced scaphoid fractures.

BACKGROUND: Nondisplaced scaphoid fractures treated with prolonged cast immobilization may result in temporary joint stiffness and muscle weakness in addition to a delay in return to sports or work. Fixation of scaphoid fractures with a percutaneous cannulated screw has resulted in a shorter time to union and to return to work or sports. The purpose of this prospective, randomized study was to compare cast immobilization with percutaneous cannulated screw fixation of nondisplaced scaphoid fractures with respect to time to radiographic union and to return to work. METHODS: Twenty-five full-time military personnel with an acute nondisplaced fracture of the scaphoid waist consented to be randomized to either cast immobilization or fixation with a percutaneous cannulated Acutrak screw (Acumed, Beaverton, Oregon) for the purpose of this study. Time to fracture union, wrist motion, grip strength, and return to work as well as overall patient satisfaction at the time of a two-year follow-up were evaluated. RESULTS: Eleven patients were randomized to percutaneous cannulated screw fixation, and fourteen were randomized to cast immobilization. The average time to fracture union in the screw fixation group was seven weeks compared with twelve weeks in the cast immobilization group (p = 0.0003). The average time until the patients returned to work was eight weeks compared with fifteen weeks in the cast immobilization group (p = 0.0001). There was no significant difference in the range of motion of the wrist or in grip strength at the two-year follow-up evaluation. Overall patient satisfaction was high in both groups. CONCLUSIONS: Percutaneous cannulated screw fixation of nondisplaced scaphoid fractures resulted in faster radiographic union and return to military duty compared with cast immobilization. The specific indications for and the risks and benefits of percutaneous screw fixation of such fractures must be determined in larger randomized, prospective studies.

Prospective evaluation of newborn soft-tissue hip "clicks" with ultrasound.

Fifty infants with soft-tissue hip "clicks" persisting after age 3 months were prospectively studied by using ultrasound. All children demonstrated a stable hip examination by Barlow and Ortolani maneuvers; however, a click was palpated with abduction and adduction of the hip. Static ultrasonography demonstrated an average alpha angle of 63 degrees in uninvolved hips and 62 degrees in the clicking hips. All hips had > 50% femoral-head coverage by the acetabulum. Dynamic ultrasound examination was normal in all cases. The soft-tissue clicks were not related to instability in this series of 50 infants.