Triplane fracture of distal femur in an adult rare case study and review.

A 30-year-old patient sustained the fracture in a motorcycle accident. A triplane-type of fracture of the distal femur was confirmed by CT scan. The trochlear fragment was reduced anatomically and was stabilized with 6.5mm cannulated screws. Once reconstruction of the coronal plane fracture was performed, the split lateral condylar fragment was fixed with a cannulated screw to the medial fragment converting three parts into one fragment. The mechanism of injury seems to be axial load to the distal femur with the knee in short of extension combined with the shearing force from the anteromedial aspect producing an anterior tangential fracture pattern. Triplane fractures are by definition fractures that have a component involving all 3 planes: sagittal, coronal and transverse, commonly seen before physeal fusion. Our case is the first reported case of triplane fracture in distal femur in an adult patient.

Failure of intramedullary femoral nail with segmental breakage of distal locking bolts: a case report and review of the literature.

Breakage of locking bolts is an important cause of interlocking nail failure in femoral fractures. It usually occurs in the form of single breakage in one of the distal bolts of the nail or nail breakage around the distal locking hole. Here we report an unusual case of intramedullary femoral nail failure with segmental breakage of both the distal locking bolts. Such a scenario usually complicates further management. We successfully managed this case with exchange nailing without bone grafting. Here we briefly reviewed the literature regarding such an unusual presentation and discussed in detail the possible etiology of such a presentation and the management options when facing such a complex situation.

Removal of a bent tibial intramedullary nail: a rare case report and review of the literature.

Intramedullary interlocking nailing is a gold standard for treatment of tibial shaft fractures. Bending of a nail secondary to trauma is a rare complication, which may be encountered in healed or unhealed tibial shaft fractures. Removal of such bent nail is always a challenge. We reported this case to discuss various techniques for removal of bent nails and to share our experience in removing a bent tibial intramedullary nail in a 30-year-old man, who was admitted in our department with re-fracture of the right tibial shaft due to a roadside accident two years after the initial surgical treatment. The intramedullary nail, bent by 30 degrees and visible on anterioposterior as well as on lateral radiographs, was firstly weakened by partially cutting the convex wall, then straightened by applying external force, and finally removed by using the standard nail removal method.

Reconstruction of bilateral spontaneous chronic idiopathic Achilles tendon rupture using LARS ligament: Case report.

Spontaneous bilateral idiopathic rupture of Achilles tendon is rare and usually results from sudden dorsiflexion of a plantar-flexed foot; the tendon is most often degenerated or diseased, and spontaneous bilateral rupture is not rare in patients suffering from chronic diseases. Management problems relate to reconstruction options and issues with early ambulation and weight bearing. We report a case of idiopathic bilateral Tendo-Achilles (TA) rupture with no obvious disease process, which was initially neglected, and subsequently reconstructed with LARS polyester ligament. The patient could be mobilized early despite bilateral involvement, but developed bilateral wound dehiscence which needed debridement and local flap coverage; aggressive rehabilitation finally leads to an excellent functional outcome. Despite the fact that artificial ligaments allow biointegration and can withstand stresses of early weight bearing, they often lead to wound related problems. Judicious use is advocated and good cases for their use maybe bilateral TA repair in neglected tears with gaps.