ABSTRACT
INTRODUCTION: Due to its ability to provide stable fixation and permit early mobilization, volar plating has become the recommended technique for the surgical stabilization of distal radius fractures. The extensor pollicis longus (EPL) tendon may be injured or ruptured as a result of undetected screw penetration or drill plunging. During surgery, it is critical to detect any potential screw penetration so that it can be corrected. CASE PRESENTATION: A 32-year-old woman presented six weeks post-distal radius plating with an inability to extend her left thumb. Clinical examination revealed loss of extension at the interphalangeal joint, stiff wrist, tender point over the dorsal aspect of the wrist, and an intact sensory nerve function. DISCUSSION: Dynamic ultrasound and magnetic resonance imaging (MRI) both revealed no evidence of tendon rupture or EPL tendon movement. X-rays revealed the distal epiphyseal screws penetrating the far cortex. Intraoperatively, the EPL tendon was found to be impinged by a screw. The tendon was released, tenolysis was performed, and the distal screws were shortened. CONCLUSION: In order to assess screw penetration into the far cortex, volar plating for distal radius fractures should be performed using intraoperative imaging views such as lateral, 45-degree supination, 45-degree pronation, dorsal tangential, and skyline views. Timely interventions after distal radius fracture fixation preserve tendon function, and early detection of tendon compromise is essential to preventing additional damage.
ABSTRACT
BACKGROUND: Among the most frequent hip fractures are trochanteric fractures, which usually occur from low-energy trauma like minor falls, especially in older people with osteoporotic bones. AIM: To evaluate the treatment efficacy of dynamic condylar screws (DCS) and proximal femoral nails (PFN) for unstable intertrochanteric fractures. METHODS: To find pertinent randomized controlled trials and retrospective observational studies comparing PFN with DCS for the management of unstable femoral intertrochanteric fractures, a thorough search was carried out. For research studies published between January 1996 and April 2024, PubMed, EMBASE, Scopus, Web of Science, Cochrane Library, and Google Scholar were all searched. The complete texts of the papers were retrieved, vetted, and independently examined by two investigators. Disputes were settled by consensus, and any disagreements that persisted were arbitrated by a third author. RESULTS: This study included six articles, comprising a total of 173 patients. Compared to the DCS, the PFN had a shorter operation time [mean difference (MD): -41.7 min, 95% confidence interval (95%CI): -63.04 to -20.35, P = 0.0001], higher success rates with closed reduction techniques [risk ratio (RR): 34.05, 95%CI: 11.12-104.31, P < 0.00001], and required less intraoperative blood transfusion (MD: -1.4 units, 95%CI: -1.80 to -1.00, P < 0.00001). Additionally, the PFN showed shorter fracture union time (MD: -6.92 wk, 95%CI: -10.27 to -3.57, P < 0.0001) and a lower incidence of reoperation (RR: 0.37, 95%CI: 0.17-0.82, P = 0.01). However, there was no discernible variation regarding hospital stay, implant-related complications, and infections. CONCLUSION: Compared to DCS, PFN offers shorter operative times, reduces the blood transfusions requirements, achieves higher closed reduction success, enables faster fracture healing, and lowers reoperation incidence.