Peri-Trapezium Peri-Trapezoid Trans-scaphoid Open Fracture Dislocation of the Carpus: A Case Report.

The axial fracture dislocation of the carpal bones is a poorly understood injury. These injuries are often associated with nerve injuries, soft tissue injuries, and amputations. An optimal treatment is not yet known. We present a rare case of an open trans-scaphoid axial fracture dislocation of the carpus, characterized by a unique mechanism of injury. The patient received timely treatment, including irrigation and debridement, as well as reduction and fixation of the carpal fracture dislocation. It is essential to understand that these injuries tend to result in poor clinical outcomes, even with optimal treatment. Therefore, engaging in meaningful discussions and setting realistic expectations with patients is imperative.

Rare Constellation of Pelvic Injuries: A Case Report.

Crescent fracture-dislocations are sunset of lateral compression injuries. They can be associated with vascular, bowel, genitourinary, or soft tissue degloving injuries. Here, we describe a patient with bilateral crescent fracture-dislocation, right common iliac artery (CIA) injury, and an extensive Morel-Lavallée lesion (MLL). A 35-year-old male was transferred to our hospital after being involved in a motor vehicle collision with an unknown mechanism. Upon evaluation, four rare injuries were found: right CIA injury, bilateral open iliac bone fracture, bilateral crescent fracture-dislocation, and an extensive MLL. The patient underwent successful right CIA thrombectomy and stenting, followed by irrigation and debridement of MLL and open pelvic fractures. However, his hospital course was complicated by septic shock with spontaneous rectal perforation, necessitating massive transfusion protocol activation and three relook laparotomies. Unfortunately, the patient died after 25 days of a turbulent hospital course. The combination of bilateral crescent fracture-dislocation, bilateral open pelvic fracture, CIA injury, and an extensive MLL is exceedingly rare. Each poses a challenge when encountered alone, nevertheless, after establishing hemodynamic stability, timely intervention is crucial to avoid possible morbidity and mortality.

Is It Compartment Syndrome? Two Case Reports and Literature Review.

Recently, a unique entity of acute compartment syndrome (ACS) has been termed "silent" compartment syndrome. These patients develop ACS in the absence of classic pain and physical findings. We report two cases of posttraumatic silent ACS in two healthy competent adult patients presenting mainly with swollen tense compartments. In the first case, ACS was suspected in a 37-year-old male with left tibia and fibula shaft fractures after reassessment of the patient's post-backslap application, which revealed painless swollen and tense compartments. In the second case, ACS suspicion was raised in a 27-year-old male with right comminuted tibial plateau fracture and a swollen but soft compartment that became tense over time. In both cases, intraoperative intracompartmental pressure testing during external fixator application confirmed the diagnosis, and both underwent emergent fasciotomy with good postoperative outcomes. The absence of pain does not exclude the diagnosis of ACS. Physicians must have a high index of suspicion when risk factors are present for ACS, and the diagnosis can be confirmed with intracompartmental pressure measurement. These case reports and literature review aim to enlighten the physicians about silent compartment syndrome.

Terrible triad of the hip: A case report.

INTRODUCTION: Pipkin-III femoral head fracture dislocation is a rare injury and its outcome is guarded. Some authors believe femoral neck fracture of Pipkin-III injury is largely iatrogenic. Recent literature showed none of these injuries had excellent outcome, and most patients end up with hip replacement. PRESENTATION OF CASE: A 34-year-old man sustained a traumatic hip injury with fracture-dislocation and an iatrogenic femoral neck fracture during reduction. A modified Gibson approach was performed to reduce and fix the femoral head and neck fractures in a retrograde fashion. Follow-up at 26 months assessment showed viable femoral head, and excellent functional outcome. DISCUSSION: Iatrogenic femoral neck fracture in the setting of femoral head dislocation is not uncommon. Clinical and radiological signs of irreducible dislocation can easily be missed which might lead to devastating complications like iatrogenic femoral neck fracture. Recognition of this unique injury, timely intervention, and meticulous dissection might positively alter the patient's outcome. CONCLUSION: This case serves to enlighten orthopedists about the risk of iatrogenic femoral neck fracture, methods to avoid such complication, and the proper management.

Locked Volar Distal Radioulnar Joint Dislocation Associated With Asymptomatic Transection of the Ulnar Artery.

Volar distal radioulnar joint (DRUJ) dislocation is a rare clinical entity that is commonly missed during initial evaluation. We report a case of a locked volar DRUJ dislocation associated with ulnar artery transection in a 53-year-old patient. He presented to the hospital after sustaining an injury to the right wrist by a heavy machinery object. Clinical evaluation showed contused skin, decreased sensation in the ulnar 2 digits, and an audible radial pulse, assessed using Doppler. Imaging studies revealed a locked volar DRUJ dislocation associated with a nondisplaced fracture of the distal ulna. Open reduction was performed with decompression of the Guyon canal. The ulnar artery was found to be transected and was primarily repaired. After the surgery, the patient showed marked improvement in neurological symptoms and patent ulnar artery flow. This case highlights the importance of meticulous evaluation and presents the heterogeneity of a volar DRUJ dislocation.