ABSTRACT
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.
Subject(s)
Ankle Fractures , Fracture Dislocation , Humans , Ankle Fractures/diagnostic imaging , Ankle Fractures/surgery , Ankle Fractures/etiology , Ankle , Treatment Outcome , Fracture Fixation/adverse effects , Fracture Fixation/methods , External Fixators/adverse effects , Fracture Dislocation/diagnostic imaging , Fracture Dislocation/surgery , Fracture Dislocation/etiology , Fracture Fixation, Internal/adverse effects , Retrospective StudiesABSTRACT
INTRODUCTION: One of the complications of the surgical therapy for proximal humerus fractures is fracture-related infection (FRI). This multicenter study aimed to investigate the incidence of FRI and clarify the risk factors associated with FRI in patients receiving open reduction and internal fixation for proximal humerus fracture. MATERIAL AND METHODS: Among 684 patients diagnosed as having proximal humerus fracture and who were treated by surgical therapy in 13 institutions (named TRON group) from 2015 through 2020, 496 patients (men, n = 134, women, n = 362; mean [SD] age, 68.5 [14.5] years; mean [SD] body mass index [BMI], 23.0 [4.4] kg/m2) were included as subjects. Excluded were 188 patients due to less than 12 month's follow-up, patients who underwent osteosynthesis using neither plate nor nail and those with open fracture. We extracted the following as risk factors of FRI: sex, BMI, smoking status, diabetes, glenohumeral fracture dislocation, fracture classification, approach, implant, waiting period, type of anesthesia, operative time and blood loss during surgery. We conducted logistic regression analysis to investigate the risk factors of FRI using these extracted items as explanatory variables and the presence or absence of FRI as the response variable. RESULT: FRI occurred after surgery for proximal humerus fracture in 9 of the 496 patients (1.8%). The causative organism was methicillin-susceptible Staphylococcus aureus in 4 patients, Pseudomonas aeruginosa in one patient and Enterococcus faecalis in one patient. In the other 3 patients, causative organisms were not detected. The univariate analysis showed significant differences for present of glenohumeral fracture dislocation (p = 0.004). Logistic regression analysis showed glenohumeral fracture dislocation to be the significant explanatory factor for FRI (odds ratio 12.3, p = 0.0375). CONCLUSION: This study revealed an infection rate following open reduction and internal fixation of proximal humerus fracture of 1.8% (9 patients) and that Staphylococcus was the most frequent causative organism. Glenohumeral fracture dislocation is a significant risk for postoperative FRI.
Subject(s)
Fracture Dislocation , Shoulder Dislocation , Shoulder Fractures , Aged , Female , Fracture Dislocation/etiology , Fracture Fixation, Internal/adverse effects , Humans , Humerus/surgery , Male , Retrospective Studies , Risk Factors , Shoulder Fractures/etiology , Shoulder Fractures/surgery , Treatment OutcomeABSTRACT
RATIONALE: Pipkin III femoral head fracture dislocation (FHFD) is rarely observed in clinical practice, and its outcome is alarming. A considerable proportion of Pipkin III fractures result from repeated or forceful closed reduction of an irreducible FHFD. Pipkin type III fractures pose a therapeutic challenge. Most patients underwent total hip arthroplasty. PATIENT CONCERNS: A 34-year-old man experienced high-energy trauma to the left hip from a terrible traffic accident. Radiography and computed tomography (CT) at the local hospital revealed a left posterior FHFD. Emergency close reduction of the hip was performed.48âhours later, the patient was transferred to our institution. New radiography and CT examinations demonstrated an iatrogenic femoral neck fracture (FNF) associated with FHFD. In addition, a right talar fracture was observed. DIAGNOSIS: Pipkin III fracture combined with contralateral talar fracture. INTERVENTIONS: Considering his Pipkin fracture classification (Pipkin Type-III) and the time to surgery after his injury (>48âhours), the patient underwent left total hip arthroplasty uneventfully, followed by below-ankle plaster cast immobilization for his right ankle. OUTCOMES: At the 6-month follow-up, the patient was able to walk pain-free, and plain radiographs were satisfactory, with no evidence of heterotopic ossification or osteonecrosis of the talus. LESSONS: Before emergency closed reduction, early recognition of the unique characteristics of an irreducible FHFD is essential to avoid iatrogenic femoral neck fracture.
Subject(s)
Closed Fracture Reduction/adverse effects , Femoral Neck Fractures/surgery , Femur Head/surgery , Fracture Dislocation/prevention & control , Fracture Fixation, Internal/methods , Hip Dislocation/surgery , Hip Fractures/diagnostic imaging , Iatrogenic Disease , Accidents, Traffic , Adult , Femoral Neck Fractures/classification , Femoral Neck Fractures/etiology , Femur Head/diagnostic imaging , Femur Head/injuries , Fracture Dislocation/diagnostic imaging , Fracture Dislocation/etiology , Fracture Dislocation/surgery , Hip Dislocation/diagnostic imaging , Hip Dislocation/etiology , Hip Fractures/etiology , Hip Fractures/surgery , Humans , Iatrogenic Disease/prevention & control , Male , Open Fracture Reduction , Treatment OutcomeABSTRACT
Cervical spine fracture-dislocation in patients with ankylosing spondylitis (AS) and severe thoracic kyphosis is extremely unstable. This study was performed to investigate the efficacy and safety of halo vest application before and during surgery for these patients. We retrospectively analyzed the case histories, operations, neurologic outcomes, follow-up data, and imaging records of 25 patients with AS and severe thoracic kyphosis who underwent surgical treatment of cervical fracture-dislocation in our department from 2008 to 2019. A halo vest was used to reduce and immobilize the fractured spinal column ends before and during surgery. The neurologic injury was evaluated using the American Spinal Injury Association (ASIA) impairment scale score, visual analog scale (VAS) score, and Japanese Orthopaedic Association (JOA) score before and after the operation. Twenty-two patients achieved closed anatomical reduction; two achieved successful reduction and one underwent failed reduction after halo vest application. No fracture site displacement occurred after movement into the prone position. No patients developed secondary neurological deterioration. The mean Cobb angle of thoracic kyphosis was 69.0° ± 12.3°. All patients underwent posterior or combined anterior-posterior surgery. The ASIA grade improved significantly (P < 0.01). The mean VAS and JOA scores also increased significantly after the operation (14.6 ± 3.0 vs. 10.4 ± 4.3 and 0.5 ± 0.6 vs. 4.6 ± 1.9, respectively; P < 0.01). One patient died 3 weeks after the operation. No other severe complications occurred. All patients had reached solid bony fusion by the 12-month follow-up. Use of a halo vest before and during the operation is safe and effective in patients with AS and severe thoracic kyphosis who develop cervical fracture-dislocation. This technique makes positioning, awake nasoendotracheal intubation, nursing, and the operation more convenient. It can also provide satisfactory reduction and rigid immobilization and prevent secondary neurologic deterioration.
Subject(s)
Fracture Dislocation/therapy , Fracture Fixation, Internal/methods , Orthopedic Fixation Devices , Spinal Fractures/therapy , Spondylitis, Ankylosing/complications , Adult , Aged , Cervical Vertebrae , Female , Fracture Dislocation/etiology , Humans , Kyphosis/etiology , Male , Middle Aged , Spinal Fractures/etiology , Thoracic VertebraeABSTRACT
Traumatic dislocation of the eye is usually encountered in high-energy injuries. These include traffic accidents, accidents at work, sporting accidents, falling from a height, impact of the hooves or horns of animals, gunshot injuries, and physical assault. Such incidents are accompanied by facial soft tissue damage and injuries to the facial skeleton, especially the orbit, and can be associated with varying degrees of dislocation of the eye. We describe a rare case of non-fatal traumatic eye dislocation into the maxillary sinus, coupled with an orbital fracture resulting from a physical assault on a 63-year-old woman. The cause of death was asphyxiation due to manual strangulation and mechanical asphyxia. Even though dislocations of the eye are relatively rare, forensic pathologists should be aware of such injuries to correct assessment of injury mechanism. The available literature regarding eye dislocation is summarized, and the forensic issues applicable to the assessment of such cases are reviewed.
Subject(s)
Eye Injuries/complications , Homicide , Maxillary Sinus , Prolapse , Asphyxia/etiology , Female , Fracture Dislocation/etiology , Humans , Middle Aged , Neck Injuries/complications , Orbital Fractures/etiologyABSTRACT
A 60-year-old woman with chronic atraumatic shoulder pain underwent arthroscopic biceps tenodesis. Upon presenting to the physical therapy clinic 7 days following surgery, she reported constant pain. Following the examination, the physical therapist reviewed the patient's postoperative radiographs and noted a comminuted but minimally displaced fracture of the right proximal humeral metaphysis. J Orthop Sports Phys Ther 2020;50(11):649. doi:10.2519/jospt.2020.9497.
Subject(s)
Arthroscopy/adverse effects , Chronic Pain/surgery , Humeral Fractures/etiology , Shoulder Pain/surgery , Tenodesis/adverse effects , Arthroscopy/methods , Female , Fracture Dislocation/diagnostic imaging , Fracture Dislocation/etiology , Fractures, Comminuted/diagnostic imaging , Fractures, Comminuted/etiology , Humans , Humeral Fractures/diagnostic imaging , Middle Aged , Muscle, Skeletal/surgery , Postoperative Complications , Radiography , Tenodesis/methodsABSTRACT
Lisfranc injuries can be devastating to the athlete and nonathlete. In the athletic population, minor loss of midfoot stability compromises the high level of function demanded of the lower extremity. The most critical aspect of treatment is identifying the injury and severity of the ligamentous/articular damage. Not all athletes are able to return to their previous level of function. With appropriate treatment, a Lisfranc injury does not mandate the cessation of an athletic career. We focus on the diagnosis and an algorithmic approach to treatment in the athlete discussion the controversy of open reduction and internal fixation versus arthrodesis.
Subject(s)
Arthrodesis , Foot Injuries/surgery , Fracture Dislocation/surgery , Fracture Fixation, Internal/methods , Ligaments, Articular/injuries , Open Fracture Reduction/methods , Sprains and Strains/surgery , Athletic Injuries/diagnosis , Athletic Injuries/etiology , Athletic Injuries/surgery , Foot Injuries/diagnosis , Foot Injuries/etiology , Fracture Dislocation/diagnosis , Fracture Dislocation/etiology , Humans , Ligaments, Articular/surgery , Sprains and Strains/diagnosis , Sprains and Strains/etiologyABSTRACT
Neglected bilateral facet dislocation of the lower cervical spine is a rare condition and found mostly in developing countries like Nepal. Delayed presentation makes treatment more challenging concerning decompression, reduction, neurological recovery, and overall outcome. We managed three cases of bilateral facet dislocations of the fifth-sixth-seventh cervical vertebra level presented after three months of injury. All of those were treated surgically by combined anterior-posterioranterior approaches with the same principle. One patient had a complete neurological recovery, the second one recovered partially with few long-term complications and the third one did not improve at all.
Subject(s)
Cervical Vertebrae , Fracture Dislocation , Spinal Cord Compression , Spinal Fractures , Spinal Fusion , Adult , Cervical Vertebrae/diagnostic imaging , Cervical Vertebrae/injuries , Cervical Vertebrae/surgery , Delayed Diagnosis , Fracture Dislocation/diagnostic imaging , Fracture Dislocation/etiology , Fracture Dislocation/surgery , Humans , Male , Middle Aged , Nepal , Range of Motion, Articular , Spinal Cord Compression/diagnostic imaging , Spinal Cord Compression/etiology , Spinal Cord Compression/surgery , Spinal Fractures/diagnostic imaging , Spinal Fractures/etiology , Spinal Fractures/surgery , Traction , Zygapophyseal Joint/diagnostic imaging , Zygapophyseal Joint/injuries , Zygapophyseal Joint/surgeryABSTRACT
Anterior reduction and interbody fusion fixation has not been compared directly with posterior reduction and short-segmental pedicle screw fixation for lower cervical dislocation, and so consensus is lacking as to which is the optimal method. The purpose of this paper is to compare long-term outcomes of the anterior versus posterior approach for traumatic cervical dislocation with spinal cord injury. One hundred and fifty-nine patients could be followed for more than 10 years (follow-up rate 84.1%). Ninety-two patients underwent anterior reduction and interbody fusion and fixation, and 67 patients underwent posterior reduction and short-segmental pedicle screw fixation. Japanese Orthopaedic Association (JOA) scores, the Neck Disability Index (NDI), the American Spinal Injury Association grading (ASIA), Odom's criteria, cervical kyphosis, operative parameters, and surgical or post-operative complications were evaluated. Patients were followed for 10 to 17 years. There was no significant difference in main JOA scores, NDI scores or ASIA scores between the two groups at follow-up. The posterior approach was associated with greater loss of alignment by two years (P = 0.012) and at final follow-up (P < 0.001). The posterior approach group had more blood loss (P < 0.001), longer operation times (P < 0.001), longer hospital stays (P < 0.001) and fewer complications than the anterior approach group. The anterior approach is better than the posterior approach for preserving cervical lordosis, which is associated with a better long-term effect.
Subject(s)
Fracture Dislocation/surgery , Fracture Fixation, Internal/methods , Spinal Cord Injuries/surgery , Spinal Fractures/surgery , Spinal Fusion/methods , Adult , Aged , Bone Plates , Bone Wires , Cervical Vertebrae/injuries , Cervical Vertebrae/surgery , Female , Follow-Up Studies , Fracture Dislocation/etiology , Fracture Fixation, Internal/adverse effects , Fracture Fixation, Internal/instrumentation , Humans , Male , Middle Aged , Pedicle Screws , Recovery of Function , Retrospective Studies , Spinal Cord Injuries/etiology , Spinal Fractures/complications , Spinal Fusion/adverse effects , Spinal Fusion/instrumentation , Treatment OutcomeABSTRACT
Lethal injuries due to large animal attack are uncommon in routine forensic practice in Europe. Specifically, few incidents are reported concerning tiger/lion attacks that usually involve captive circus or zoo animals. We present the case of a 61-year old animal tamer who was mauled to death by four tigers while he was training them for a circus performance. Careful investigation of the circumstances surrounding the fatality revealed that the tamer had most likely been struck with a tiger paw and then mauled by additional tigers resulting in serious and fatal injuries. Although a full medico-legal autopsy was not authorized, total body CT scan coupled with post-mortem external examination allowed a reconstruction of events.
Subject(s)
Bites and Stings/etiology , Multiple Trauma/etiology , Tigers , Aggression , Animals , Atlanto-Occipital Joint/diagnostic imaging , Atlanto-Occipital Joint/injuries , Bites and Stings/pathology , Fracture Dislocation/diagnostic imaging , Fracture Dislocation/etiology , Humans , Multiple Trauma/pathology , Spinal Fractures/diagnostic imaging , Spinal Fractures/etiology , Tomography, X-Ray Computed , Whole Body ImagingABSTRACT
Background: This study aimed to describe a novel surgical technique in which a bridge plate was used for the treatment of hamatometacarpal fracture-dislocations and to assess its radiologic and clinical outcomes. Methods: A retrospective review of 16 patients treated with the bridge plate technique for hamatometacarpal fracture-dislocations was performed between 2010 and 2015. Clinical and radiographic evaluations were performed at months 3, 6, and 12 postoperatively. Active wrist and metacarpophalangeal joint ranges of motion and Quick Disabilities of Arm, Shoulder, and Hand (DASH) scores were recorded for the injured hands. Grip strength data were collected for both the injured hands and the contralateral uninjured hands. Results: All patients included in our study were male (mean age 31 years). The average Quick DASH score was 24.3 ± 9.1 at 3 months, 12.3 ± 7.3 at 6 months, and 6.2 ± 6.6 at 12 months. All patients returned to their original jobs within 5 weeks of the procedure. Grip strength eventually recovered to 90% of that of the uninjured hand, and none of the patients complained of finger or wrist joint stiffness. Conclusions: The use of the bridge plate technique may be an effective alternative treatment for patients with comminuted hamatometacarpal fracture-dislocations.
Subject(s)
Bone Plates , Fracture Dislocation/surgery , Fracture Fixation, Internal/methods , Fractures, Comminuted/surgery , Hand Joints/injuries , Adult , Female , Fracture Dislocation/diagnostic imaging , Fracture Dislocation/etiology , Fractures, Comminuted/diagnostic imaging , Fractures, Comminuted/etiology , Hamate Bone/injuries , Hand Strength , Humans , Male , Metacarpal Bones/injuries , Retrospective Studies , Treatment Outcome , Young AdultABSTRACT
This case report presents a very rare fracture combination in a perilunate dislocation including the scaphoid, capitate, hamate and triquetrum and the cornu anterior of the lunate, with an intact scapholunate ligament in a left wrist. An open reduction and internal fixation of the scaphoid, capitate, hamate and triquetrum was performed.
Subject(s)
Carpal Bones/injuries , Fracture Dislocation/diagnostic imaging , Fracture Dislocation/surgery , Fracture Dislocation/etiology , Fracture Fixation, Internal , Humans , Male , Open Fracture Reduction , Young AdultABSTRACT
Arthroscopic treatment is an effective technique for osteochondral lesion of talus (OLT); however, some patients still suffer pain and limitation of activities after surgery. The purpose of this study was to evaluate the efficacy of extracorporeal shock wave therapy (ESWT) after ankle arthroscopy for OLT. We reviewed the clinical history of a series of 78 patients with OLT who underwent arthroscopic microfracture. ESWT was prescribed for 15 patients who complained of ankle pain and restriction of weightbearing activities 3 months postoperatively. The parameters assessed were visual analog scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale scores (before ESWT, at 6 and 12 weeks, and at last follow-up after ESWT) and magnetic resonance imaging (MRI) before and 1 year after ESWT. Follow-up was 27.8 ± 15.2 months. VAS and AOFAS scores showed a significant improvement at 12 weeks after ESWT and a progressive trend at last follow-up. Areas of lesions in sagittal plane in MRI were distinctly reduced at last follow-up. ESWT for osteochondral lesions of talus after arthroscopy results in good clinical outcomes.
Subject(s)
Ankle Injuries/surgery , Ankle Joint/surgery , Cartilage, Articular/surgery , Extracorporeal Shockwave Therapy/methods , Fracture Dislocation/surgery , Talus/surgery , Accidental Injuries/etiology , Accidental Injuries/surgery , Accidents, Traffic , Adolescent , Adult , Ankle Injuries/etiology , Arthralgia/etiology , Arthralgia/surgery , Arthroscopy , Cartilage, Articular/injuries , Female , Fracture Dislocation/etiology , Humans , Male , Middle Aged , Motorcycles , Talus/injuries , Visual Analog Scale , Young AdultABSTRACT
BACKGROUND: L3 vertebral fractures with posterior dislocation are rare and usually secondary to high-energy trauma. To assess the outcome of a valuable distraction technique, using long-tail multiaxial pedicle screw which we have employed in reduction of L3 vertebral fracture with posterior dislocation, and emphasize the importance of preoperative blood vessel evaluation. CASE PRESENTATION: A 47-year-old patient fell from a height of 4 m and was paralyzed. Computed tomography scan revealed a three-column ligamentous injury with posterior fracture-dislocation of the L3 vertebral body. Computed tomography angiography showed that the third lumbar artery was ruptured without active bleeding. The patient underwent posterior approach with reduction, transpedicular fixation, and posterolateral fusion with autologous bone graft. Finally, Vertebral reduction and sagittal balance were achieved and patients recovered well after operation. CONCLUSION: Preoperative blood vessel evaluation is very important to avoid massive bleeding during the surgery, and the standard technique which can achieve good reduction is easy to understand, perform, and is reproducible.
Subject(s)
Arteries/injuries , Bone Screws , Fracture Dislocation/surgery , Lumbar Vertebrae/blood supply , Lumbar Vertebrae/surgery , Open Fracture Reduction/instrumentation , Spinal Fractures/surgery , Vascular System Injuries/etiology , Accidental Falls , Arteries/diagnostic imaging , Bone Transplantation , Computed Tomography Angiography , Fracture Dislocation/diagnostic imaging , Fracture Dislocation/etiology , Fracture Dislocation/physiopathology , Fracture Healing , Humans , Lumbar Vertebrae/injuries , Lumbar Vertebrae/physiopathology , Male , Middle Aged , Recovery of Function , Spinal Fractures/diagnostic imaging , Spinal Fractures/etiology , Spinal Fractures/physiopathology , Spinal Fusion , Treatment Outcome , Vascular System Injuries/diagnostic imagingABSTRACT
OBJECTIVE: The purpose of this study was to compare perioperative hidden blood loss after hip hemiarthroplasty via the SuperPATH approach and the conventional posterior approach (the Moore approach). PATIENTS AND METHODS: From January 2015 to January 2017, 130 patients (80.7⯱â¯6.0 years) with displaced femoral neck fracture (Garden type III or IV) undergoing hip hemiarthroplasty were included in this study. As a non-randomisation study, Fifty-two patients (SuperPATH group) were operated using the SuperPATH approach, and 78 patients (Moore group) were operated with the conventional posterior approach (Moore approach). The demographic and relevant clinical information of the patients were collected. According to the combination formulas of Nadler, Gross and Sehat, the hidden blood loss (HBL) of each patient was calculated. Student's t-test for independent samples was used to compare the normally distributed variables and the Mann-Whitney U test was used to compare variables not following a normal distribution. RESULTS: The visible blood loss (VBL) in the SuperPATH group was 123.7⯱â¯47.5â¯ml, the hidden blood loss (HBL) was 1084.1⯱â¯816.8â¯ml and the HBL% was 82.7⯱â¯16.5%. In the Moore group, the VBL was 303.6⯱â¯139.6â¯ml, the HBL was 700.2⯱â¯563.8â¯ml and the HBL% was 61.5⯱â¯23.8%. The patients in the SuperPATH group had more HBL and HBL% (Pâ¯<â¯0.05). However, no significant difference was observed of total blood loss (TBL) between the two groups (Pâ¯=â¯0.125). CONCLUSIONS: HBL should not be ignored in patients who underwent hip hemiarthroplasty for displaced femoral neck fractures, as it is a significant portion of TBL. Compared with the conventional approach, the SuperPATH approach had a greater amount of HBL. A better understanding of HBL after hip hemiarthroplasty may help surgeons improve clinical assessment and ensure patient safety.
Subject(s)
Blood Loss, Surgical , Femoral Neck Fractures , Hemiarthroplasty , Postoperative Complications , Aged, 80 and over , Blood Loss, Surgical/prevention & control , Blood Loss, Surgical/statistics & numerical data , China/epidemiology , Clinical Competence , Diagnostic Errors/prevention & control , Female , Femoral Neck Fractures/diagnosis , Femoral Neck Fractures/epidemiology , Femoral Neck Fractures/physiopathology , Femoral Neck Fractures/surgery , Fracture Dislocation/diagnosis , Fracture Dislocation/etiology , Hemiarthroplasty/adverse effects , Hemiarthroplasty/methods , Humans , Male , Outcome and Process Assessment, Health Care , Postoperative Complications/diagnosis , Postoperative Complications/epidemiology , Postoperative Complications/prevention & control , Quality ImprovementABSTRACT
BACKGROUND: Ankle fractures represents the third most frequent fracture in elderly patients. There is a current tendency to fix long bones fractures with locking plates. However, we rarely find published accounts about the use of locking plates in distal fibula fractures, except for biomechanical ones, studying human cadaveric fibula. OBJECTIVES: The main objective was to compare radiographic bone union rates at 6 and 12 weeks of follow up, then wound complications and hardware removal rates, and construct cost. STUDY DESIGN & METHODS: We retrospectively analyzed 105 patients who underwent surgery with locking plates or non-locking plates over a two-year period, out of which 42 patients were treated with non-locking plates (VIVES™ - Strykerâ) and 63 with locking plates (VariAx™ - Strykerâ,). We analyzed bone union on anterior posterior and lateral X-rays of the ankle. We collected data of wound complications and hardware removal from patient records. Multiple linear regression techniques were performed after identifying dependent variables. RESULTS: There was no significant difference between non-locking and locking plates in the radiographic bone union rate of distal fibula, respectively at 6 and 12 post-operative weeks (85.71% vs. 81%; pâ¯=â¯0.525 and 97.62% vs. 96.83%; pâ¯=â¯1). No significant difference was found in the wound complication rate between the two groups (11.9% vs. 11.12%; pâ¯=â¯0.9). No significant differences were found in the hardware removal rate, either with or without operative site's infection (respectively: 30.95% vs. 39.68%; pâ¯=â¯0.361 and 21.42% vs. 38.09%; pâ¯=â¯0.071). Cost efficiency is in the favor of non-locking plates. CONCLUSION: Non-locking constructs are as effective as locking constructs in the treatment of displaced distal fibula fractures at a substantially lower cost. High-quality randomized controlled trials are needed in the future to verify the finding of this study.
Subject(s)
Ankle Fractures , Fibula , Fracture Dislocation , Fracture Fixation, Internal , Fracture Healing , Postoperative Complications , Aged , Ankle Fractures/diagnosis , Ankle Fractures/epidemiology , Ankle Fractures/surgery , Bone Plates/adverse effects , Female , Fibula/diagnostic imaging , Fibula/injuries , Fibula/surgery , Fracture Dislocation/diagnosis , Fracture Dislocation/etiology , Fracture Dislocation/surgery , Fracture Fixation, Internal/adverse effects , Fracture Fixation, Internal/instrumentation , Fracture Fixation, Internal/methods , France/epidemiology , Humans , Male , Outcome Assessment, Health Care , Postoperative Complications/diagnosis , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Postoperative Complications/surgery , Radiography/methods , Reoperation/methods , Reoperation/statistics & numerical data , Time FactorsABSTRACT
A man in his mid-80s presented with bilateral posterior fracture dislocations of the humerus after suffering a seizure. He had Parskinson's disease and lived with his wife at home. His left shoulder was not felt to be reconstructable. The initial treatment plan was to perform reverse total shoulder arthroplasty (rTSA) on the left and non-operatively reduce his right shoulder. A left rTSA was performed, but his right shoulder was unstable due to a glenoid fracture and soft tissue instability. In order to preserve the patient's quality of life, a right rTSA was performed 4 days later. In the follow-up period, the patient was able to regain enough pain-free range of motion on activities of daily living. The patient died from complications of Parkinson's disease 10 months postoperatively.
Subject(s)
Arthroplasty, Replacement, Shoulder/methods , Fracture Dislocation/surgery , Shoulder Injuries/surgery , Accidental Falls , Aged, 80 and over , Fracture Dislocation/etiology , Humans , Male , Parkinson Disease , Seizures/complications , Shoulder Injuries/etiologyABSTRACT
BACKGROUND: There are only a few published case reports of irreducible Galeazzi fracture-dislocation, and patients in these studies had undergone reduction by open surgical methods. Arthroscopy for the distal radioulnar joint of the wrist joint has recently been used for wrist pathology. We aim to describe the surgical procedure involved in arthroscopic reduction of irreducible Galeazzi fracture-dislocation and clinical outcome and review the literature. CASE PRESENTATION: We present the case of a 26-year-old man, a professional athlete, who sustained Galeazzi fracture-dislocation during a bicycle race. The distal radioulnar joint was irreducible because the fragment of the ulnar styloid was trapped between the sigmoid notch and ulnar head after a doctor had previously reduced it manually. Operative treatment was performed using a 30° oblique, 1.9-mm arthroscope. Reduction of the fragment of the ulnar styloid was achieved using distal radioulnar joint arthroscopy. The metaphyseal and intra-articular fracture of the radius and the fragment of the ulnar styloid were fixed using a volar locking plate and tension band wiring technique, respectively. A daily injection of parathyroid hormone and low-intensity pulsed ultrasound were used postoperatively. The patient was asymptomatic and returned to the preinjury level of athletic activity 2 months postoperatively, and bone union of the radius and ulna was achieved without distal radioulnar joint instability 15 months postoperatively. CONCLUSIONS: Less invasive reduction of the dorsal anatomical structure enabled our patient to return early to sports. We consider arthroscopic reduction to be superior to the open surgical method in terms of evaluating interpositions; additionally, arthroscopic reduction is minimally invasive and does not need immobilization because it does not cause significant damage to the dorsal capsule and subsheath of the extensor carpi ulnaris, which comprise the triangular fibrocartilage complex.
Subject(s)
Arthroscopy/methods , Fracture Dislocation/surgery , Fracture Fixation, Internal/methods , Radius Fractures/surgery , Wrist Injuries/surgery , Adult , Arthroscopy/instrumentation , Bone Plates , Fracture Dislocation/diagnostic imaging , Fracture Dislocation/etiology , Fracture Fixation, Internal/instrumentation , Humans , Male , Radius Fractures/complications , Radius Fractures/diagnostic imaging , Tomography, X-Ray Computed , Treatment Outcome , Wrist Injuries/etiology , Wrist Joint/diagnostic imaging , Wrist Joint/surgeryABSTRACT
OBJECTIVE: We present a systematic review of the literature regarding types and anatomic distribution of fractures in association with generalized convulsive status epilepticus (GCSE) and convulsive seizures in adult patients accompanied by an illustrative case of a patient with GCSE and diffuse postictal pain from underlying bone fractures. METHODS: The library search engines PubMed and EMBASE were screened systematically using predefined search terms. All identified articles written in English were screened for eligibility by two reviewers. The preferred reporting items for systematic reviews and meta-analyses guidelines were followed. RESULTS: The screening of 3145 articles revealed 39 articles meeting the inclusion criteria. Among all fractures, bilateral posterior fracture-dislocations of the shoulders were reported most frequently (33%), followed by thoracic and lumbar vertebral compression fractures (29%), skull and jaw fractures (8%), and bilateral femoral neck fractures (6%). Risk factors for seizure-related fractures are seizure severity, duration of epilepsy, the use of antiseizure drugs known to decrease bone density, and a family history of fractures. Based on these findings, a three-step screening procedure is proposed to uncover fractures in the postictal state. All studies were retrospective without standardized screening methods for seizure-associated fractures resulting in a very low level of evidence and a high risk of bias. SIGNIFICANCE: Posterior fracture-dislocations of the shoulders, thoracic and lumbar vertebral compression, fractures of the skull and jaw, and bilateral femoral neck fractures are most frequently reported. Preventive measures including bone densitometry, calcium/vitamin D supplementation, and bisphosphonate therapy should be reinforced in epilepsy patients at risk of osteoporosis. As long as the effect of standardized screening of fractures is not investigated, it is too early to integrate such a screening into treatment guidelines. In the meantime, clinicians are urged to heighten awareness regarding seizure-associated fractures, especially in patients with postictal pain, as symptoms can be unspecific and misinterpretation may impede rehabilitation.