Dorsal Chopart's fracture dislocation - A rare injury.

A rare case of Dorsal Chopart's fracture dislocation after a fall from height is presented. It combines the features of pure dorsal Chopart's dislocation and the longitudinal swivel variant described by Main and Jowett presenting as dorsomedial fracture dislocation of the medial three fourths of the navicular, crushing the lateral one fourth. The possible mechanism of injury has been described. It has been successfully treated with closed reduction and percutaneous k-wire fixation. At two-year follow-up the patient was asymptomatic, back to his moderately active work.

A systematic review of combined pelvic and acetabular injuries.

PURPOSE: Injuries of both pelvic ring and acetabulum as rare very few articles are available in literature. There are no set protocols in defining the injury let alone defining early and definitive management strategies. This article is an attempt to encompass all available data to give us guidelines in managing these injuries. METHODS: An extensive literature review was carried out on PubMed/Medline, google scholar and Embase databases was done with the eligibility criteria of 1) Case series with a minimum of 20 cases. 2) The patient's outcome reported. 3) Full article available. 4) Article in English. 5) Minimum Jadad score of 3. As per PRISMA guidelines the search was done and gradually filtered down to relevant articles which were 8 in number. RESULTS: The incidence of these injuries range from 5 to 16%. The transverse acetabular fracture pattern is the commonest followed by associated both column fractures. There is equal propensity of Anteroposterior compression and lateral compression injuries. The injury mechanism appears to transmitted lateral force from the greater trochanter inwards with an implosion injury causing acetabular and pelvic injury as a continuum. The initial management is similar to managing pelvic ring injuries with focus on patient resuscitation, hemodynamic stabilization and temporary stabilization. The injury severity score and the mortality rates are comparable to isolated unstable pelvic ring injuries. Definitive management focuses on fixing the posterior pelvic ring first followed by the acetabular fracture and then the anterior pelvic ring. The displacement rates and outcome is worse than isolated acetabular injuries or pelvic injuries. CONCLUSION: Combined Pelvic and acetabular injuries are complex injuries which need to be managed initially as we manage pelvic injury and later as we fix as an acetabular fracture meticulously.

Acetabulum fractures in elderly: A systematic review of fracture pattern and treatment.

PURPOSE: Acetabulum fractures are being increasingly seen with low impact injuries in elderly patients. This article aimed to study systematically literature on geriatric acetabulum fractures. Objectives of this systematic review were to study (1) demography of patients, common mechanisms of injury and types of fracture patterns commonly seen in elderly patients, (2) treatment used for these fractures in literature and (3) mortality rates in elderly with these fractures. METHODS: Systematic search was carried out in May 2020 using predefined search strategy for all studies published in the English language in last 20 years. Literature search and data abstraction was done by two independent reviewers. RESULTS: After screening of all abstracts, a total of 48 studies were included in the systematic review. In total there were 7876 geriatric patients with acetabulum fractures. Mean age of the patients was 72.47 years. There were 4841 males (61.5%). Fall from low heights was the most common mechanism of injury, present in 47.12% patients followed by motor vehicular accidents in 28.73%. Most common fracture pattern was both column fracture, seen in 19.03% patients, followed by anterior column and posterior hemitransverse fracture in 17.23%, anterior column fractures in 17.13%, and posterior wall fractures in 13.46% patients. Out of total 5160 patients for whom details of treatment were available, 2199 (42.62%) were given non-operative treatment, 2285 (44.28%) were treated with ORIF of acetabulum fracture, 161 (3.12%) were treated with percutaneous fixation and 515 (9.98%) were treated with primary THA. Gull sign, femoral head injury and posterior wall comminution were associated with poorer prognosis after ORIF and may form an indication for a primary THA. CONCLUSION: Literature on treatment of geriatric acetabulum fractures is not enough to draw any definite conclusions. There is limited evidence from current literature that surgery could be considered a safe treatment option for displaced acetabulum fractures in elderly. Primary THA can provide early mobility and reduce chances of resurgery in fracture patterns where restoration of joint surface may not be possible.

Traumatic proximal tibiofibular dislocation with neurovascular injury.

23 years old male presented with inferolateral dislocation of proximal tibiofibular joint associated with popliteal artery and common peroneal nerve injury. The extension of the injury to involve the interosseus membrane up to the distal tibiofibular joint. The association of popliteal artery injury is not reported before to the best of our knowledge.

Talar neck fracture with talar head dislocation and intact ankle and subtalar joints--a rare case report.

A rare case of talar neck fracture with intact ankle and subtalar joint is presented. The talar head fragment is dislocated dorsally with the fractured surface of the head facing plantarward. Only two such cases were reported in the literature. The mechanism of injury described in the yesteryears for talar neck fractures does not explain this variety of injury. A possible mechanism of injury has been described. This rare fracture has been successfully treated without any complications after a follow-up of 2 and 1/2 years.

Outcome analysis of pelvic ring fractures.

BACKGROUND: The behavior of pelvic ring fractures in the long run has been very sparsely studied. The purpose of this study is to assess the long-term outcome of pelvic ring fractures. MATERIALS AND METHODS: A total of 24 patients with pelvic ring fractures, not involving the acetabulum, were followed up for an average duration of 33 months (range 24-49 months). The clinicoradiological assessment was done using the pelvic scoring system adapted from Cole et al. Parameters assessed included sacroiliac (SI) joint involvement and, among SI joint injuries, the presence of a fracture disruption and the degree of displacement. RESULTS: Pain and limp were present in 13 patients (54.2%) each and residual working disability in 9 patients (37.5%). The overall Cole's pelvic score was 31.3 +/- 7.02 of a total score of 40. The average pelvic score in patients with SI disruption was 29.2 +/- 6.75; much lower than patients without SI disruption with an average score of 34.9 +/- 6.25 reaching statistical significance. The pelvic score among patients with a displacement 10 mm 25.88 +/- 7.14. The difference was statistically significant. CONCLUSIONS: Pelvic ring injuries can lead to long term problems significantly. The involvement of the SI joint affects the long-term outcome adversely, more so if the residual displacement is >10 mm. The pelvic scoring system is comprehensive and depicts subtle differences in the outcome, which the individual parameters of the assessment fail to show.

Long-term outcome of conservatively managed displaced acetabular fractures.

BACKGROUND: The purpose of this study was to determine the long-term outcome of conservatively managed acetabular fractures involving the weight-bearing dome, which otherwise deserves an operative treatment. METHODS: Thirty-two patients with displaced acetabular fractures (>3 mm displacement) involving the weight-bearing dome and not associated with unstable pelvic ring injuries met the inclusion criteria for this study with a minimum of 2 years of follow-up evaluation. They were assessed using the Merle de'Aubigne and Postel clinical scoring and Matta's radiologic scoring system. The mean duration of follow-up was 4.1 years (2-12 years). RESULTS: The reducibility of acetabular fractures by conservative management stood at 18 of 32 (56.3%) synchronizing with 18 of 32 (56.3%) good to excellent clinical score. The mean clinical score was 14.25 +/- 3.41 of a total score of 18. In patients with good fracture reduction, good to excellent results were seen in 83.3% cases. The radiologic grade was good to excellent in 50% cases with good clinicoradiologic correlation (p = 0.0001). CONCLUSIONS: Acetabular fractures involving the weight-bearing dome if reduced by closed means can be maintained by heavy lateral and longitudinal traction resulting in good clinicoradiologic outcome comparable with operative management.

Diaphyseal sclerotic osteosarcoma presenting as a pathological fracture.

A diaphyseal, intramedullary, highly sclerotic lesion presenting as a pathological fracture, without a periosteal reaction or an appreciable soft tissue component on radiographs was investigated. A discrepancy between the MRI and histopathological findings led to marginal excision of the lesion only to reveal later that it was a sclerotic variety of osteosarcoma. Such a presentation has not been reported in literature as per our knowledge. We forfeited the opportunity of limb salvage by doing initial marginal excision and fixation. In such circumstances, a representative biopsy is critical and repeat biopsy is warranted before going for definitive management.