Isolated open comminuted fracture of the first rib.

In the emergency department, open isolated rib fractures are rarely seen. There is scarce literature related to open isolated first rib comminuted fracture. We report a 33-year-old male who presented with an isolated open first rib comminuted fracture following a road traffic accident. He did not have any neurovascular or major organ injuries and was managed successfully with conservative treatment.

Fixation augmentation using calcium-phosphate bone substitute improves outcomes of complex tibial plateau fractures. A matched, cohort study.

INTRODUCTION: Injectable cements have been developed to improve fixation's stability and thus obtain early return to adequate joint function. We aimed to compare post-operative radiographic and clinical outcomes of patients suffering from a complex tibial plateau fracture (TPF) fixed with calcium-phosphate bone substitutes (CPBS) augmentation to a matched group of patients with identical fracture pattern, treated with the same fixation's type, but augmented with bone grafting. METHODS: After local ethic committee approval, we retrospectively identified in a prospectively collected database, patients with complex comminuted metaphyseal and epiphysial bicondylar TPF (Schatzker type VI) admitted in our emergency department between January 2011 and December 2013. From those, 23 patients (14 males, 9 females) were treated with CPBS (Quickset-CP®, Graftys, Aix-en-Provence, France) fixation augmentation. Patients' mean age were 44.4 years. We then created a control group using a 1:1 matching process on gender, age, fracture pattern, and method of fixation. Patients were evaluated prospectively at 3, 6, and then every six  months using radiographic (AP/ML views) and clinical criteria (knee osteoarthritis outcomes score (KOOS) and EuroQOL-5D). RESULTS: Articular step-off and variation of articular step-off were significantly lower in the CPBS groups (mean step-off 1.4 ± 1.9 (0.5-6.5 mm) and mean step-off Δ = 0.3 ± 0.4 (0.5-2.2 mm)) than in the control group (mean step-off 3.6 ± 2.1 (1-7.5 mm) and mean step-off Δ = 2.2 ± 2 (0.5-7 mm) p < 0.01). At last follow-up, patients of the control group presented a higher rate of step-off > 2 mm and step-off Δ > 2 mm (respectively, 56 and 35%) than patients of the CPBS group (26 and 9%). Odd ratio of, respectively, 3.6 (95% CI (1.08-12.7) and p = 0.03) and 5.6 (95% CI (1.04-30.1) and p = 0.03).At mean follow-up of 29 months, KOOS pain subscore was significantly better in patients of the CPBS group (85.3 ± 12.1) than in control patients (74.2 ± 10.4 and p = 0.03). CONCLUSION: The present study demonstrates that calcium-phosphate bone substitute used as synthesis augmentation improves mid-term radiological outcomes of patients suffering from complex tibial plateau fracture. Series reporting outcomes from a larger number of patients and longer follow-up must confirm clinical benefits and safety of this method.

Novel management of an isolated comminuted cricoid cartilage fracture.

Laryngeal trauma is a rare occurrence that can result in significant morbidity and mortality. Isolated cricoid cartilage fractures are exceedingly rare, and their treatment is highly variable. We describe a case of an isolated comminuted, uncalcified cricoid cartilage fracture in a 34-year-old man that responded well to novel management with suture and 2-octylcyanoacrylate tissue adhesive fixation intraoperatively and topical ciprofloxacin/dexamethasone applied to the airway postoperatively. We discuss the novel application of cyanoacrylate glue in laryngeal trauma and the potential benefits of topical ciprofloxacin/dexamethasone application to the airway.

[Clinical study of sodium hyaluronate in supplementary treatment of comminuted fracture of ankle].

OBJECTIVE: To investigate the effects of sodium hyaluronate in supplementary treatment of comminuted fracture of ankle. METHODS: Thirty-seven patients suffered from comminuted fracture of ankle were operated for restoration by routing methods, and received 2 ml of sodium hyaluronate injection intra-articularly before the closure of incision. The ankle was fixed and given the second intra-articular injection on the 3rd day after operation. Then, the patients were given sodium hyaluronate injection intra-articularly at a week intervals till the paste was removed after 4 weeks. All patients were followed up. The clinical results were evaluated by measuring the symptoms of pain, and the function of walking and other daily living activities. RESULTS: All the patients were followed up for 6 to 27 months, among them, 30 patients were cured completely without any symptoms, the ankle function for walking and daily living activities was normal, 6 patients felt pain with violent activity or walking exceeding 1 km, one patient suffered from comminuted fracture with compressed depression was not improved due to his ankle being not restored properly. CONCLUSION: Intra-articular injection of sodium hyaluronate is an effective supplementary treatment for comminuted fracture of ankle.