1/64. Neurological complications in insufficiency fractures of the sacrum. Three case-reports.Three cases of nerve root compromise in elderly women with insufficiency fractures of the sacrum are reported. Neurological compromise is generally felt to be exceedingly rare in this setting. A review of 493 cases of sacral insufficiency fractures reported in the literature suggested an incidence of about 2%. The true incidence is probably higher since many case-reports provided only scant information on symptoms; furthermore, sphincter dysfunction and lower limb paresthesia were the most common symptoms and can readily be overlooked or misinterpreted in elderly patients with multiple health problems. The neurological manifestations were delayed in some cases. A full recovery was the rule. The characteristics of the sacral fracture were not consistently related with the risk of neurological compromise. In most cases there was no displacement and in many the foramina were not involved. The pathophysiology of the neurological manifestations remains unclear. We suggest that patients with sacral insufficiency fractures should be carefully monitored for neurological manifestations.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
2/64. osteotomy for malunion of a talar neck fracture: a case report.A malunion of the talar neck after a Hawkins type II fracture/dislocation of the talar neck occurred in a 34-year-old man after nonoperative treatment. Rigid varus deformity of the forefoot was a source of severe pain and disability in this patient. We describe our surgical technique for osteotomy of the talar neck with insertion of a tricortical iliac crest bone graft to correct the deformity. At follow-up (56 months), the patient had consistent relief of pain and was employed at his preinjury job doing heavy labor. The score on the American Orthopaedic foot and ankle Society ankle-Hindfoot Scale improved from 11 points, preoperatively, to 85 points, postoperatively. Radiographs showed maintenance in the position of the osteotomy and no evidence of avascular necrosis in the talar body. Evidence of arthrosis of the talonavicular joint was apparent radiographically, but the patient did not complain of symptoms referable to this area.- - - - - - - - - - ranking = 0.625keywords = fracture (Clic here for more details about this article) |
3/64. Endoscopic bone graft for delayed union and nonunion.Nonunion and delayed union are serious consequences in the treatment of fractures. Bone graft has been a mainstay of treatment for nonunion and delayed union. But with rapid development of the endoscopic procedure, bone grafting can be performed after curettage of fibrous tissue around the fracture gap and sclerotic fracture end under direct visual control of the endoscope. This technical note provides procedures for this technique.- - - - - - - - - - ranking = 0.375keywords = fracture (Clic here for more details about this article) |
4/64. Attritional flexor tendon ruptures due to distal radius fracture and associated with volar displacement of the distal ulna: a case report.Flexor tendon rupture following distal radius fractures are rare. In this report, a volarly displaced distal ulna that perforated the volar wrist capsule caused delayed flexor tendon ruptures 25 years after a distal radius fracture. The repair with free tendon graft and the excision of the distal ulna produced a successful result.- - - - - - - - - - ranking = 0.75keywords = fracture (Clic here for more details about this article) |
5/64. clavicle malunion.The clavicle fracture that has united with deformity or shortening may have an adverse effect on normal shoulder girdle function. We report on 4 patients in whom a malunited fracture of the clavicle was believed to be a contributing factor to shoulder girdle dysfunction. In each patient, the functional status of the involved limb was improved after corrective osteotomy at the site of deformity, realignment, and plate fixation.- - - - - - - - - - ranking = 0.25keywords = fracture (Clic here for more details about this article) |
6/64. Salvage of failed resection of the distal ulna. Case report.A 45-year-old woman completely lost the ability of active supination of the forearm after a Darrach resection for malunited fracture of the distal radius. A three-component reconstruction was performed to stabilise the distal stump of the ulna and prevent convergence between the two forearm bones. The procedure combined advancement lengthening osteotomy of the ulna, longitudinal intramedullary tenodesis of the extensor carpi ulnaris tendon, and dorsal transfer of the pronator quadratus through the interosseous space. Four months after the salvage procedure she again had full active supination of the forearm and she returned to work two months later.- - - - - - - - - - ranking = 0.125keywords = fracture (Clic here for more details about this article) |
7/64. Delayed brachial plexus neurapraxia complicating malunion of the clavicle.Delayed brachial plexus neurapraxia is a rare complication of midshaft clavicular fracture. The symptoms are variable and occur insidiously. Surgical decompression to release the compression of brachial plexus is the treatment of choice and usually has a good result. We report a patient whose brachial plexus was compressed by malunion of the clavicle. This patient had a good outcome after treatment with intramedullary nailing and Knowles pin fixation after corrective osteotomy without bone grafting.- - - - - - - - - - ranking = 0.12529300844225keywords = fracture, compression (Clic here for more details about this article) |
8/64. rotation of the clavicular portion of the pectoralis major for soft-tissue coverage of the clavicle. An anatomical study and case report.BACKGROUND: The purposes of this study were to describe the anatomical features of a rotational flap consisting of the clavicular portion of the pectoralis major and to report the surgical technique and the outcome of use of this flap in a patient with poor soft-tissue coverage following multiple operations for a clavicular fracture complicated by nonunion and infection. methods: Ten shoulders from five cadavera were dissected to isolate the clavicular portion of the pectoralis major. The vascular pedicle, thoracoacromial artery, and axillary artery were identified, and the length of the vascular pedicle from the axillary artery to the muscle was measured. The angle of rotation of the flap about its intact clavicular origin was measured before and after division of the acromial branch of the thoracoacromial artery. The clavicular origin was then incised, and the overall length, width, and thickness of the muscle as well as the distance from each end of the muscle to the vascular pedicle were measured. RESULTS: The average length of the vascular pedicle from the axillary artery to the pectoralis muscle belly was 5.3 centimeters (range, 3.7 to 6.5 centimeters). The average maximum angle of rotation with the clavicular origin intact was 60 degrees (range, 55 to 67 degrees) before division of the acromial branch and 73 degrees (range, 65 to 82 degrees) after division. The average total length of the clavicular head was 20.2 centimeters (range, 18.0 to 23.0 centimeters). The average width of the clavicular head was 2.9 centimeters (range, 2.0 to 4.0 centimeters), and the average thickness was 0.5 centimeter (range, 0.2 to 0.7 centimeter). The vascular pedicle entered the muscle an average of 8.7 centimeters (range, 5.2 to 10.7 centimeters) lateral to the most medial extent of the muscle and an average of 11.5 centimeters (range, 9.5 to 14.0 centimeters) medial to the most lateral extent of the muscle. The rotational flap was successfully used clinically to provide soft-tissue coverage after bone-grafting and internal fixation of a clavicular nonunion that had been complicated by infection. CONCLUSIONS: The clavicular head of the pectoralis major may be used as a local rotational flap to cover soft-tissue deficiencies over the clavicle. It can be harvested with relative ease without damaging the sternocostal head.- - - - - - - - - - ranking = 0.125keywords = fracture (Clic here for more details about this article) |
9/64. Femoral head avulsion fracture with malunion to the acetabulum: a case report.The case of a patient who sustained an avulsion fracture of the femoral head (Pipkin Type I) that was unrecognized is described. The patient was referred to the authors' institution four months after injury, and radiographic studies showed a malunited avulsion fracture of the femoral head to the acetabulum. The patient subsequently went on to an excellent result after surgical debridement. The authors recommend additional radiographic studies in cases to exclude unrecognized fractures where a possible hip subluxation may have occurred.- - - - - - - - - - ranking = 0.875keywords = fracture (Clic here for more details about this article) |
10/64. Recurrent supracondylar humerus fracture following prior malunion.In this report, two patients sustained a recurrent supracondylar humerus fracture following malunion of a previous supracondylar humerus fracture. The patients were treated for their first fracture at 5 and 6 years of age, respectively. One underwent open reduction with percutaneous pinning, and the other was treated with closed reduction with casting. Both patients healed in a moderate degree of extension after the first fracture. Two years later, both sustained a second fracture of the supracondylar humerus. Both had closed reduction with percutaneous pinning and went on to heal uneventfully. We speculate that ensuing post-traumatic extension deformity may accentuate a child's tendency for elbow hyperextension. Extension malunion may place the child at increased risk for a second fracture via similar mechanisms of injury.- - - - - - - - - - ranking = 1.25keywords = fracture (Clic here for more details about this article) |
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