11/372. Tardy displacement of traumatic radial head dislocation in childhood.The diagnosis of traumatic dislocation of the radial head, either isolated or as part of a Monteggia fracture-dislocation, was delayed in 10 of the 110 children treated with these injuries during the study period. In eight children, the dislocation was overlooked on the initial radiographs. In two children, the radial head was reduced on the initial elbow radiographs, but it was dislocated 10 days later in one child and 21 days later in the other. The most likely explanation is that the radial head dislocated at the time of impact, spontaneously reduced by the time the first radiographs were obtained, and redislocated while the arm was in a cast. We conclude that radiographic assessments of the radiocapitellar joint, by using the radiocapitellar line, are required in children with elbow and forearm injuries at presentation and when the cast is removed.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
12/372. Irreducible Galeazzi fracture-dislocation due to an avulsion fracture of the fovea of the ulna.We report a rare case of Galeazzi fracture-dislocation with an irreducible distal radioulnar joint. The cause of the irreducibility was entrapment of a fragment avulsed from the fovea of the ulna. The patient was successfully treated with open reduction and internal fixation of the radius, ulnar styloid process and avulsed fracture at the fovea of the ulna.- - - - - - - - - - ranking = 10keywords = fracture (Clic here for more details about this article) |
13/372. Palmar lunate trans-scaphoid, trans-triquetral fracture-dislocation.A palmar lunate dislocation associated with fractures of the scaphoid and triquetrum and an avulsion fracture of the radial styloid is described. The injury resulted from a high energy dorsiflexion/axial compression force. Open reduction of the dislocated lunate and internal fixation of the scaphoid were done as an emergency procedure. A second operation was required to internally fix the displaced triquetral fracture and reduce the lunotriquetral dissociation. A good result was documented at 6 months.- - - - - - - - - - ranking = 7keywords = fracture (Clic here for more details about this article) |
14/372. Bilateral radial head and neck fractures.Isolated radial head and neck fractures comprise 1-2% of all fractures seen by physicians. Although bilateral distal radial fractures have been documented, primarily in gymnasts, no literature is present on bilateral radial head or neck fractures. This article presents two such patients who sustained nondisplaced bilateral radial head or neck fractures resulting from falls on outstretched hands. The detection, classification, and treatment options of radial head fractures is reviewed.- - - - - - - - - - ranking = 10keywords = fracture (Clic here for more details about this article) |
15/372. Nonunion of fracture of the neck of the radius: a report of three cases.Nonunion of a radial neck fracture is uncommon. Our report of three cases aims to highlight the fact that this complication is possible following such a fracture in adults. Appropriate clinical and radiologic follow-up is necessary to make sure such nonunion not missed. Surgical fixation (when nonunion of radial neck fracture is suspected) or excision of the radial head may be necessary if the complication is symptomatic. When associated with an ulna fracture, the threshold for internal fixation of both fractures must be lower.- - - - - - - - - - ranking = 9keywords = fracture (Clic here for more details about this article) |
16/372. Transcranial doppler detection of fat emboli.BACKGROUND AND PURPOSE: The fat embolism syndrome (FES) is characterized by the simultaneous occurrence of pulmonary and neurological symptoms as well as skin and mucosal petechiae in the setting of long-bone fractures or their surgical repair. Its pathophysiology is poorly understood, and effective treatments are lacking. We present 5 patients with long-bone fractures in whom in vivo microembolism was detected by transcranial Doppler. methods: Five patients with long-bone fractures were monitored with transcranial Doppler for microembolic signals (MESs) after trauma. Two patients also had intraoperative monitoring. A TC-2020 instrument equipped with MES detection software was used. Detected signals were saved for subsequent review. Selected signals satisfied criteria defined previously and were categorized as large or small. RESULTS: Cerebral microembolism was detected in all 5 patients and was transient, resolving within 4 days of injury. Intraoperative monitoring revealed an increase in MESs during intramedullary nail insertion. The characteristics of MESs after injury varied among patients, with large signals being more frequent in the only patient with a patent foramen ovale. CONCLUSIONS: Cerebral microembolism after long-bone fractures can be detected in vivo and monitored over time. These findings may have potential diagnostic and therapeutic implications.- - - - - - - - - - ranking = 4keywords = fracture (Clic here for more details about this article) |
17/372. Ultrasonographic localization of a displaced screw in the carpal canal. A case report.We present a case of a 65-year-old patient with a surgically treated distal radius fracture. At 5-month follow-up, conventional radiography revealed breakage of the plate and a screw displaced into the volar soft tissue. Preoperative ultrasonography including dynamic assessment of the tendons showed the screw intratendinously as a hyperechogenic structure with repetitive echoes. This unusual localization was proven by surgery. Dynamic ultrasonography played an important diagnostic role in the localization of the loosened and displaced osteosynthetic material.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
18/372. 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 = 1keywords = fracture (Clic here for more details about this article) |
19/372. Tardy ulnar tunnel syndrome caused by Galeazzi fracture-dislocation: a neuropathy with a new pathomechanism.We present a case of late-onset ulnar tunnel syndrome following a Colles fracture. The nerve palsy was caused by a vascular branch that stretched over the ulnar head, compressing the nerve and generating friction against the ulnar head when the forearm was rotated. This is the first report of such a pathomechanism.- - - - - - - - - - ranking = 5keywords = fracture (Clic here for more details about this article) |
20/372. Fractures of the proximal radial head and neck in children with emphasis on those that involve the articular cartilage.This is a review of 116 children who had a fracture of the proximal radial head or neck over a 15-year period. Of 33 teenagers with closed physes, 17 (52%) had intraarticular involvement. Of 83 younger children with an open proximal radial physis, six (7%) had an intraarticular fracture (Salter-Harris type III or IV). Of the 17 patients with closed physes and intraarticular fracture, 13 had adequate follow-up. There were eight excellent, three good, one fair, and one poor results. Of the six children with open physes and intraarticular fracture, there were one good and five poor results. This study confirms that intraarticular fracture of the radial head is much more common if the proximal radial physis is closed. In addition, this review indicates that the prognosis is extremely poor for children who have a radial head intraarticular fracture that also involves an open physis (Salter-Harris types III and IV), particularly when the fracture is treated initially nonoperatively. Displaced proximal radial fractures that involve both physeal and articular cartilage may be occult, and as with all physeal and intraarticular fractures, anatomic reduction (open if necessary) is mandatory.- - - - - - - - - - ranking = 9keywords = fracture (Clic here for more details about this article) |
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