1/188. Communicating defects of the triangular fibrocartilage complex without disruption of the triangular fibrocartilage: a report of two cases.Perforations or communicating defects of the triangular fibrocartilage complex have been more commonly identified after Palmer published his classification system (J hand Surg 1989;14A:594-606). To his variants of class 1B (traumatic) ulnar avulsion with or without distal ulnar fracture, a third category may be added: defects of the ulnar collateral ligament without any associated disruption of the triangular fibrocartilage. The ulnar collateral ligament can be defined as an ulnar capsular structure between the more discrete elements of the triangular fibrocartilage and the ulnar ligaments, with the defect or perforation being distal to the intact triangular fibrocartilage and exiting into the floor of the extensor carpi ulnaris sheath. We present 2 cases that illustrate the diagnosis, the use of both magnetic resonance imaging and arthrography to confirm the diagnosis, the associated dorsal ulnar cutaneous nerve pain distribution, and the open direct and retinacular flap repair.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
2/188. Transverse carpal ligament disruption associated with simultaneous fractures of the trapezium, trapezial ridge, and hook of hamate: a case report.Traumatic disruption of the transverse carpal ligament associated with fractures of the trapezial ridge and hook of hamate is a known entity. Only one report of a coronal fracture of the trapezium has been mentioned in the literature. We report a combination of these two injury patterns. diagnosis was aided by computed tomography. Treatment involved excision of the trapezial ridge and hook of hamate fragments with lag screw fixation of the trapezial body fracture.- - - - - - - - - - ranking = 7keywords = fracture (Clic here for more details about this article) |
3/188. Isolated capitate fracture diagnosed by computed tomography. Case report.Isolated fractures of the capitate, though rare, are probably often missed entirely. As in scaphoid fractures, repeated radiographs, tomography, or bone scanning are necessary for the diagnosis. Reviewing the literature, we found that most capitate fractures reported were transverse or combined with other carpal injuries, including the scapho-capitate fracture syndrome. Our patient presented an isolated oblique intraarticular fracture of the capitate. An old fracture of the styloid process of the ulna was seen at the primary examination. This special type of capitate fracture has not been previously described. The fracture was missed on standard radiographs, but discovered by computed tomography (CT). The different types of fractures of the capitate and their treatment are discussed.- - - - - - - - - - ranking = 13keywords = fracture (Clic here for more details about this article) |
4/188. Wire-loop fixation of volar displaced osteochondral fractures of the distal radius.We describe the technique of wire-loop fixation to treat 4 young men with a unique variant of Melone's type 4 articular fracture of the volar lunate facet, characterized by a displaced rotated articular fragment supported by a limited amount of subchondral bone. This is an unusual injury that threatens the integrity of both the radiocarpal and distal radioulnar joints. It is the result of a compressive force to the wrist and may require trispiral computed tomography for delineation. Open reduction and internal fixation is recommended to maintain stability and articular congruity. The displaced volar-articular fragment, however, may be relatively small; therefore, direct manipulation could lead to soft tissue stripping and osteonecrosis. We have found the technique of wire-loop fixation to be a simple, reproducible, and effective alternative method of internal fixation for these difficult fractures. Malunion, nonunion, loss of fixation, tendon rupture, infection, arthrosis, or pain caused by hardware has not occurred. Use of this technique is not recommended in patients with osteoporotic bone.- - - - - - - - - - ranking = 6keywords = fracture (Clic here for more details about this article) |
5/188. 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) |
6/188. pseudarthrosis of the capitate.Nonunion of an isolated fracture of the capitate is an infrequent condition. The authors present a patient who had few symptoms. Computed tomography showed more bone destruction than the standard X-ray. The nonunion healed with the use of a cancellous bone graft.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
7/188. Serratus fascia "sandwich" free-tissue transfer for complex dorsal hand and wrist avulsion injuries.The serratus anterior fascia was used as a free-tissue transfer in four patients for the reconstruction of dorsal hand defects. All patients had multiple open metacarpal fractures with extensor tendon injuries. The fascia was used to "sandwich" the extensor tendons in a bed of areolar gliding tissue to avoid adhesions. The mean follow-up was 2 years. There were no complications and all flaps survived completely. All flaps were grafted with meshed split-thickness skin at the time of transfer with a 100 percent take in all cases. A good functional result was noted in all patients. This free-tissue transfer is recommended for complex injuries to the dorsum of the hand associated with soft-tissue defects.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
8/188. wrist arthroscopy and dislocation of the radiocarpal joint without fracture.The authors report a rare case of dorsal dislocation of the radiocarpal joint without any bony lesion associated. The traumatic cause was a high energy motorbike accident. Fractures of the other limbs were associated. The authors report the clinical, radiological, and arthroscopic features. wrist arthroscopy showed a complete tear of all the extrinsic ligaments, a radial avulsion of the triangular fibrocartilage complex, and the integrity of the intracarpal ligaments, which guided the treatment. The dislocation was treated by closed reduction and radiocarpal pinning. The authors propose wrist arthroscopy in radiocarpal dislocation for diagnosis of soft tissue and cartilaginous lesions to guide the treatment (close or open).- - - - - - - - - - ranking = 4keywords = fracture (Clic here for more details about this article) |
9/188. Acute compartment syndrome of the forearm in association with ulnar shortening osteotomy: a case report.A 41-year-old man experienced severe pain in the forearm after undergoing ulnar shortening osteotomy to treat positive ulnar variance, a complication of a fracture of the distal end of the radius. The patient had compartment syndrome with compartment pressure of 55 mm Hg. A decompressive fasciotomy of the volar compartment provided total relief of pain and, subsequently, full recovery of all functions. We report the case and discuss the serious nature of compartment syndrome, its associated complications, and methods of diagnosis and management.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
10/188. Vascularized metacarpal bone graft for scaphoid non-union and Kienbock's disease.A new vascularized bone graft from the base of the second metacarpal was used to treat scaphoid non-union and Kienbock's disease. In two patients with scaphoid non-union, the procedure promoted healing, even when the proximal segment was poorly vascularized. In one patient with Kienbock's disease, the graft held stable and wrist pain was markedly reduced. Further clinical experience may establish this procedure as an option for carpal bone fractures or disease.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
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