Cases reported "Fractures, Closed"

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1/66. Three cases of patella fracture in 1,320 anterior cruciate ligament reconstructions with bone-patellar tendon-bone autograft.

    Between September 1992 and December 1996 we reviewed three transverse displaced fractures of the patella occuring in 1,320 ACL reconstructions using bone-patellar tendon-bone autograft. All the patients suffered local injury to the donor knee between 8 and 12 weeks postoperatively. Immediate rigid fixation using single or double anterior tension band allowed early mobilization and full weight bearing. Between 6 and 9 months after fracture, the screws and the wire were removed and the grafts tested. Results of the pivot shift and Lachman test under anesthesia were negative and arthroscopic visualisation showed the graft to be intact. Postoperative assessment included the Lysholm and Tegner scales, the International knee documentation Committee Evaluation form (IKDC), KT-1000 arthrometer, and isokinetic dynamometer strength testing. No significant differences in the final outcome were noted between reconstructions complicated by patellar fracture and normal ACL reconstructions.
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2/66. Nonunion following subcapital (neck) fractures of the proximal phalanx of the thumb in children.

    Six cases of nonunion of subcapital (neck) fractures of the proximal phalanx of the thumb in children were seen over a period of 5 years. Ages at the time of injury ranged between 2 and 3 years. Entrapment of the thumb in a closing door was the mechanism of injury in all cases. All fractures were closed and were significantly displaced. Immediate management was by closed reduction and splinting in four cases, closed reduction and K-wire fixation in one case and no treatment in one case, which was later treated by delayed open reduction and K-wire fixation. Only two of the six ununited fractures were eventually treated with bone grafts and both fractures united resulting in a stable thumb but with a limited range of flexion of the interphalangeal joint. Factors that may increase the risk of nonunion of these fractures in children are discussed.
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3/66. trapezoid bone fracture.

    Fractures of the carpal bones involve only a single bone or complex bones with or without ligament rupture. However, fractures of the trapezoid are rarely seen. Because the trapezoid is fastened to the trapezium, capitate, and scaphoid by strong ligaments, fracture or dislocation is limited by this rigid fixation. The authors present a single bone fracture of the trapezoid in a 40-year-old man. A tomogram of the carpal bone was useful in diagnosing the trapezoid fracture. The mechanism for development of fracture of the trapezoid alone is unknown. However, fracture of the trapezoid seemed to occur when the wrist joint was forced with excessive flexion stress that was placed on the trapezoid through the second metacarpal bone indirectly. This occurred in the same manner that a walnut is broken with nutcrackers.
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4/66. Fatal fat embolism syndrome: a case report.

    Fat embolism syndrome is a dire complication of long bone trauma. It is usually associated with neurological, hematological and respiratory involvement, the latter being the major cause of death. We present a case of severe fat embolism syndrome occurring 3 hours after a long bone injury, leading to permanent vegetative state and death without any respiratory signs. The diagnosis was confirmed by cytology of the bronchoalveolar lavage fluid. Clinical presentation of the puzzling fat embolism syndrome and diagnostic tests in suspected fat embolism syndrome are reviewed.
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5/66. Repair of traumatic urethral fistula and huge tissue defect with Lehoczky's island flap.

    A 20-years-old male patient suffered pelvic bone fracture and a penetrating urethral injury through the perineum due to a car accident. The injury and the unsuccessful reconstruction resulted in a large perineal tissue defect, urethral fistula, and dislocation of the anus close to the fistula. The authors performed a successful reconstruction; closure of the urethral fistula, sinking of the anus to its proper place, and substitution of the missing skin and subcutaneous tissue with Lehoczky's flap. The flap with its good blood supply and mass of tissue repaired the defect and promoted the rapid, functionally and cosmetically excellent result.
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6/66. Refracture of proximal fifth metatarsal (Jones) fracture after intramedullary screw fixation in athletes.

    This study details six instances of refracture of clinically and radiographically healed fractures of the base of the fifth metatarsal after intramedullary screw fixation. Four professional football players, one college basketball player, and one recreational athlete underwent intramedullary screw fixation of fifth metatarsal fractures. The athletes were released to full activities an average of 8.5 weeks (range, 5.5 to 12) after fixation, when healing was clinically and radiographically documented. Three football players developed refracture within 1 day of return to full activity. The other three athletes refractured at 2.5, 4, and 4.5 months after return to activity. Two football players underwent repeat fixation with larger screws and returned to play in the same season. The college basketball player underwent bone grafting and returned to play in subsequent seasons. The other three athletes underwent nonoperative management and healed uneventfully over 6 to 8 weeks. On the basis of this series, we recommend that 1) screw fixation using a large-diameter screw should be given careful consideration for patients with large body mass for whom early return to activity is important; 2) functional bracing, shoe modification, or an orthosis should be considered for return to play; 3) if refracture occurs, exchange to a larger screw may allow return to play in the same season; and 4) alternative imaging should be considered to help document complete healing.
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7/66. Type III occipital condylar fracture presenting with hydrocephalus, vertebral artery injury and vasospasm: case report.

    Occipital condylar fractures (OCF) are rare and have a high mortality rate. We report a patient with OCF who presented with acute hydrocephalus and died from diffuse vasospasm secondary to vertebral artery injury. A 45-year-old man fell 20 feet from a deer stand and landed on his head. CT showed a type III OCF continuing to the anterior rim of the foramen magnum on the left, with a bone fragment pushing into the medulla, causing hydrocephalus. The patient was stabilized, and a four-vessel arteriogram showed diffuse vasospasm with complete occlusion of the left vertebral artery at the level of the OCF. To our knowledge, this is the first documented case of the conjunction of OCF, hydrocephalus, and vasospasm.
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8/66. Scapho-capitate fracture syndrome. A case report.

    A rare injury of the wrist, scapho-capitate fracture syndrome, in a young patient is reported. Despite early recognition of the injury and surgical intervention, the scaphoid fracture did not unite and another attempt to achieve union with bone grafting and internal fixation also failed. The wrist continued to be painful and stiff. Radiographs of the wrist, 18 months after the injury, showed nonunion of the scaphoid, avascular necrosis of the scaphoid and the lunate and carpal collapse with midcarpal joint arthritis. Due to persistent and disabling symptoms arthrodesis of the wrist had to be carried out. Possible causes for the bad outcome after this injury are discussed. We recommend open reduction for the fracture of the capitate and open reduction and internal fixation with primary bone grafting for a displaced comminuted scaphoid fracture.
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9/66. urinary incontinence after pelvic trauma: a case report.

    Stress and Urge urinary incontinence may develop after a pelvic trauma especially after pelvic bone fractures. Incontinence may persist even though any type of bladder neck suspension is performed if malunion occurs between fracture ends. In stress and urge urinary incontinence developed after pelvic trauma, patients should also be evaluated for malunion of fractures which may lead to bone spurs and during any type of bladder neck suspension these should also be removed.
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10/66. Marchetti nailing with decortication and bone graft in non-unions of the two upper thirds of the humerus.

    METHOD: Twelve patients with humeral shaft non-unions were treated using a Marchetti-Vicenzi nailing. The fractures site was decorticated and bone graft added. RESULTS: fracture healing was obtained in all cases. The mean healing time was 4.7 months. The range of motion of the shoulder was excellent in nine patients, moderate in two and poor in one. The elbow had an excellent range of motion in ten patients, moderate in one and poor in one. The functional result was excellent in nine patients, good in two, and fair in one. CONCLUSION: Marchetti-Vicenzi nailing with bone grafting appears to be a good method for the treatment of humeral shaft non-unions. It is technically easy and its results are satisfactory.
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