Cases reported "Fractures, Comminuted"

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1/11. Sideswipe elbow fractures.

    A retrospective review of all cases of sideswipe elbow fractures (SSEFs) treated at two community hospitals from 1982 to 1992 was conducted to determine the functional outcome of the operative treatment of SSEFs. All five injuries involved the left elbow, and they included open fractures of the olecranon, the radius and ulna, the ulna and humerus, the humerus, and traumatic amputation of the arm. Concomitant injuries included three radial nerve palsies and two injuries each to the median nerve, ulnar nerve, and brachial artery. Treatment included irrigation, debridement (repeated if necessary), open reduction and internal fixation, external fixation (one case), and delayed amputation (one case). An average of 130/-10 degrees elbow flexion/extension, and 60/60 degrees supination/pronation was obtained for the three of four patients with reconstructions who returned for follow-up.
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2/11. Recurrent fracture of the humerus in a softball player.

    Fracture of a normal humerus can occur during the act of throwing an object. We present the case of a young woman who sustained a spiral fracture of the distal humeral shaft with concomitant radial nerve palsy while throwing a softball and who, after clinical and radiographic evidence of bony healing, suffered a repeat humerus fracture, also while throwing a softball.
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3/11. Proximal median neuropathy secondary to humeral neck fracture.

    Median neuropathies proximal to the wrist are uncommon and usually result from penetrating injuries, fracture dislocation of the distal humerus, or compression by fibrous bands. A 66-year-old man suffered a comminuted fracture of the proximal humerus after a fall. Electrodiagnostic studies revealed a severe proximal median neuropathy and a mild distal radial mononeuropathy. Proximal median neuropathy rarely occurs in humeral neck fracture, mostly because the median nerve is not in close contact with the humerus proximally.
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4/11. Fracture of the distal part of the radius associated with severed ulnar nerve.

    We report a case of a severed ulnar nerve after fracture of the distal part of the radius. The most likely hypothesis is stretching of the ulnar nerve fixed by Guyon's canal and severed on the sharp edge of the proximal radius. Although very rare, this lesion must be investigated particularly in cases with marked displacement, especially ulnar and/or volar.
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5/11. titanium mesh repair of the severely comminuted frontal sinus fracture.

    BACKGROUND: Severely comminuted frontal sinus fractures are difficult to contour and immobilize. Frequently, plates or wires are inadequate in fixating all fragments together, resulting in less than optimal outcomes. Advancements in the development of biomaterials have now made titanium mesh a new option for the repair of severely comminuted fractures. methods: Fourteen patients with severely comminuted frontal sinus fractures were treated with titanium mesh from 1994 to 1999. The fractures were reduced and immobilized using a simple algorithm: (1) Isolated anterior table fractures were repaired with reduced bony fragments attached to titanium mesh. (2) Anterior table fractures with nasofrontal duct involvement were repaired by sinus obliteration and anterior wall reconstruction with reduced bony fragments attached to titanium mesh. (3) Anterior and posterior table fractures with cerebrospinal fluid leak or displacement were treated with the cranialization of the sinus and anterior wall reconstruction with reduced bony fragments attached to titanium mesh. RESULTS: Of the 14 patients treated, 12 were available for postoperative evaluation. Parameters such as nasal function, cranial nerve V and VII function, cosmesis, and complications (hardware extrusions, sinusitis, meningitis, osteomyelitis, mucopyocele, brain abscess, pneumocephalus, and cerebrospinal fluid leak) were evaluated. All patients had good function of the superior division of cranial nerves V and VII. Two patients (16%) had minor wound infections, which resolved under treatment with antibiotics. All had excellent cosmetic results as measured by postreduction radiographs and personal and family perceptions of forehead contour. CONCLUSION: titanium mesh reconstruction of severely comminuted frontal sinus fractures has few complications while providing excellent forehead contour and cosmesis.
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6/11. Secondary ulnar nerve palsy in adults after elbow trauma: a report of two cases.

    Secondary ulnar nerve palsy, an unusual condition in which the onset of ulnar nerve dysfunction occurs 1 to 3 months after elbow trauma, can be the cause of sudden deterioration of elbow function. Initially recognized in 1899, this condition has not been reported often. We describe 2 patients who had no subjective or objective evidence of ulnar nerve dysfunction after elbow trauma but had a sudden loss of motion, pain, and clinical and electrophysiologic evidence of ulnar nerve compression at the elbow 4 to 5 weeks after trauma. Marked improvement occurred after ulnar nerve subcutaneous transposition and contracture release.
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7/11. blindness after Le Fort I osteotomy: a possible complication associated with pterygomaxillary separation.

    INTRODUCTION: Visual loss after Le Fort I osteotomy is a devastating complication the mechanism of which is not always clear. methods: A case report of blindness following Le Fort I osteotomy is presented. The literature on the various skull base complications associated with Le Fort I osteotomies is reviewed and the mechanisms of these complications discussed. CONCLUSION: The radiological findings in this case are similar to those previously reported. They strongly support the hypothesis that an adverse transmission of forces associated with pterygomaxillary separation via the sphenoid bone to the intra- and extracranial portions of the skull base is the main reason for injury to the optic and other cranial nerves as well as to the branches of the carotid artery.
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8/11. Split flexor carpi ulnaris transfer: a new functioning free muscle transfer with independent dual function.

    BACKGROUND: A functioning free muscle transfer is a well-established modality of restoring upper limb function in patients with significant functional deficits. Splitting the neuromuscular compartments of the free muscle based on its intramuscular neural anatomy and using each compartment for a different function would allow for restoration of two functions instead of one at the new distant site. methods: The authors previously reported on the clinical use of a pedicled split flexor carpi ulnaris muscle transfer. They now report the use of this muscle as a functioning free split muscle transfer to restore independent thumb and finger extension in a patient with total extensor compartment muscle loss in the forearm and a concomitant high radial nerve avulsion injury. RESULTS: Nine months postoperatively, the patient was able to extend his thumb and fingers independent of each other. CONCLUSION: This is the first report of a functioning free split muscle transfer demonstrating two independent functions in the upper limb.
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9/11. Subcoracoid trapping of the proximal fragment of a fractured clavicle.

    An unusual indication--not previously reported--for surgical treatment of a clavicle fracture, in a 56-year-old male, is presented. The proximal fragment had been entrapped under the coracoid, and there were symptoms from impairment of the musculocutaneous nerve. Reduction by closed means proved unsuccessful, and an open procedure was necessary for this rare type of the common clavicle fracture.
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10/11. Operative treatment of humeral shaft fractures.

    The results of the operative treatment of 27 humeral shaft fractures treated at the University of Louisville during a 2-year period were reviewed. The aim of this study was to analyze 1) the indications and results of surgical treatment, 2) the indications for nailing versus plating, and 3) the failures and their treatment (especially surgical nonunions). Indications for surgery were polytrauma patients (including open fractures, associated neurovascular injuries, associated ipsilateral forearm injuries) and isolated unstable fractures in which closed reduction failed. Plate and screw osteosynthesis was used in patients with proximal and distal fractures, in the presence of neurovascular injuries, progressive radial nerve palsy and failure of closed reduction due to interposition of soft tissue. Intramedullary antegrade nailing was preferentially used in polytrauma patients. Seven patients (25%) needed further surgery because of nonunion. The frequency was higher after plating (30%) than after nailing (20%), it was more common in comminuted fractures, middle third fractures and after insufficient distal locking. Exchange nailing resulted in union in 5 of the 7 cases. Although excellent results with low complication rates are reported in the recent literature following plate and screw osteosynthesis or locked intramedullary nailing, we found that operative treatment of difficult humeral shaft fractures is still fraught with a high complication rate.
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