Cases reported "Fractures, Open"

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1/347. Articular fractures of the proximal interphalangeal joint with missing elements: repair with partial toe joint osteochondral autografts.

    Five cases of traumatic destruction of a condyle of the proximal interphalangeal joint repaired with a free autogenous graft of a corresponding toe condyle are presented. Precise fitting is essential: 1 patient required a second graft when the initial undersized graft was absorbed. Four of the 5 cases regained laterally stable bicondylar joints and functional fingers. Range of motion varied inversely to the magnitude of the injury and the surgery. Active range of motion at the proximal interphalangeal joint was 80 degrees in 2 digits, 45 degrees in 1, and 10 degrees in 1 complex case; 1 case was considered a failure. ( info)

2/347. Remission of idiopathic thrombocytopenic purpura after femoral lengthening. Clinical case followed for 5 years.

    We report on a patient with chronic idiopathic thrombocytopenic purpura (ITP) who went into remission after femoral lengthening. Although it is possible that spontaneous remission (frequency 5%-10%) of chronic ITP coincided with the femoral lengthening, limb lengthening could also have caused the thrombocytosis. This case suggests a close relationship between osteogenesis and hematopoiesis during regenerate bone formation. Limb lengthening can therefore be defined as the formation not only of bone and soft tissue but also of hematopoietic tissue. ( info)

3/347. Salvage of contaminated fractures of the distal humerus with thin wire external fixation.

    Fractures and osteotomies of the distal humerus that are contaminated or infected represent a difficult management problem. Stable anatomic fixation with plates and screws, the acknowledged key to a good result in the treatment of bicondylar fractures, may be unwise. A thin wire circular (Ilizarov) external fixator was used as salvage treatment in such complex situations in five patients. The fixator allowed functional mobilization of the elbow while allowing achievement of the primary goal of eradicating the infection or colonization. Two patients required a second operation for fixation of a fibrous union of the lateral condyle. One patient with a vascularized fibular graft later required triple plate fixation for malalignment at the distal host and graft junction. Four of five patients ultimately achieved complete union. The fracture remained ununited in one patient who has declined additional intervention. All five patients achieved at least 85 degrees ulnohumeral motion, two after a secondary elbow capsulectomy performed after healing was achieved. This experience suggested that the Ilizarov construct, although not a panacea, represents a reliable method of skeletal stabilization that allows functional mobilization while elimination of infection or colonization is ensured. If necessary, stiffness and incomplete healing can be addressed with an increased margin of safety at subsequent operations. ( info)

4/347. 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. ( info)

5/347. Immediate autografting of bone in open fractures with bone loss of the hand: a preliminary report. case reports.

    Three patients with open fractures of the hand associated with bone loss were treated within four to six hours of injury by corticocancellous bone grafting and soft tissue coverage after meticulous debridement, copious irrigation of the wounds, and broad-spectrum antibiotics given intravenously. Long term follow-up was uneventful and showed that the graft had taken and healed well with early and full restoration of function and a good cosmetic result. Immediate corticocancellous bone grafting of an injured hand could be used in selected cases with well-debrided, surgically clean wounds as long as there is a rich blood supply. Adequate bone fixation, soft tissue coverage, and broad-spectrum antibiotics given intravenously will remove the risk of infection. hand architecture is corrected while wound contracture and secondary deformity are avoided. Both patients' discomfort and hospital costs are considerably reduced. ( info)

6/347. 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. ( info)

7/347. Bisegmental rotational fracture dislocation of the pediatric cervical spine. A case report.

    STUDY DESIGN: A case of a bisegmental rotational fracture dislocation in the pediatric cervical spine is presented. OBJECTIVES: To highlight the problems in the diagnostics and surgical management of this rare type of injury. SUMMARY OF BACKGROUND DATA: Fractures of the cervical spine are relatively uncommon in childhood. To the authors' knowledge, this is the first reported case of a bisegmental rotational fracture dislocation in the pediatric cervical spine managed by a combined anteroposterior approach. methods: A 6-year-old girl was hit by a car as a pedestrian. In addition to an open fracture dislocation of the Lisfranc joint in the right foot, she sustained a bisegmental fracture dislocation at the lower cervical spine (C3-C5) with no neurologic deficit. The complete diagnosis of a locked rotational fracture dislocation could be established only by using computed tomography scans with three-dimensional reconstructions. The injury was managed with a combined anteroposterior open reduction and a bisegmental anterior fusion. RESULTS: Implant removal was performed after bony fusion 6 months after surgery. At follow-up assessment 2.5 years later, the girl had a good radiologic result and a full and pain-free functional recovery. CONCLUSIONS: Bisegmental rotational fracture dislocations in pediatric cervical spines are not easily diagnosed and may require three-dimensional computed tomography scan reconstructions for complete assessment. In such rare cases, a combined anteroposterior surgical procedure may be indicated, with a bisegmental anterior fusion providing a good functional result. ( info)

8/347. Open clavicle fractures: a case report.

    Open fractures of the clavicle are rare, whereas closed fractures are quite common. Presented here is a case report of a grade IIIA open clavicle fracture. After reviewing the literature, there appears to be little information on the treatment or outcome of these fractures. One can only surmise that the outcome and complications are similar to those of other open fractures. ( info)

9/347. Avascular necrosis of the distal phalangeal epiphysis following physeal fracture: a case report.

    Avascular necrosis of the distal phalangeal epiphysis following an unrecognized angulated Salter II fracture of the distal phalanx treated by open reduction and internal fixation resulted in premature closure of the growth plate and mild shortening. The epiphysis itself revascularized and good function of the distal interphalangeal joint was maintained. ( info)

10/347. Salvage of open tibial fracture with segmental loss of tibial nerve: case report and review of the literature.

    We report a case history, treatment, and follow-up of an open comminuted distal tibial fracture with significant soft tissue loss and segmental loss of the tibial nerve and posterior tibial artery. This constellation of injuries with an insensate plantar foot has often been an indication for amputation. In this instance, a functional distal extremity was salvaged with the use of Ilizarov fixation, delayed primary tibial nerve cable grafting, and staged soft tissue coverage. Clinical follow-up and review of the literature on the techniques used are offered for consideration. ( info)
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