Cases reported "Fractures, Ununited"

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1/17. Nonunion of a pediatric lateral condyle fracture without ulnar nerve palsy: sixty-year follow-up.

    Displaced lateral condyle fractures in the pediatric population are usually treated with open reduction and internal fixation. Significant complications associated with the nonoperative management include nonunion, malunion, deformity, and tardy ulnar nerve palsy. However, few cases of nonunion of the lateral condyle and tardy ulnar nerve palsy with long-term follow-up have been reported. We present a radiographically documented case of a pediatric lateral condyle fracture and subsequent nonunion with significant cubitus valgus deformity without ulnar nerve palsy sixty years following injury.
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2/17. Is there a place for external fixation in humeral shaft fractures?

    There is a good indication for unilateral axial dynamic external fixation in fractures of the humeral shaft when the fracture appears in the distal third or in cases of bilateral fractures. A non-union or a posttraumatic paralysis of the radial nerve may be indications for external fixation as well as fractures associated with multiple injuries. Further indications include osteitis, infected non-union and comminuted fracture. There is maximum protection of the soft tissue with this method of treatment. External fixation combines the advantages of conservative and operative treatment by influencing callus formation by dynamizing, distraction or compression. Minimizing soft tissue damage facilitates the decision for early exploration of the radial nerve in cases of palsy. A safer positioning technique of the distal screws of the fixator is described.
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ranking = 0.28571428571429
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3/17. Long-standing nonunion of fractures of the lateral humeral condyle.

    BACKGROUND: patients with nonunion of a fracture of the lateral humeral condyle often have pain, instability, or progressive cubitus valgus deformity with tardy ulnar nerve palsy. However, some patients have minimal or no symptoms or disabilities. We evaluated patients with long-standing established nonunion of the lateral humeral condyle to correlate the clinical long-term outcome of this condition with the original fracture type. methods: Nineteen elbows in eighteen patients who were at least twenty years of age were evaluated. Fourteen patients were male, and four were female. The average age at presentation was 42.5 years. The average interval from the injury to the presentation of the symptoms of the nonunion was thirty-seven years. patients were divided into two groups on the basis of the size of the fragment and the location of the fracture line. Group 1 included nine elbows with nonunion resulting from a Milch Type-I injury, and Group 2 included ten elbows with a nonunion resulting from a Milch Type-II injury. Evaluations were performed with use of radiographic examination, clinical assessment, and calculation of the Broberg and Morrey score. RESULTS: Symptoms were seen more frequently in Group 1 than in Group 2. The range of flexion in Group 1 (range, 60 degrees to 145 degrees; average, 99 degrees) was more restricted than that in Group 2 (range, 100 degrees to 150 degrees; average, 129 degrees) (p = 0.0078). The functional score in Group 2 was significantly higher than that in Group 1 (p = 0.03). CONCLUSION: Disabling symptoms only rarely developed in Group-2 patients. Occasionally, however, these patients do present with clinically detectable dysfunction of the ulnar nerve. In contrast, pain, instability, and loss of range of motion as well as ulnar nerve dysfunction developed in Group 1. For this reason we think that a nonunion of a Milch Type-I fracture should be treated as soon as possible after injury, preferably before the patient reaches skeletal maturity.
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ranking = 0.42857142857143
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4/17. Osteosynthesis for old, established non-union of the lateral condyle of the humerus.

    In thirty elbows that had an established non-union of a fracture of the lateral humeral condyle that had occurred more than five years before, treatment consisted of one of three operations: anterior transposition of the ulnar nerve (nine patients), corrective osteotomy of the humerus and anterior transposition of the ulnar nerve (four patients), or osteosynthesis of the non-union combined with neurolysis and anterior transposition of the ulnar nerve, with or without corrective osteotomy of the humerus (seventeen patients). Of the thirty patients, fifteen had been apprehensive when using the elbow, due to lateral instability, or had had pain in the elbow. In thirteen of these fifteen patients, the non-union was treated by osteosynthesis. Afterward, the pain and apprehension disappeared, but the range of motion of the elbow decreased in all but three patients. Three patients had clicking between the humerus and radius, and the bone failed to unite in three others. Osteosynthesis is indicated for the treatment of non-union of the lateral humeral condyle only if the patient has serious pain in the elbow or apprehension when using the elbow, due to lateral instability.
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ranking = 0.42857142857143
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5/17. Os peroneum fracture with sural nerve entrapment neuritis.

    The os peroneum is a sesamoid bone contained in the peroneus longus tendon. When present, it usually is located at the plantar lateral aspect of the cuboid. The author presents a case of os peroneum fracture causing sural nerve entrapment. A review of literature is also presented.
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ranking = 0.71428571428571
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6/17. Tendon ruptures with scaphoid nonunion. A case report.

    Intratendinous ruptures of flexor tendons about the hand and wrist are rare. Flexor pollicis longus and index flexor digitorum profundus tendon ruptures, most commonly seen in patients with rheumatoid arthritis, occurred in a nonrheumatoid 48-year-old man with an asymptomatic scaphoid nonunion. This rare injury may simulate an anterior interosseous nerve syndrome. The absence of prior symptoms does not preclude tendon rupture secondary to scaphoid nonunion. Restoration of power pinch provides good function despite limited range of motion.
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7/17. brachial plexus palsy secondary to clavicular nonunion. Case report and literature survey.

    Compression neurapraxias of the brachial plexus secondary to nonunion of the clavicle are extremely rare. These palsies routinely affect the medial cord, producing primarily ulnar nerve symptoms. The nonunions that cause them are almost exclusively hypertrophic and are usually in the middle third of the clavicle. These palsies result from the entrapment of the medial cord of the brachial plexus within the costoclavicular space of Berkheiser. Onset of symptoms is highly variable. Treatment recommendations are divided between partial clavicular excision and open reduction with internal fixation. Because this lesion requires operative intervention, it must be carefully distinguished from traction palsy of the plexus for which it is easily mistaken. This distinction requires a meticulous neurologic examination during the initial evaluation of the patient with an acute calvicular fracture.
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ranking = 0.14285714285714
keywords = nerve
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8/17. Attritional flexor tendon rupture due to a scaphoid non union imitating an anterior interosseous nerve syndrome: a case report.

    A case is presented of acute loss of function of flexor pollicis longus and profundus tendon to the index finger. Although the aetiology was obscure, the acute onset suggested a mechanical cause rather than a nerve compression disorder such as anterior interosseous nerve palsy. x-rays showed an ununited scaphoid fracture related to an injury many years previously. Surgical exploration revealed attritional rupture of flexor pollicis longus and partial division of profundus tendon to index finger by a spicule of ununited scaphoid which had eroded through the volar capsule. Removal of the spicule and tenodesis of flexor pollicis longus gave a good long term result.
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ranking = 0.85714285714286
keywords = nerve
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9/17. Ununited fracture of the lateral condyle of the humerus. A 50 year follow-up.

    This is a case report of a 74-year-old man with an ununited fracture of the lateral condyle of the humerus of 50 years duration. There was minimal loss of motion, a moderate cubitis valgus deformity, and a definite ulnar nerve palsy. Despite the deformity and ulnar palsy, he was able to provide for himself and to perform satisfactorily as a laborer.
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ranking = 0.14285714285714
keywords = nerve
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10/17. Computed tomography of thoracic and lumbar spine fractures that have been treated with Harrington instrumentation.

    Twenty patients with fractures of the thoracic and lumbar spine underwent computed tomography (CT) following Harrington distraction instrumentation and spinal fusion. CT was done to search for a cause of persistent cord or nerve root compression in those patients who failed to improve and completely recover their partial neurologic deficit (14 cases). In 6 patients seen in the late recovery period, CT was performed to evaluate the causes of pain and instability at the fracture site. Even though the image was degraded due to the artifacts generated by the metallic rods, significant information was available in each case. The most common abnormality was the presence of residual bone fragments originating in the burst fracture of a vertebral body displaced posteriorly, into the spinal canal. In patients with complications in the late recovery period, CT found exuberant callus indenting the canal or lack of fusion of the bone grafts placed in the anterolateral aspect of the vertebral bodies. This experience indicates that CT is the modality of choice for spinal canal evaluation in those patients who fail to have an optimal clinical course following fractures of the thoracic and lumbar spine treated with Harrington rods.
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ranking = 0.14285714285714
keywords = nerve
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