Cases reported "Multiple Trauma"

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1/32. Split free flap and monofixator distraction osteogenesis for leg reconstruction.

    The use of a split muscle flap widens the indications of unilateral external fixation in the treatment of type IIIB open tibial fractures with large bone defects. The same frame can be used for early stabilization and for secondary distraction lengthening procedures. The use of a split flap allows an easy, safe, and painless pin migration. The combination of these techniques represents a very safe solution, especially for patients in poor general and vascular condition.
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ranking = 1
keywords = tibia
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2/32. Traumatic rupture of the tibialis posterior tendon after ankle fracture: a case report.

    Degenerative tears of the posterior tibial tendon associated with chronic disease are well documented in the literature. Traumatic ruptures of this tendon, however, are much less common and consequently have received little attention. An association has been shown between pronation-external rotation ankle fractures and tears of the tendons that cross the medial aspect of the ankle, most commonly the posterior tibial tendon. In the present case report, we share our unique experience of an open-ankle fracture associated with the traumatic rupture of the posterior tibial tendon. This injury illustrates that soft-tissue injury must always be suspected concomitantly in the treatment of certain fractures on the basis of both mechanism of injury and fracture pattern.
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ranking = 7
keywords = tibia
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3/32. Reconstruction of a tibial defect with microvascular transfer of a previously fractured fibula.

    A 43-year-old man sustained severe injuries to his lower limbs with extensive soft-tissue damage and bilateral tibial-fibular fractures. Acutely, the patient underwent external fixation and a free latissimus dorsi flap for soft-tissue coverage of the left leg. However, the tibia had a nonviable butterfly fragment that left a 7-cm defect after debridement. Subsequently, the contralateral fractured fibula was used as a bridging vascularized graft for this tibial defect. The transfer of a fibula containing the zone of injury from a previous high-energy fracture has not been reported. This case demonstrates the successful microvascular transfer of a previously fractured fibula for the repair of a contralateral tibial bony defect.
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ranking = 8
keywords = tibia
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4/32. Use of an islanded fasciocutaneous flap in the lower limb following distraction callotasis.

    Severe limb injuries present a challenge to the attending surgeon and there has been an emergence of complex modes of treatment. The ilizarov technique for distraction osteogenesis is accepted as a worthwhile option in selected cases of massive segmental bone loss. The blood supply of the bone during this process has been studied experimentally but the response of the soft tissue envelope to the process of compression followed by slow and progressive elongation is not entirely understood. We present a case of lower limb trauma where a combined approach to reconstruction was required with acute shortening followed by distraction osteogenesis for a major segmental tibial defect. Late soft tissue reconstruction for persistent ulceration over the tibia was then undertaken using a distally based fasciocutaneous flap.
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ranking = 2
keywords = tibia
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5/32. Treatment of infection and non-union after bilateral complicated proximal tibial fracture.

    BACKGROUND AND AIMS: Complicated tibial fractures form a great challenge for orthopaedic surgeons. Non-unions and infections are more common in complicated than in closed fractures. In the present study, we describe a patient case treated for non-union combined to chronic osteomyelitis after bilateral open proximal tibial fractures. MATERIAL AND methods: A female patient born in 1946 was multi-traumatised, when a car hit her as a pedestrian. She went through multiple operations of both tibias due to bilateral complicated proximal fractures. Fractures were stabilised at first with internal fixation, which had to be changed to external fixation due to infection of both sides. During the last operative step a commercial bone graft based on hydroxyapatite and bovine type I fibrillar collagen/tricalcium phosphate ceramic (Collagraft) mixed with autogenous bone marrow was applied. RESULTS: Fractures united after 28 (right tibia) and 22 (left tibia) months of follow-up. At the final follow-up visit 55 months after the initial accident patient walked without any aid and showed no signs of an infection. CONCLUSIONS: The use of commercial mixed xeno-/autogenous-bone graft may provide a feasible alternative in complicated chronic non-unions of the tibia even when an infection is present, especially when autogenous bone is not easily available after previous attempts of bone grafting.
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ranking = 10
keywords = tibia
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6/32. Type III tibial avulsion fracture with associated anterior cruciate ligament injury: Report of two cases in adults.

    Tibial spine avulsion fractures are more common in children than adults. Many reports have provided classification and treatment options, including fixation for displaced type III fractures. However, long-term follow-up on injury to the anterior cruciate ligament and knee joint stability in adults is not well documented. We present 2 cases of type III tibial avulsion fractures in adults with associated interstitial injury to the anterior cruciate ligament. Primary anterior cruciate ligament reconstruction was performed in both patients.
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ranking = 5
keywords = tibia
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7/32. Injuries to the posterolateral aspect of the knee accompanied by compression fracture of the anterior part of the medial tibial plateau.

    We present 12 cases of patients with injury to the posterolateral aspect of the knee accompanied by a compression fracture of the anterior part of the medial tibial plateau. There were 11 male patients and 1 female patient with an average age of 26 years (range, 17 to 44 years). There were 4 cases of posterolateral rotatory instability and 8 cases of straight lateral instability of the knee. The size of the compression fracture was classified into 2 types, small (8 cases) and large (4 cases). Although the mechanism of injury was considered to be hyperextension and varus force, the pattern of cruciate ligament injuries varied from case to case. The following 3 questions should be considered to determine which cruciate ligament is damaged: (1) Was the ipsilateral foot fixed to the ground? (2) Was forward inertia involved? (3) Was there a direct blow to the anteromedial aspect of the tibia or to the femur? Accompanied fractures of the medial tibial plateau were considered to have been compressed by the medial femoral condyle. The size of the accompanying compression fracture varied; 7 of 8 cases with a small-type fracture had posterior cruciate ligament injuries and 3 of 4 cases with a large-type fracture had anterior cruciate ligament injuries. The size of the fracture is determined by which point of the medial tibial plateau touched the medial femoral condyle. We propose that a compression fracture of the anterior part of the medial tibial plateau indicates a coexistent posterolateral aspect injury, and that especially a small compression fracture strongly suggests an accompanying posterior cruciate ligament injury, as well.
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ranking = 9
keywords = tibia
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8/32. Multiple sequential posttraumatic pseudoaneurysms following high-energy injuries: case report and review of the literature.

    A 15-year-old boy sustained severe multisystem injuries from a satchel charge while in his native village in southern lebanon. After evacuation and resuscitation measures, he had successful intensive multidisciplinary surgical care. His long-bone fractures were stabilized by tubular external fixation systems, and his lacerated right tibialis anterior artery was grafted. Twenty days after injury, he developed a pseudoaneurysm of the left distal ulnar artery, which was surgically resected and the ulnar artery proximally ligated. Two weeks later, a pseudoaneurysm of the left peroneal artery, distal to the knee and coupled with an arteriovenous fistula, was diagnosed. This was treated by fluoroscopic controlled embolization with placement of stents. The patient recovered uneventfully. He was last seen two years after surgery, and no gross vascular compromise of any of his limbs was evident. This appears to be the only reported patient with late-developing multiple posttraumatic pseudoaneurysms after severe blast and shrapnel injuries. This development suggests that late sequelae of blast injuries may be topographically widespread and can evolve months after the injury. As such, these patients should be followed closely with a high degree of suspicion for the appearance of new signs or symptoms.
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ranking = 1
keywords = tibia
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9/32. Occult bilateral acetabular fractures associated with high-energy trauma and osteoporosis.

    Acetabular fractures that are radiographically occult are associated with osteoporosis, low-energy trauma, and advanced age. We present a case of bilateral occult acetabular fractures in a 65-year-old woman who presented with an open tibia-fibula fracture and compartment syndrome and thoracolumbar spine fractures sustained in a motor vehicle accident. Initial radiographs of the pelvis and a pelvic CT scan did not show any bony injuries when the films were reviewed prospectively. At 6 weeks after injury, a CT scan and plain radiographs showed bilateral healing transverse acetabular fractures with acetabular protrusio on the left. At most recent follow-up, the patient had posttraumatic hip arthritis with moderate protrusio on the left and was ambulating with a cane. Total hip arthroplasty is anticipated in the future.
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ranking = 1
keywords = tibia
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10/32. Unimuscular neuromuscular insult of the leg in partial anterior compartment syndrome in a patient with combined fractures.

    A complicated case of ipsilateral fractures of the left femur and tibia after a road traffic accident is reported. The patient presented with numbness of the first web of his left foot and contracture of the extensor hallucis longus muscle, with fixed length deformity after intramedullary nailing of the femur and tibia. The extensor digitorum longus and tibialis anterior muscles were spared. Tinel's sign could be elicited at the mid-portion of the anterior compartment of the injured leg. This indicated that the distal half of the anterior tibial nerve (deep peroneal nerve), together with the extensor hallucis muscle of the anterior compartment of the leg, had been damaged. The subsequent management of this patient is described.
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ranking = 4
keywords = tibia
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