Neglected medial swivel dislocation of talonavicular joint with calcaneus, cuboid and 5th metatarsal fractures - A case report.
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ABSTRACT: Level of clinical evidence
Level 4.
SUBMITTER: Kanwat H
PROVIDER: S-EPMC7920153 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:This case report demonstrates a unique variant of a Chopart dislocation resulting in a plantar cuboid and navicular dislocation without concomitant fracture in a 48-year-old man. The mechanism of injury involved a low-energy plantarflexion moment from stepping off a small embankment. This report reviews the pertinent midfoot anatomy, discusses the proposed mechanism of injury, and demonstrates an effective method of treating these complex injuries with open reduction and internal fixation. Final results with 20 months of follow-up were excellent. This unusual midfoot dislocation is a complex injury that required open treatment for anatomic restoration. In complex Chopart dislocations, early open reduction should be strongly considered as the initial treatment to properly restore anatomy and function. Level of Evidence: Level V, expert opinion.
| S-EPMC8696829 | biostudies-literature
Project description:ObjectivesThe varying mechanical properties of human bone have influence on the study results. Pullout and shear forces of human bone were compared to different substitutes to evaluate their suitability for biomechanical studies.MethodsAfter bone mineral density (BMD) determination, axial pullout tests were performed with cortical 3.5 mm nonlocking (NL) and 2.7 mm head locking (HL) screws on human, porcine and polyurethane composite bones. Porcine and human constructs were additionally loaded in shear direction.ResultsApparent BMD was significantly lower in osteoporotic (159 mgHA/ccm ± 56) and nonosteoporotic (229 mgHA/ccm ± 25) human bone than that in porcine bone (325 mgHA/ccm ± 42; p < 0.01). Axial construct stiffness and ultimate pullout force of porcine bone (NL: 666N/mm ± 226, 910N ± 140; HL: 309N/mm ± 88, 744N ± 185) was significantly different from composite bone (NL: 1284N/mm ± 161; 1175N ± 116; HL: 1241N/mm ± 172, 1185N ± 225) and osteoporotic human bone (NL: 204N/mm ± 121, 185N ± 113; HL: 201N/mm ± 65; 189N ± 58) but not from nonosteoporotic human bone (NL: 620N/mm ± 205, 852N ± 281; HL: 399N/mm ± 224; 567N ± 242). Porcine bone exhibited an ultimate shear force (NL: 278N ± 99; HL: 431N ± 155) comparable to nonosteoporotic human bone (NL: 207 ± 68: HL: 374N ± 137).ConclusionScrew pullout and shear forces of porcine bone are close to nonosteoporotic human bone.The translational potential of this articleHuman bone specimens used in biomechanical studies are predominantly of osteoporotic bone quality. Conclusions on nonosteoporotic human bone behaviour are difficult. Alternatives such as porcine bone and composite bone were investigated, and it could be shown that screw pullout and screw shear forces of porcine bone are close to nonosteoporotic human bone.
| S-EPMC6071584 | biostudies-literature
Project description:Calcaneal fractures are the most common fracture of the tarsal bones and represent 1% to 2% of all fractures. Roughly 75% of these fractures include intra-articular involvement of the posterior facet of the calcaneus. Intra-articular calcaneal fractures are challenging injuries to manage for both patients and surgeons given their association with both early and late complications. This article aims to review the management, classification systems, surgical approaches, and care regarding intra-articular calcaneal fractures. A review of the current literature yielded treatment strategies that aim to reduce complications such as soft tissue injury or loss of articular reduction while maintaining satisfactory clinical outcomes. The purpose of this article is to review these current concepts in the management of intra-articular calcaneal fractures. Level of Evidence: Level V, expert opinion.
| S-EPMC8564939 | biostudies-literature
Project description:Isolated cuboid dislocations are rare injuries Jacobson (1990). It is clinically significant and important in surgical education, as it is an injury and a source of lateral foot pain that can be misdiagnosed at the time of initial presentation and may be difficult to identify clinically or with imaging Drummond and Hastings (1969).We present a case report in a 33year old rugby player, who was injured during a match after a tackle. The patient had ongoing concerns that he was not recovering following initial discharge, as he was unable to weight bear since his initial presentation to the Emergency Department (E.D.), and he had ongoing lateral foot pain.Important clinical findings include lateral foot pain, a palpable gap at the cuboid level and difficulty weight-bearing. Closed reduction is usually difficult as it can be blocked mechanically by the extensor digitorum brevis muscle or peroneus longus tendon Dobbs et al. (1969). Initial X-Rays may be inconclusive with this presentation. CT scanning is indicated if suspicion for pathology is high. Open reduction and internal fixation with Kirschner wires are usually necessary for isolated cuboid dislocations.Our take home message from this case report is that cuboid dislocations are rare injuries and are important to be aware of in reviewing X-rays in the E.D. Particularly in patients with inversion and plantar flexion type injuries to their foot and ankle joint, with an inability to weight bear and lateral midfoot pain following their injury.
| S-EPMC5544476 | biostudies-other
Project description:BackgroundNeglected clubfoot in older children is characterized by a stiff, nonreducible deformity with relative elongation of the lateral column of the foot with respect to the medial column. Surgical correction often has involved a double osteotomy with elongation of the medial column and shortening of the lateral column, or the use of an external fixator to achieve more gradual correction. Both approaches have shortcomings.Questions/purposesWe therefore (1) used objective physical examination measurements and a functional assessment to evaluate the effectiveness of cuboid osteotomy combined with a selective soft tissue release to achieve correction of neglected clubfoot in older children, (2) determined the rate of complications, and (3) ascertained whether the initial correction achieved was maintained.MethodsWe reviewed 31 patients (56 feet) older than 5 years with severe, neglected nonreducible clubfoot deformity who underwent the index procedure. Minimum followup was 2 years (average, 6 years; range, 2-9 years). Postoperatively, the Laaveg and Ponseti classification and Dimeglio score were used to grade correction. Complication rates were tallied.ResultsAccording to the Laaveg and Ponseti classification, 24 feet showed excellent correction, 20 good, nine fair, and three poor at 1-year followup. These results were maintained up to the latest followup. Patients showed significant improvement of Dimeglio score after surgery (p < 0.0001). Two patients had postoperative skin-related complications that healed without additional surgery.ConclusionsCuboid subtraction osteotomy combined with posteromedial release is an effective approach to manage a stiff nonreducible neglected clubfoot deformity in older children.
| S-EPMC3705072 | biostudies-literature
Project description:Dogs are commonly kept as household pets, but sometimes pet dogs bite people. We report the case of a 69-year-old man who was bitten by his pet pit bull terrier. The dog bite resulted in multiple open wrist fractures and dislocation of the distal radioulnar joint, requiring surgical debridement, open reduction and internal fixation, and bone grafting. CT of the fractures showed that the dog's maxillary canine teeth had been deeply embedded in the hamate and second metacarpal bones, requiring that the dog's mouth be opened and the teeth disengaged in order to remove the injured limb from the dog.
| S-EPMC6488688 | biostudies-literature
Project description:We report a case of a 30-year-old man with a carpometacarpal joint dislocation of the thumb associated with trapezium and Bennett's fractures. This combined injury pattern appears to be very rare. Since, to our knowledge a similar case was not found in the literature. The lesion was managed with closed reduction and percutaneous pinning, resulting in good functional outcome.
| S-EPMC2686798 | biostudies-other
Project description:PurposeTo compare the bone healing, clinical, and return to daily activity outcomes after either surgical or conservative management of acute zone 1, 2, and 3 fifth metatarsal fractures.MethodsA literature search was performed to identify studies published from the earliest record to January 2019 using EMBASE (Ovid), MEDLINE via PubMed, CINAHL, and Web of Science. All articles assessing clinical outcomes of acute proximal fifth metatarsal fractures were included. Bone healing and clinical outcomes were thereafter calculated using a simplified pooling method.ResultsThirty-two articles comprising of a total of 1,239 fractures were included, of which one was a randomized controlled trial, seven were prospective studies, and 24 were retrospective studies. 627 zone 1 fractures demonstrated union rates of 93.2% following conservative treatment and 95.1% following surgical treatment. Conservatively managed zone 1 fractures were displaced 49.5% of the time, compared to a rate of 92.8% for the surgically treated cases. For Jones' (zone 2) fractures, bone healing outcomes of conservative versus surgical treatment showed union rates of 77.4% versus 96.3%, refracture rates of 2.4% versus 2.1%, and mean time to union of 11.0 weeks versus 9.4 weeks, respectively. Only ten proximal diaphyseal (zone 3) fractures were reported, with a mean return to work of 8.2 weeks.ConclusionAcute zone 1 fractures are preferably treated conservatively as similar union rates were found after both conservative and surgical management. In contradistinction, acute zone 2 fractures demonstrate higher union rates and faster time to union when treated surgically. The outcomes of acute zone 3 fractures are rarely reported in the literature, so treatment recommendations remain unclear. Further research of proximal fifth metatarsal fractures is warranted to provide more definitive conclusions, but current findings can aid surgeons during the shared clinical decision making process.Level of evidenceIV.
| S-EPMC7973408 | biostudies-literature
Project description:IntroductionZygomatic complex fracture is one of the most frequently occuring injuries to facial structures and often involves damage to the surrounding structures, including the orbital floor and/or medial orbital wall. These complicated injuries can cause both serious opthalmic and aesthetic complcations that make reconstructions more difficult.Case presentationA 22 year old male presented with facial asymmetry. On examination, there were neglected fractures of left orbitozygomaticomaxillary complex with various compications. We performed lateral orbitotomy, bone graft, medial and lateral cantopexy with 3D reconstruction models as a guidance. There were some appearance improvements including improved orbital dystopia and corrected facial asymmetry. However, his vision could not be corrected because the reconstruction was too late.DiscussionSeveral examinations before reconstruction of the injury has to be done, especially radiological examinations to decide proper diagnosis and reconstruction plans. Some complications may make difficulties in establishing precise time for surgery. Three-dimensional (3-D) reconstrucion model can help increase accuracy of the reconstruction but consume more time.ConclusionSevere maxillofacial fracture should be treated immediately to avoid further complications. Multidisciplinary examinations can provide more accurate preliminary recommendations particularly when combine with properly calibrated CT scan imaging.
| S-EPMC6704383 | biostudies-literature
Project description:Background:Fractures of the fifth metatarsal base (5th MT) are common foot injuries, but their treatment remains a subject of debate. The aim was to assess the midterm outcome of functionally treated epi-metaphyseal fractures (Lawrence and Botte types I and II) of the 5th MT.Methods:This study was a longitudinal retrospective database study with prospective follow-up. Included were all patients with an acute, isolated fracture to the 5th MT base (types I and II). All patients were treated functionally: weightbearing as tolerated without immobilization. Fracture types and fracture characteristics (displacement <2 mm/>2 mm, articular involvement, number of fragments) were assessed retrospectively. Patient-reported outcome measures (PROMs) including the visual analog scale for foot and ankle (VAS FA) and the quality-of-life score (QoL) SF-12 were collected prospectively at 2- and 5-year follow-up. Out of 95 patients, 43 patients (45%) were included with a median follow-up of 5.7 (1.5) years.Results:For both the VAS FA and SF-12, excellent scores were observed. For 30 patients (77%), longitudinal 2- and 5-year follow-up was available. No significant longitudinal changes could be observed for the VAS FA and SF-12. For both time points, neither fracture type nor characteristics significantly influenced any outcome parameter assessed.Conclusion:Functional treatment by full weightbearing and free range of motion led to excellent 5-year results for both type I and II fractures. Neither fracture location nor characteristics had a significant influence on the 5-year PROMs.Level of evidence:Level III, comparative study.
| S-EPMC7294529 | biostudies-literature