Nonoperative Treatment of Fracture of the Entire Posterior Process of the Talus With Subtalar Dislocation: Case Report.
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SUBMITTER: McCoy JS
PROVIDER: S-EPMC8697178 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:IntroductionTalar neck fractures are injuries which frequently result in adverse outcomes or impairment of functional activity. Four groups were identified according to Hawkins classification and Canale modification. We present a female patient with a fractured neck of the talus associated with talonavicular dislocation, but intact tibiotalar and subtalar joints; an injury pattern not fulfilling the criteria described in the Hawkins classification.Patient concernsA 46-year-old woman missed a step and fell down stairs with an immediate painful right ankle and inability to bear weight.DiagnosisTalar neck fracture with an unusual isolated talonavicular dislocation.InterventionsTemporary closed reduction followed by open reduction and internal fixation were performed.OutcomesThe patient had excellent functional and radiological outcomes following surgical management.ConclusionWe discuss the management of this rare case in addition to a review of the current literature to provide the best evidence-based recommendations for this injury pattern.
| S-EPMC9646572 | biostudies-literature
Project description:INTRODUCTION:Subtalar dislocations are rare injuries and treatment recommendations missing. Gross contamination and devascularisation are aspects supporting talectomy as potential treatment choice. Reconstruction in these cases can be challenging. The Masquelet technique presents one viable option. PRESENTATION OF CASE:A carpenter sustained a high energy chrush injury with traumatic open lateral talar dislocation qualifying as Gustillo Anderson type IIIc injury, a mangeled extremity index of 7 and gross contamination. The severity of soft tissue damage and contamination prompted the decision for talectomy before plastic coverage with a gracilis flap. Additionally a Masquelet procedure with cement spacer was initiated. After consolidation of the soft tissues a hindfoot arthrodesis with approximate preservation of leg length could be performed. In the course of treatment, the patient suffered no infection and could resume full weight bearing after nine months. The patient resumed his previous occupation with adapted workload and is satisfied with the treatment result. DISCUSSION:In the present case the principle options were talus preservation or talectomy with reconstruction. Talus preservation in the presence of gross contamination can be associated with the risk of infection, in addition there is a risk to develop secondary arthritis. For this individual patient the a fast and definite solution was important at this point in life. Surgeons therefore opted for talectomy. To optimally reconstruct leg length and optimize for arthrodesis the Masquelet technique was employed. CONCLUSION:The Masquelet technique is a viable option also in the emergency situation to preserve extremity length and optimize tissue viability.
| S-EPMC6833435 | biostudies-literature
Project description: Not available
| S-EPMC4171447 | biostudies-literature
Project description:BackgroundFractures of the posterior process of the talus are frequently overlooked, possibly leading to nonunion, arthritis, and chronic pain. Given the rare occurrence, previous case series have been small and without functional outcome scores. Therefore, we aimed to provide evidence on outcomes after nonoperative and operative management of posterior process fractures of the talus.MethodsAll patients treated at a level 1 trauma center between 2012 and 2018 were retrospectively evaluated. Patient, fracture, and treatment characteristics were collected, and functional outcome as well as quality of life were assessed. Twenty-nine patients with posterior process fractures of the talus were identified in our database.ResultsThe most frequently seen mechanism of trauma was fall from height in 13 patients (44.8%). Twenty-two patients underwent primary arthrodesis or operative reduction and fixation of the fracture (75.9%). Eighty-two percent of the patients returned the questionnaires with a mean follow-up of 6 years. The 2 patients with primary arthrodesis were excluded from outcome analysis. The mean Foot Function Index score was 1.8 (range 0.0-10). The mean American Orthopaedic Foot & Ankle Society (AOFAS) score was 78.7 points (range 0-100). The mean quality of life EuroQol-5D (EQ-5D) index score was 0.78 (range -0.26 to 1). The mean visual analog scale (VAS) on overall patient satisfaction was 8.2 (range 1-10).ConclusionOperative management of extended posterior talar fractures was found to provide good functional outcome, quality of life, and patient satisfaction. Although the patients treated nonoperatively were found to have less severe injuries, they demonstrated worse overall outcome, which is supportive of surgical management. Nonoperative treatment is therefore only justified in selected patients.Level of evidenceLevel IV, retrospective case series.
| S-EPMC6900211 | biostudies-literature
Project description:Introduction:Acromioclavicular (AC) joint injury associated with coracoid process (CP) fracture is a rare injury and only case reports had been published in the literature. Although AC joint injury is not uncommon, there is controversy as regard the best stabilization method whether to use wires, hook plate, arthroscopic reconstruction or the recently described techniques of anatomic restoration of both the coracoclavicular (CC) and acromioclavicular (AC) ligaments to add stability in both the vertical as well as the horizontal plane for the AC joint. Isolated CP fracture rarely necessitates surgical intervention; but in association with AC joint injury; a controversy as regard best management, surgical approach, technique of stabilization and implant used is present due to paucity of literature. Patient and method:A 36?years old manual worker who sustained a combined injury of AC joint (grade III) and CP comminuted base fracture had been treated surgically in our hospital using a biplanar fixation technique; blind 4?mm cannulated screw for the CP fracture and anatomic reconstruction of the AC ligament using FibreTape (Arthrex, Naples, FL); to add stability in both the vertical and horizontal plane. Follow up was done for one year. Results:After completion of rehabilitation program, patient could return to work with no shoulder pain in ten weeks postoperatively. Till the last follow up there was no evidence of loss of reduction or shoulder pain with a Constant score of 86. Conclusion:Our technique in combined AC joint and CP fracture, address both injuries to add biplanar AC joint stability allowing accelerated rehabilitation and avoids metal hardware complications.
| S-EPMC5987262 | biostudies-literature
Project description:Study Design Case report. Objective The diagnosis and surgical management of a patient with traumatic bilateral posterior dislocation of L4-L5 is presented with a thorough review of the existing literature. Summary of Background Data Traumatic dislocation of L4-L5 has been reported in the English literature in only five cases; of these, only two were retrolisthesis. Methods A 20-year-old patient was involved in a high-energy vehicular accident and presented with back pain and inability to ambulate. Neurological assessment showed motor strength grade 2/5 in the proximal lower-extremity muscle groups (L1-L3 myotomes) and 0/5 strength distally (L4-S1 myotomes); in addition, incontinence of sphincters was found. X-rays and computed tomography (CT) scan revealed a three-column ligamentous injury with posterior fracture-dislocation of the L4 vertebral body with complete posterior displacement of L4 to L5 vertebral body. The patient underwent posterior approach with reduction, transpedicular fixation, and posterolateral fusion with autologous bone graft. Results At 1-year follow-up, the patient had recovered muscular strength in proximal lower-extremities muscle groups, sphincter function had fully recovered, and he was able to ambulate with crutches. There was no recovery of distal extremity sensorimotor function. Plain radiograph and CT scan showed good alignment and progressive maturation of his fusion procedure. Conclusion Traumatic retrolisthesis of L4-L5 is a high-energy unstable fracture; reduction of the dislocation is challenging because of the heavy forces acting in the lower lumbar spine. Instrumented fusion restores alignment and maintains segmental stability.
| S-EPMC3864497 | biostudies-other
Project description:IntroductionShoulder dislocation is the most common type of all joints dislocations. It occurs when there is separation in the glenohumeral joint. Posterior dislocation accounts for less than 4% of all shoulder dislocations. In fact, it is misdiagnosed in 60-79% of the patients in the initial presentation. In children a posterior shoulder dislocation is usually caused by a congenital anomaly or in those who have ligamentous laxity. Traumatic posterior shoulder dislocation without fracture of the proximal humeral epiphysis in children is very rare, and only few cases have been reported.Case presentationThis report presents a rare case of a 10-year-old child with a traumatic posterior shoulder dislocation without fracture.Discussionthis patient present with a rare posterior dislocation, which is direct and without fracture. It does not present with a marked deformity and it is hard to detect without a complete physical examination and radiographic series.ConclusionPosterior shoulder dislocations are rare, and even more rare in children without fractures. It is easily missed and needs careful history taking, physical exam and correct x-ray view to reach the diagnosis.
| S-EPMC6108073 | biostudies-literature
Project description:IntroductionDislocation of the knee after primary total knee arthroplasty is rare in a posterior stabilized knee and extremely rare in a constrained total knee arthroplasty. Constrained total knee prostheses are used for severe knee deformities and to provide stable and mobile knees.Presentation of caseIn this case, we describe a dislocation of a primary constrained total knee arthroplasty using the Genesis II (Smith & Nephew, Memphis Tennessee, USA) prosthesis. Without any significant trauma, the constrained insert dislocated fifteen months after surgery and revision surgery with a bigger insert was needed. Surgical error may have been the cause of dislocation, but we were unable to establish a clear reason behind this dislocation.DiscussionKnee dislocation after TKA is rare but easily overlooked and can lead to serious complications and permanent disability. This system should provide stable and mobile knees to correct collateral ligament laxity.ConclusionHere, we report the first case, to our knowledge, of dislocation with a constrained prosthesis without any history of trauma.
| S-EPMC6141696 | biostudies-literature
Project description:High-energy trauma can cause transsyndesmotic ankle fracture dislocation. These fractures are quite rare. Here we present a clinical case of a male patient with this type of injury. A systematic review of PubMed, Ovid MEDLINE, and Embase electronic databases revealed only two prior publications on a similar topic. We discuss the typical clinical features of these injuries, the treatment of high-energy trauma which can cause transsyndesmotic ankle fracture dislocation, and its prognosis.
| S-EPMC6230424 | biostudies-literature
Project description:The treatment of unstable burst fractures of the atlas (Jefferson fractures) is controversial. Unstable Jefferson fractures have been managed successfully with either immobilization, typically halo traction or halo vest, or surgery. We report a patient with an unstable Jefferson fracture treated nonoperatively with a cervical collar, frequent clinical examinations, and flexion-extension radiographs. Twelve months after treatment, the patient achieved painless union of his fracture. The successful treatment confirms prior studies reporting unstable Jefferson fractures have been treated nonoperatively. The outcome challenges the clinical relevance of treatment algorithms that rely on the "rules of Spence" to guide treatment of unstable Jefferson fractures and illustrates instability may not necessarily be present in patients with considerable lateral mass widening. Additionally, it emphasizes a more reliable way of assessing C1-C2 stability in unstable Jefferson fractures is by measuring the presence and extent of anterior subluxation on lateral flexion and extension views.
| S-EPMC2311473 | biostudies-other