Transtrapezial peritrapezoidal transcapital axial radial fracture dislocation of the carpus.
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ABSTRACT:
SUBMITTER: Hacki J
PROVIDER: S-EPMC2724622 | biostudies-other | 2009 Sep
REPOSITORIES: biostudies-other
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Project description:IntroductionWe report the case of volar dislocation of the ulnar head occurred after osteosynthesis for the treatment of distal radius fracture.Presentation of caseThe patient, 68-year-old female, had the dorsal displaced left distal radius fracture and volar dislocation of the ulnar head. Osteosynthesis was performed using a volar locking plate without postoperative immobilization. Two weeks after surgery, volar dislocation of the ulnar head in distal radioulnar joint (DRUJ) was noted on CT. Re-operation, triangular fibrocartilage complex (TFCC) was sutured to the ulnar fovea using a suture anchor, was performed in order to stabilize DRUJ. At 24 months after surgery, left wrist joint pain and the range of motion have improved, and the Mayo wrist score was excellent.DiscussionBased on the fact that the radius was fractured and the ulna was dislocated in DRUJ at the time of injury, the present case may have been a Galeazzi fracture.ConclusionWhen distal radius fracture is complicated by ulnar instability of DRUJ, active repair of the TFCC function may be necessary to prevent residual postoperative instability.
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Project description:BackgroundIrreducible fracture-dislocations of the ankle are rare orthopedic emergencies that should not be missed. The Bosworth fracture-dislocation is a rare fracture where an incarcerated fibula fragment remains locked behind the posterior lateral tubercle of the tibia. We present a case describing a variation of a Bosworth injury, with a dislocation of an intact distal fibula with an associated medial malleolus fracture.MethodsOur patient is a 55-year old male who presented to the emergency department with a left ankle injury after being involved in a road traffic accident. Radiographs show a posterior dislocation of an intact distal fibula associated with a fracture of the medial malleolus and disruption of the ankle mortise.ResultsAn attempt to reduce the dislocation at the emergency department under sedation was unsuccessful. The patient was subsequently taken to the operating theatre for manipulation and reduction and application of an external fixator. Definitive fixation was performed successfully a week later.ConclusionA high index of suspicion is critical for diagnosing a Bosworth fracture-dislocation, as this diagnosis is commonly missed. Early diagnosis and proper surgical anatomic reduction are important to prevent chronic ankle instability and evolution towards ankle arthritis.Level of evidenceLevel IV, case study.
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Project description:BACKGROUND:Simultaneous dislocation of the radial head and distal radio-ulnar joint without fracture (Criss-Cross Injury) in an adult patient is rarely reported in previous studies. The pathological changes and injury patterns have not been clearly demonstrated. CASE PRESENTATION:A 26-year-old woman presented with acute pain of the right wrist and elbow after a fall from cycling. Physical examination revealed an unstable elbow and wrist joint. Plain radiographs showed volar dislocation of the radial head and dorsal dislocation of the distal radius without associated fracture, forming a criss-cross appearance of the ulna and radius on the lateral radiograph. MRI images confirmed partial rupture of the proximal interosseous membrane from its dorsal attachment on the radius, as well as partial rupture of the medial collateral ligament. Conservative treatment failed because the radiocapitellar joint and distal radio-ulnar joint could not be simultaneously reduced. Surgical exploration revealed a highly unstable radial head, but the annular ligament was found to be intact. Manual force was applied to reduce the radial head and a percutaneous K-wire was used to stabilize the proximal radioulnar joint with the forearm in full supination. After surgery, the elbow was immobilized in 90° flexion by a long arm cast for 4 weeks. The K-wire was removed at 6 weeks postoperatively. At 18 months postoperatively, the patient had regained a full range of flexion and extension, with normal supination and a slight limitation in pronation. CONCLUSIONS:The proximal IOM, especially the dorsal band, was injured in Criss-Cross injuries, while the central part of the IOM remained intact. This injury pattern distinguished itself from Essex-Lopresti injury, which mainly involves rupture of the central band of the IOM.
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Project description:Nearly all mechanochemical models of the cross-bridge treat myosin as a simple linear spring arranged parallel to the contractile filaments. These single-spring models cannot account for the radial force that muscle generates (orthogonal to the long axis of the myofilaments) or the effects of changes in filament lattice spacing. We describe a more complex myosin cross-bridge model that uses multiple springs to replicate myosin's force-generating power stroke and account for the effects of lattice spacing and radial force. The four springs which comprise this model (the 4sXB) correspond to the mechanically relevant portions of myosin's structure. As occurs in vivo, the 4sXB's state-transition kinetics and force-production dynamics vary with lattice spacing. Additionally, we describe a simpler two-spring cross-bridge (2sXB) model which produces results similar to those of the 4sXB model. Unlike the 4sXB model, the 2sXB model requires no iterative techniques, making it more computationally efficient. The rate at which both multi-spring cross-bridges bind and generate force decreases as lattice spacing grows. The axial force generated by each cross-bridge as it undergoes a power stroke increases as lattice spacing grows. The radial force that a cross-bridge produces as it undergoes a power stroke varies from expansive to compressive as lattice spacing increases. Importantly, these results mirror those for intact, contracting muscle force production.
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Project description: Not available
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Project description:Botulism developed in a patient following surgical repair of an open radial fracture. Symptoms resolved after treatment with antitoxin and antibiotics, and hardware excision was deferred. Subsequent osteomyelitis necessitated hardware exchange, and wound cultures grew Clostridium argentinense. This case highlights the management of botulism associated with orthopedic hardware.
| S-EPMC2815637 | biostudies-literature
Project description:Glenoid rim fractures are recognized as a risk factor for recurrent instability after anterior shoulder dislocation. In addition to traditional open treatments of bony Bankart lesions, several arthroscopic techniques of fixation and reconstruction recently have been described. We present a technique of arthroscopic nonrigid fixation for large glenoid rim fractures, as an alternative to existing procedures.
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Project description:Operative management of a coracoid process fracture is indicated in case of painful nonunion, displacement of more than 1 cm, or multiple disruptions of the superior shoulder suspensory complex. Several techniques have been described with open reduction of the fracture and internal fixation using cortical screws with or without additional fixation of the acromioclavicular joint. This Technical Note aims to introduce an alternative safe, minimally invasive method for arthroscopic fixation of a coracoid fracture with simultaneously reduction of the acromioclavicular joint. The described arthroscopic technique might be helpful for shoulder surgeons who want to fix the coracoid process while avoiding the disadvantages of an open approach.
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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.
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Project description:Pediatric elbow dislocations are rare injuries and are often accompanied by concomitant fractures. We report a rare case of medial dislocation of the right elbow without accompanying fracture in a 10.5-year-old boy after fall from a bicycle. After radiographic and magnetic resonance imaging evaluation, closed reduction under general anesthesia was performed and the elbow was immobilized in a posterior above-elbow slab. Elbow mobilization was started after 2 weeks and the posterior slab was discontinued after 4 weeks. At 3 months, the patient had a full range of active elbow flexion extension and pronation supination. At 4-year followup, radiographs show a normal alignment of the elbow with mild changes of heterotopic ossification. We believe that this is the first such case ever reported in literature. Early recognition and prompt diagnosis is the key to achieve a good result.
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