1/28. Triplane fractures in the hand.Two new cases of triplane fracture of the distal tibia are reported in the proximal phalanx of the thumb and the distal radius, respectively, of a 12-year-old girl and a 13-year-old boy. Neither fracture showed any displacement, achieving healing at 4 weeks of external immobilization. Triplane fractures can occur across growth plates other than the distal tibia. Because of the rapid physiologic physeal arrest, the potential for growth deformity is null. In cases without displacement, these fractures should be treated conservatively by external immobilization, as one would treat a one-plane fracture.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
2/28. Salter-Harris type III and IV epiphyseal fractures in the hand treated with tension-band wiring.We present tension-band wiring in the treatment of Salter-Harris types III and IV avulsion fractures in the hand. By placing a small-gauge wire through the insertion of the ligament into the fracture fragment, accurate reduction and stability, allowing early mobilization, are achieved, avoiding many of the pitfalls and complications of other methods of internal fixation. The technique is simple and adheres to important physiological and biomechanical principles.- - - - - - - - - - ranking = 4keywords = seal (Clic here for more details about this article) |
3/28. Avascular necrosis of the distal phalangeal epiphysis following physeal fracture: a case report.Avascular necrosis of the distal phalangeal epiphysis following an unrecognized angulated Salter II fracture of the distal phalanx treated by open reduction and internal fixation resulted in premature closure of the growth plate and mild shortening. The epiphysis itself revascularized and good function of the distal interphalangeal joint was maintained.- - - - - - - - - - ranking = 4keywords = seal (Clic here for more details about this article) |
4/28. bone resorption of the proximal phalanx after tendon pulley reconstruction.A 35-year-old male worker sustained a degloving injury of the left hand. An abdominal flap was used for skin coverage. Tenolysis and reconstruction of the A2 pulley was done using a procedure based on the 3-loop technique, which was modified by putting the tendon loop under the extensor apparatus and periosteum. X-ray revealed hourglass-shaped bone resorption around the proximal phalanx, just under the reconstructed pulley. Diaphyseal narrowing remained present in follow-up x-rays obtained 9 and 10 years later. The remodeling of the resorption was poor. Too much pressure may have caused this bone resorption from the shortened pulley and the circulatory deprivation may have been caused by the dissected periosteum and blocking by the surrounding tendon loop. The degloving injury, which also deprived the digits of a blood supply, may have been an additional underlying risk factor. We recommend that future comparative studies of pulley reconstruction take into account mechanical effectiveness as well as force distribution.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
5/28. Irreducible juxta-epiphyseal fracture due to entrapment of extensor hood: a case report.A case of irreducible juxta-epiphyseal fracture of the proximal phalanx of the little finger is presented. The extensor hood was trapped under the proximal end of the distal fracture fragment and open reduction was necessary. An open reduction was performed using the dorsal approach, with good results.- - - - - - - - - - ranking = 5keywords = seal (Clic here for more details about this article) |
6/28. Physeal arrest due to laser beam damage in a growing child.A laser beam applied directly to epiphyseal cartilage may damage the cartilage selectively without affecting adjacent bone. The damaged physis is replaced by bone, which forms a bone bridge between the metaphysis and epiphysis, similar to the bone bridges that follow fracture of any long bone. This case report documents damage to two distal phalangeal epiphyseal plates as a sequela of laser beam injury. This resulted in premature partial physeal closure (physeal bars), which in turn caused progressive angular deformity and relative shortening of the digits, requiring multiple osteotomies for correction. This report suggests that special care must be exercised when using laser therapy near physes in growing children.- - - - - - - - - - ranking = 8keywords = seal (Clic here for more details about this article) |
7/28. An irreducible juxta-epiphyseal fracture of the proximal phalanx. Report of a case.The causes of irreducibility of juxta-epiphyseal fractures of the proximal phalanx are illustrated in a patient with button hole rent in the periosteum and extensor hood mechanism causing trapping of the distal fragment. The entrapment, in the manner of a Chinese finger trap, was aggravted by traction on the digit. Open reduction was necessary to reduce the fracture.- - - - - - - - - - ranking = 5keywords = seal (Clic here for more details about this article) |
8/28. fibrin glue fixation of a digital osteochondral fracture: case report and review of the literature.Surgical treatment options for digital osteochondral fractures are limited by the small amount of bone available for fixation and the propensity for digital stiffness with the introduction of hardware. fibrin sealant is used in a variety of clinical settings as a biologic bonding agent and may circumvent the drawbacks of traditional fixation or simple excision for certain digital osteochondral injuries. Successful use of fibrin sealant fixation for a patient with an osteochondral fracture involving the proximal interphalangeal joint is documented, and the literature on fibrin sealant for osseous fixation is reviewed.- - - - - - - - - - ranking = 3keywords = seal (Clic here for more details about this article) |
9/28. Irreducible palmar epiphyseal fracture-dislocation of the distal interphalangeal joint of a finger.A case of irreducible palmar epiphyseal fracture-dislocation of the distal interphalangeal joint is reported. The intact collateral ligaments and flexor digitorum profundus tendon did not permit adequate distraction of the joint, thereby preventing reduction of a displaced epiphyseal fracture.- - - - - - - - - - ranking = 6keywords = seal (Clic here for more details about this article) |
10/28. Free vascularized whole joint transfer in children.Reconstruction of the traumatized finger joint with epiphyseal destruction has long been problematic. Since free vascularized whole joint transfer was introduced as a treatment for joint and epiphyseal destruction, this procedure has been selected as an alternative treatment because it may provide a growing epiphysis. We have reviewed our series of 19 joint transfers. Mean age at operation was 6.2 years (range 3 to 12). Average active range of motion was 31 degrees/61 degrees for the group with posttraumatic reconstruction (n = 12) and 21 degrees/43 degrees for the group with reconstruction of a congenital deformity (n = 7), with an overall average of 27 degrees/54 degrees. Average range of motion following transfer of an metatarsophalangeal (MTP) or metacarpophalangeal (MCP) joint to an MCP joint position was 39 degrees/75 degrees (n = 4); proximal interphalangeal (PIP) to PIP transfer was 22 degrees/39 degrees (n = 13); and PIP to MCP transfer was 38 degrees/51 degrees (n = 2). The proximal phalanges in MCP joints transferred to the MCP position grew an average of 7.0 mm, and the middle phalanges of joints transferred to the PIP position grew 4.3 mm. Almost normal growth was observed in all transferred joints except two that showed premature epiphyseal closure. Indications for this procedure and techniques to improve range of motion are described.- - - - - - - - - - ranking = 3keywords = seal (Clic here for more details about this article) |
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