1/14. Low-energy scapular body fracture: a case report.scapula fractures are relatively rare and most often the result of high-energy trauma. However, they should always be included in a physician's differential diagnosis when a patient has a complaint of shoulder pain after trauma or violent muscular contraction about the shoulder. Because the vast majority are the result of a high-energy mechanism of injury, the physician should, as always, completely evaluate the patient for associated injuries. Most scapula fractures can be diagnosed on physical examination with localized tenderness, swelling, and hematoma formation over the fracture site. Radiographic confirmation and evaluation is routinely made using the three-view trauma series of the shoulder; additional views are rarely indicated. Treatment, consisting of a sling or sling and swath for comfort, mild narcotic medication, and early range-of-motion exercises virtually always leads to union and good glenohumeral function. Operative treatment is rarely indicated. A case of an low-energy isolated scapular body fracture sustained by a 41-year-old man is presented.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/14. Isolated fracture of the capitate with proximal pole dorsal dislocation. A case report.Isolated fractures of the capitate are uncommon. We report a rare case of isolated fracture of the capitate with dorsal dislocation of the proximal pole. After open reduction and K-wire fixation the fracture united, and a full range of wrist motion was achieved. No signs of avascular necrosis were observed after 3 years.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
3/14. Marchetti nailing with decortication and bone graft in non-unions of the two upper thirds of the humerus.METHOD: Twelve patients with humeral shaft non-unions were treated using a Marchetti-Vicenzi nailing. The fractures site was decorticated and bone graft added. RESULTS: fracture healing was obtained in all cases. The mean healing time was 4.7 months. The range of motion of the shoulder was excellent in nine patients, moderate in two and poor in one. The elbow had an excellent range of motion in ten patients, moderate in one and poor in one. The functional result was excellent in nine patients, good in two, and fair in one. CONCLUSION: Marchetti-Vicenzi nailing with bone grafting appears to be a good method for the treatment of humeral shaft non-unions. It is technically easy and its results are satisfactory.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
4/14. One-stage elbow interposition arthroplasty with a fasciocutaneous distally planned lateral arm flap.We report a case of severe posttraumatic ankylosis of the elbow with chronic osteomyelitis of the lateral condyle of the humerus. The triple problem of restoring elbow mobility, providing for coverage, and controlling infection was treated in a one-stage procedure. A distally planned fasciocutaneous lateral arm flap was used for elbow interposition arthroplasty. Clinical examination at 27 months showed restoration of a useful range of elbow motion and good pain relief.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
5/14. Delayed treatment of a malreduced distal femoral epiphyseal plate fracture.Fractures of the epiphyseal plate are considered rare when compared with the more prevalent injuries found in competitive sports, but the complications associated with this type of trauma are a major concern. The factors affecting the success or failure of healing include the severity of injury, patient age, and the type and expedience of treatment. This case study examines the clinical presentation and treatment of a 15-yr-old high school football player who sustained a displaced, distal femoral epiphyseal Salter II fracture. Primary treatment consisted of nonmanipulative, nonweight bearing knee immobilization. The treatment resulted in malunion, pain, decreased range of motion and physical deformity; therefore, the patient sought a second opinion. On physical exam, the displacement and rotational deformity of the fracture site were unacceptable. The fracture was treated 20 days post-injury via open reduction with internal fixation. On follow-up, the athlete demonstrated radiographic healing, normal physical exam, and no significant leg length discrepancy or deformity. The athlete successfully returned to full competitive sport activity.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/14. Entrapment of the flexor digitorum superficials in the radius fracture site.Entrapment of the flexor tendon after fracture of both forearm bones is very rare. This report describes entrapment of the middle finger flexor digitorum superficialis (FDS) tendon alone in the radius fracture site. A 13-year-old boy fractured both forearms and had closed reduction and a long-arm cast. After the cast was removed he had full middle finger motion with the wrist flexed but was unable to extend the proximal interphalangeal or metacarpophalangeal joints and could extend only the distal interphalangeal joint of the middle finger with the wrist in the neutral or extension position. Entrapment of the middle finger FDS tendon was suspected. After surgical release of the FDS tendon at the fracture site the patient had good functional results.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
7/14. A unique osteochondral fracture of the first metatarsophalangeal joint.Presented is a case report of an osteochondral fracture occurring at the base of the proximal phalanx of the hallux secondary to trauma. Initial radiographic and clinical examination did not reveal the diagnosis. However, prolonged symptoms of pain, swelling, and limitation of first metatarsophalangeal joint range of motion led to further radiographic evaluation, which confirmed a suspected diagnosis of an osteochondral fracture. This is regarded as a most interesting case by the authors, in light of the fact that review of the literature revealed a paucity of descriptions of osteochondral fracture of the first metatarsophalangeal joint. In addition, all of the previously described lesions have been localized to the first metatarsal head. A review of the literature failed to reveal any fractures occurring at the base of the proximal phalanx of the hallux.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
8/14. Massive bone allografts for traumatic skeletal defects.Large bone allograft transplants have been successfully used to reconstruct skeletal defects created by tumor resections and failed arthroplasties, but little has been reported on their use in traumatic defects. Of approximately 500 allograft procedures done at the massachusetts General Hospital from 1979 to 1988, 11 were done for restoration of traumatic bone loss. The average age of the patients was 30 (range 11 to 71 years), and the location of the defect was the tibia or femur in 10 of the 11 patients studied. Eight osteoarticular grafts (six hemicondylar and two total condylar) and three intercalary grafts were used for six open and five closed fractures. The time from injury to reconstruction averaged 17 months (3 to 96 months). Primary reconstruction was done in three cases and a salvage procedure in eight. patients were assessed by the operating surgeon and a physical therapist using an evaluation system that considers function, life-style, and emotional acceptance. According to the system, nine patients had excellent or good results (six hemicondylar grafts, three intercalary grafts), one patient had a fair result (total elbow graft), and one patient had failure of a total condylar graft and subsequently required an amputation. This study suggests that large bone allografts are of value in reconstructing traumatic skeletal defects, especially those involving an articular surface in a young patient.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
9/14. Simultaneous rupture of the tibialis posterior and flexor digitorum longus tendons in a closed tibial fracture.An interposition of ruptured tendons of the tibialis posterior and flexor digitorum longus occurred between the lower third tibial fracture fragments in a closed tibial fracture in a 26-year-old man. The tendon ruptures were not diagnosed preoperatively but were recognized at the time of open reduction. The tendons were repaired and the fracture internally fixed. Six months postoperatively, the patient had a 10 degree dorsal extension deficit in the ankle joint, the motion was painless, and the strength of the posterior tibial compartment muscles was grade 5.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
10/14. Nonunion of the humerus: rigid fixation, bone grafting, and adjunctive bone cement.Five patients with humeral nonunions were treated by open reduction and internal fixation with compression plating and adjunctive methylmethacrylate inserted by use of several techniques to gain secure screw purchase in markedly osteoporotic bone. The rigid fixation was supplemented in each case with cortical-cancellous bone grafting. Postoperative abduction splinting was applied in each case. The average follow-up examination was 24 months, with all five nonunions having healed at an average of five months postoperation. The shoulder arc of motion averaged 120 degrees, and the elbow arc of motion averaged 125 degrees.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
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