1/16. Articular impingement in malunited fracture of the humeral head.We report on the case of a fracture of the humeral metaepiphysis, surgical neck, and greater tuberosity treated conservatively. Malunion of a fracture of the greater tuberosity developed an impingement on the glenoid surface, causing an articular locking in internal rotation that resolved with slight pressure and a painful "click." The impinging bone was removed arthroscopically. Its extreme posterior position required opening a second, novel portal close to the posterior edge of the acromion for instrument access. Complete removal of the impinging bone restored free internal rotation without signs of impingement on the glenoid surface. Passive motion was initiated immediately postoperatively, and active motion in a water pool was initiated after 2 weeks. After 1 year, the patient has no pain, has maintained complete range of motion, and experiences no limitations in daily or sports activities. The peculiar features of this case are the absence of soft tissue scar stiffness and deficiency of the rotator cuff, because malunion of the bone fragment to the posterior edge of the humeral head produced a mechanical block of internal rotation, and the arthroscopic treatment of the impingement through an atypical superoposterior portal, which has not been described in the literature before.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/16. Intra-articular corrective osteotomy for the malunited intercondylar humeral fracture: a case report.A 35-year-old patient sustained comminuted intercondylar fracture of the distal humerus. At six months post-open reduction and internal fixation, the malunion was corrected with an intra-articular osteotomy. The patient obtained a painless, functional elbow joint with increased grip strength after corrective osteotomy, although she had complained of severe elbow pain, limited range of motion, and loss of grip strength before osteotomy. A 15 degrees cubitus varus deformity was also corrected . Radiographs of the elbow joint did not show accelerated degenerative changes at over three years follow-up post-corrective osteotomy. Intra-articular corrective osteotomy should be considered as a salvage procedure for the treatment of a malunited intercondylar humeral fracture, especially in patients who are thought to be too young for elbow arthroplasty.- - - - - - - - - - ranking = 0.33333333333333keywords = motion (Clic here for more details about this article) |
3/16. Arthroscopically treated proximal humeral fracture malunion.Articles describing the treatment of proximal humerus malunion are limited. Although in most of the cases, shoulder arthroplasty is the treatment of choice, when the articular surface of the humeral head is intact, other techniques can be considered and successfully used as well. Using arthroscopic techniques for proximal humerus malunion treatment is rarely reported in the literature. We could find only a few cases in which arthroscopic subacromial decompression was used to treat greater tuberosity malunion. Arthroscopic debridement and capsulotomy are also considered in the treatment of proximal humeral malunion cases with shoulder joint stiffness. This case report describes the completely arthroscopic treatment of a 4-part proximal humeral fracture malunion associated with pain and restricted range of motion. The main deformity in our case was medially displaced malunited lesser tuberosity that was blocking the internal rotation of the humerus. Isolated displaced lesser tuberosity fractures are rare injuries. Open techniques are usually the treatment of choice. We did not find any reports of arthroscopic treatment of lesser tuberosity malunion as a separate entity or as a component of a proximal humerus malunion. The early result in our case strongly encourages using arthroscopic techniques for lesser tuberosity malunion treatment as well as expanding the indications for shoulder arthroscopy in proximal humerus malunion cases.- - - - - - - - - - ranking = 0.33333333333333keywords = motion (Clic here for more details about this article) |
4/16. Malunion of femoral head fractures treated by partial ostectomy: three case reports.Malunion of femoral head fractures has been rarely reported. We report on three cases of malunion of the femoral head, which were treated by partial ostectomy. All patients were involved in traffic accidents and had a posterior fracture-dislocation of the hip. The types of femoral head fractures were Pipkin type I with inferomedial fracture fragment in all cases. Initially, they were treated by closed reduction and skeletal traction for between 6 and 8 weeks. The patients were then transferred to our hospital; the chief complaint was of limited hip motion. A protruding bony mass limiting the hip motion was resected in all cases. The Smith-Petersen approach was used in all cases. The malunion sites were located distally to the original fracture site in all cases. Full weight bearing was permitted, and a range of motion exercises was started postoperatively. Excellent results were obtained with almost complete restoration of hip motion without pain. In the follow-up radiographs, there were no cases of avascular necrosis.- - - - - - - - - - ranking = 1.3333333333333keywords = motion (Clic here for more details about this article) |
5/16. Remodeling of phalangeal neck fracture malunions in children: case report.We report a case of a malunion of a proximal phalanx neck fracture in a 5-year-old boy that remodeled nearly completely, resulting in excellent proximal interphalangeal joint motion and function.- - - - - - - - - - ranking = 0.33333333333333keywords = motion (Clic here for more details about this article) |
6/16. Acetabular reduction osteotomy using surgical dislocation of the hip joint for treatment of a malunited acetabular fracture.INTRODUCTION: Acetabular fractures remain a challenge for the orthopedic and trauma surgeon, with frequently poor outcome in terms of pain and lack of motion and high rate of posttraumatic arthritis especially in badly reconstructed fractures where the anatomy was not restored. Surgical treatment of malunited acetabular fractures is often necessary, although it can be very complex. CASE PRESENTATION: We report a young woman who sustained both column fracture with central dislocation of the femoral head in which the posterior wall fragment was initially not fixed anatomically. CONCLUSIONS: Surgical dislocation of malunited acetabular fractures is a relatively new therapeutic option that provides full access to the femoral head and acetabulum without compromising the blood supply to the femoral head. Our results show that it can also be of great help in restoring malunited acetabular fractures.- - - - - - - - - - ranking = 0.33333333333333keywords = motion (Clic here for more details about this article) |
7/16. Early corrective osteotomy for a malunited colles' fracture using volar approach and calcium phosphate bone cement: a case report.We report a case of malunion of the distal radius after a colles' fracture treated with osteotomy using a volar approach combined with calcium phosphate bone cement grafting of the dorsal defect via a drill hole from the volar cortex 6 weeks after the injury. One year and 4 months after surgery range of motion and grip strength were improved and x-rays of the wrist showed complete union of the distal radius with progressive absorption of the calcium phosphate bone cement.- - - - - - - - - - ranking = 0.33333333333333keywords = motion (Clic here for more details about this article) |
8/16. Neglected femoral diaphyseal fracture.Femoral diaphyseal fractures usually result after trauma of high magnitude and because of this, can be life-threatening injuries or may result in considerable physical disability if not treated with care and caution. Nonoperative treatment of these fractures continues to be popular among the patient population in the Indian subcontinent, which in majority of cases, leads to healing in malalignment, shortening of the limb, chondromalacia patellae, and loss of knee motion. Although the majority of these fractures are being treated by operative methods today, success of the treatment depends largely on the surgeon's familiarity with the procedure or the type of fracture pattern (comminuted or segmental) particularly in a polytraumatized patient. Delayed union and nonunion of femoral-diaphyseal fractures and implant failures usually result after these procedures or the type of injury. The purpose of this study is to discuss various types of neglected femoral diaphyseal fractures and to review the literature on their treatment.- - - - - - - - - - ranking = 0.33333333333333keywords = motion (Clic here for more details about this article) |
9/16. Remodelling of a displaced phalangeal neck fracture.Phalangeal neck fractures are uncommon in children. When these injuries to the proximal and middle phalanges are displaced and not treated operatively the fracture may heal in a malunited position with loss of motion at the IP joint. Remodelling in the area of the phalangeal neck is thought to be reduced because of its distance from the physis. In cases of malunion osteotomy of the phalangeal neck may be required to restore anatomy and motion. A case is described which demonstrates complete remodelling of a displaced middle phalangeal neck fracture in a child and recovery of a normal range of motion without operative intervention.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
10/16. Reconstruction after malunion and nonunion of intra-articular fractures of the distal humerus. methods and results in 13 adults.We reviewed the results of 13 adults of secondary reconstruction of malunited and ununited intraarticular distal humeral fractures. Their average age was 39.7 years, and preoperatively all had pain, loss of motion and functional disability; the average arc of motion was only 43 degrees and the average flexion contracture was 45 degrees. Nine patients had ulnar neuropathy. Elbow reconstruction, at an average of 13.4 months after the original injury, included osteotomy for malunion or debridement for nonunion, realignment with stable fixation and autogenous bone grafts, anterior and posterior capsulectomy and ulnar neurolysis. The elbows were mobilised 24 hours postoperatively. There were no early complications and all nonunions and intra-articular osteotomies healed. After a mean follow-up of 25 months, the average arc of motion was 97 degrees with no progressive radiographic degeneration. ulnar nerve function improved in all cases and clinical assessment using the Morrey score showed two excellent, eight good and three fair results. Reconstruction of intra-articular malunion and nonunion of the distal humerus in young active adults is technically challenging, but can improve function by restoring the intrinsic anatomy of the elbow.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
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