1/23. Articular fractures of the proximal interphalangeal joint with missing elements: repair with partial toe joint osteochondral autografts.Five cases of traumatic destruction of a condyle of the proximal interphalangeal joint repaired with a free autogenous graft of a corresponding toe condyle are presented. Precise fitting is essential: 1 patient required a second graft when the initial undersized graft was absorbed. Four of the 5 cases regained laterally stable bicondylar joints and functional fingers. Range of motion varied inversely to the magnitude of the injury and the surgery. Active range of motion at the proximal interphalangeal joint was 80 degrees in 2 digits, 45 degrees in 1, and 10 degrees in 1 complex case; 1 case was considered a failure.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/23. Salvage of contaminated fractures of the distal humerus with thin wire external fixation.Fractures and osteotomies of the distal humerus that are contaminated or infected represent a difficult management problem. Stable anatomic fixation with plates and screws, the acknowledged key to a good result in the treatment of bicondylar fractures, may be unwise. A thin wire circular (Ilizarov) external fixator was used as salvage treatment in such complex situations in five patients. The fixator allowed functional mobilization of the elbow while allowing achievement of the primary goal of eradicating the infection or colonization. Two patients required a second operation for fixation of a fibrous union of the lateral condyle. One patient with a vascularized fibular graft later required triple plate fixation for malalignment at the distal host and graft junction. Four of five patients ultimately achieved complete union. The fracture remained ununited in one patient who has declined additional intervention. All five patients achieved at least 85 degrees ulnohumeral motion, two after a secondary elbow capsulectomy performed after healing was achieved. This experience suggested that the Ilizarov construct, although not a panacea, represents a reliable method of skeletal stabilization that allows functional mobilization while elimination of infection or colonization is ensured. If necessary, stiffness and incomplete healing can be addressed with an increased margin of safety at subsequent operations.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
3/23. Emotional impairment after right orbitofrontal lesion in a patient without cognitive deficits.The present study describes a patient, M.L., with right orbitofrontal lesion, who showed no impairment on main neuropsychological tests, including those measuring frontal functions. Nevertheless, he had deeply affected emotional responses. In line with Damasio's work, the patient had lower skin conductance during the projection of a standardized set of emotional slides. Furthermore, he showed altered facial expressions to unpleasant emotions, displaying low corrugator supercilii electromyographical activity associated with reduced recall of unpleasant stimuli. During a task focusing on imagery of emotional situations, M.L.'s heart rate and skin conductance responses were affected during both pleasant and unpleasant conditions. Facial expressions to unpleasant imagery scripts were also impaired. Thus, the orbitofrontal cortex proved to play a critical role in retrieval of psychophysiological emotional patterns, particularly to unpleasant material. These results provide the first evidence that orbitofrontal lesions are associated with emotional impairment at several psychophysiological levels.- - - - - - - - - - ranking = 5keywords = motion (Clic here for more details about this article) |
4/23. Use of a hinged external fixator for elbow instability after severe distal humeral fracture.The authors report the case of a forty-year-old man who developed acute elbow instability after fixation of an open, comminuted distal humeral fracture. Treatment with a hinged, external elbow fixator was successful in reestablishing elbow stability and a functional range of elbow motion. To the best of the authors' knowledge, the use of this device for acute elbow instability after distal humeral fracture fixation has not been previously reported.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
5/23. One-stage emergency treatment of open grade IIIB tibial shaft fractures with bone loss.The purpose of this study was to report the authors' experience with emergency reconstruction of severe tibial shaft fractures. Five male patients were admitted to the emergency room with a grade IIIB open tibial shaft fracture with bone loss (average age, 33 years; age range, 18-65 years). Injuries were the result of motorcycle accidents (N = 2), pedestrian accidents (N = 1), gunshot wound (N = 1), and paragliding fall (N = 1). Primary emergent one-stage management for all patients consisted of administration of antibiotics, debridement, stabilization by locked intramedullary nailing, bone grafting from the iliac crest, and coverage using free muscle flaps (four latissimus dorsi and one gracilis). The average follow-up was 21 months (range, 8 months-3.5 years). Partial weight bearing with no immobilization was started at 3 months, and full weight bearing began 5 months after trauma. No angular complications and no nonunions were observed. There was one case of superficial infection without osteitis. All fractures healed within 6 months in 4 patients and within 10 months in 1 patient. At the last follow-up examination, ankle and knee motion was normal and no pain was noted, except for 1 patient who had associated lesions (ankle motion reduced by 50%). Aggressive emergency management of severe open tibial fractures provides good results. It improves end results markedly, not only by reducing tissue loss from infection, but also reducing healing and rehabilitation times.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/23. Treatment of pilon fractures using the ilizarov technique. case reports and review of the literature.Tibial pilon fractures are difficult to manage because of their severity. These injuries are frequently open and contaminated, with marked comminution of the articular surface and metaphysis. The results of open reduction and internal fixation are dependent on the severity of the initial injury and the quality and stability of the reduction. The literature reports numerous complication rates associated with open reduction and internal fixation of pilon fractures. The ilizarov technique of external fixation has fewer complications, and allows restoration of joint surfaces, reconstruction of length, and alignment of the extremity while maintaining a sufficient range of joint motion. Two cases of pilon fractures in which the Ilizarov method was utilized are reported, along with a review of the literature.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
7/23. Treatment of infected tibial nonunions with debridement, antibiotic beads, and the Ilizarov method.This study of 10 patients presents the early results of a protocol of debridement, antibiotic bead placement, and use of the Ilizarov method with a circular external fixator for treatment of infected nonunions of the tibia in a military population. The nonunions resulted from high-energy fractures in nine cases and an osteotomy in one. The Ilizarov techniques used were transport (five cases), shortening and secondary lengthening (two cases), minimal resection with compression (one case), and resection with bone grafting (two cases). Flap coverage was required for five patients. There were two recurrences of infection (20%) among patients with the most compromised soft tissue. Only 50% of patients were able to perform limited duties while wearing the external fixator. Only four patients returned to active duty; however, three patients from special operations units were able to return to jump status. Six patients underwent medical retirement because of insufficient function, resulting from decreased ankle or knee range of motion and arthrosis or muscle weakness.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
8/23. Temporary external fixation across the ankle after tibial nailing.We describe the application of a temporary spanning external fixation device across the ankle in conjunction with intramedullary tibial nailing. This technique can be useful in selected patients with open fractures associated with severe soft-tissue trauma, skin grafts, or muscle flaps. The external fixator allows for wound access and keeps the foot and ankle in a neutral position preventing equinus. A brief period of rigid ankle immobilization is beneficial in preventing muscle motion and sheer stresses on flaps and skin grafts. The external fixator is removed at 3 to 6 weeks once the soft tissues have healed.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
9/23. Dislocation of the carpal scaphoid: an 8-year follow-up.Isolated dislocation of the carpal scaphoid is a rare injury, with 10 cases reported in the English-language literature. We report an 8-year follow-up of a dislocated scaphoid treated with open reduction and Kirschner wire fixation. Good to excellent range of motion was the result.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
10/23. Vastus medialis muscle flap and hemi V-Y skin flap for knee extensor and soft tissue reconstruction.Simultaneous reconstruction of extensor mechanism and skin defect of the knee joint is a difficult problem. We present a case of a 55-year-old man with loss of patella and 9 x 6 cm skin defect after total patellectomy for infected open patellar fracture. Vastus medialis muscle flap and hemi V-Y skin flap were elevated. Vastus medialis muscle flap was advanced and sutured to the remaining patellar tendon. Hemi V-Y skin flap covered the skin defect. The wound healed uneventfully. After a follow-up period of 30 months, active range of motion of the knee joint is 0-120 degrees, and extension strength of the knee joint is [4] in a manual muscle test. He can stand on his right leg without any assistance. The combination of vastus medialis flap and hemi V-Y skin flap is a valuable option in knee reconstruction after total patellectomy.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
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