1/139. Simultaneous bilateral elbow dislocation in an international gymnast.Elbow dislocation is a rare injury in elite athletes. We report an unusual case of simultaneous bilateral elbow dislocations with a unilateral radial head fracture in an international female athlete competing on the asymmetrical bars. These injuries require prompt reduction and immediate mobilisation if an abrupt end to a promising career is to be prevented.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |
2/139. Wire-loop fixation of volar displaced osteochondral fractures of the distal radius.We describe the technique of wire-loop fixation to treat 4 young men with a unique variant of Melone's type 4 articular fracture of the volar lunate facet, characterized by a displaced rotated articular fragment supported by a limited amount of subchondral bone. This is an unusual injury that threatens the integrity of both the radiocarpal and distal radioulnar joints. It is the result of a compressive force to the wrist and may require trispiral computed tomography for delineation. Open reduction and internal fixation is recommended to maintain stability and articular congruity. The displaced volar-articular fragment, however, may be relatively small; therefore, direct manipulation could lead to soft tissue stripping and osteonecrosis. We have found the technique of wire-loop fixation to be a simple, reproducible, and effective alternative method of internal fixation for these difficult fractures. Malunion, nonunion, loss of fixation, tendon rupture, infection, arthrosis, or pain caused by hardware has not occurred. Use of this technique is not recommended in patients with osteoporotic bone.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |
3/139. Palmar lunate trans-scaphoid, trans-triquetral fracture-dislocation.A palmar lunate dislocation associated with fractures of the scaphoid and triquetrum and an avulsion fracture of the radial styloid is described. The injury resulted from a high energy dorsiflexion/axial compression force. Open reduction of the dislocated lunate and internal fixation of the scaphoid were done as an emergency procedure. A second operation was required to internally fix the displaced triquetral fracture and reduce the lunotriquetral dissociation. A good result was documented at 6 months.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |
4/139. Transcranial doppler detection of fat emboli.BACKGROUND AND PURPOSE: The fat embolism syndrome (FES) is characterized by the simultaneous occurrence of pulmonary and neurological symptoms as well as skin and mucosal petechiae in the setting of long-bone fractures or their surgical repair. Its pathophysiology is poorly understood, and effective treatments are lacking. We present 5 patients with long-bone fractures in whom in vivo microembolism was detected by transcranial Doppler. methods: Five patients with long-bone fractures were monitored with transcranial Doppler for microembolic signals (MESs) after trauma. Two patients also had intraoperative monitoring. A TC-2020 instrument equipped with MES detection software was used. Detected signals were saved for subsequent review. Selected signals satisfied criteria defined previously and were categorized as large or small. RESULTS: Cerebral microembolism was detected in all 5 patients and was transient, resolving within 4 days of injury. Intraoperative monitoring revealed an increase in MESs during intramedullary nail insertion. The characteristics of MESs after injury varied among patients, with large signals being more frequent in the only patient with a patent foramen ovale. CONCLUSIONS: Cerebral microembolism after long-bone fractures can be detected in vivo and monitored over time. These findings may have potential diagnostic and therapeutic implications.- - - - - - - - - - ranking = 2keywords = injury (Clic here for more details about this article) |
5/139. median nerve compression associated with displaced Salter-Harris type II distal radial epiphyseal fracture.Three children with grossly displaced Salter-Harris Type II fractures of the distal radial epiphysis underwent immediate manipulation under anaesthetic (MUA) because of rapidly developing median nerve compression. In each case nerve function was quickly restored with no late neurological sequelae. We believe that in children who sustain this injury with signs of median nerve compression, immediate MUA without carpal tunnel release is acceptable initial management. Late exploration of the median nerve can be considered should a neurological deficit persist.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |
6/139. adult monteggia fracture with ipsilateral distal radius fracture: case report.Although the adult Monteggia fracture is a well-known injury, the combination of a Monteggia fracture and an ipsilateral distal radius fracture is extremely rare. It is important for the treating physician to recognize that this injury involves not only the bone elements but also their articulations. The distortion of the integrity of both the elbow and the wrist results in the potential for functional compromise, if inadequately treated. The case report presented here describes a 21-year-old woman with this complex injury resulting from a fall. The injury included a Monteggia type II fracture and an ipsilateral distal radius intra-articular fracture in the left forearm. An excellent result was obtained by surgical intervention in both the radial and ulnar bones. The factors we believe contributed to the excellent result were early diagnosis, anatomic reduction, stable fixation, and early physical exercise. The mechanism of injury giving rise to this rare combination of fractures is discussed, as well as a review of the literature.- - - - - - - - - - ranking = 5keywords = injury (Clic here for more details about this article) |
7/139. A new fracture of the forearm adjacent to a healing fracture.A 10-year-old girl sustained closed fractures of the distal radius and ulna. This was manipulated and she was treated in an above-elbow plaster for 4 weeks. Two weeks later she was discharged, only to have a second injury to the same forearm. X-ray showed a new fracture distal to undisrupted callus.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |
8/139. Flexon-type Salter-Harris I injury of the proximal tibial epiphysis.The authors report a case of a flexion-type epiphyseal separation of the proximal tibia. The injury described herein is a displaced Salter-Harris type I injury. literature pertaining to this rare injury is reviewed, and management options are discussed.- - - - - - - - - - ranking = 7keywords = injury (Clic here for more details about this article) |
9/139. Galeazzi-equivalent fracture in children associated with tendon entrapment--report of two cases.INTRODUCTION: This is a report of 2 consecutive cases of the Galeazzi-equivalent fracture in children. CLINICAL PICTURE: In both cases, the mechanism of injury was falls onto the outstretched hand. Radiographs showed fracture of the radius with separation of the distal ulnar physis. TREATMENT: Initial treatment by closed manipulation failed; hence, open reduction and internal fixation was required. The cause of failure of closed manipulation in both cases was interposition of soft tissue into the ulnar fracture site. OUTCOME: Both cases showed good functional outcome after open reduction and internal fixation. CONCLUSION: Recognition of this form of injury is necessary to ensure proper treatment is undertaken to prevent the complications of inadequate reduction and growth retardation.- - - - - - - - - - ranking = 2keywords = injury (Clic here for more details about this article) |
10/139. brachial artery injury in closed posterior elbow dislocation case report.The authors describe a case with a closed posterior elbow dislocation associated with a distal radial fracture and complete transsection of the brachial artery. The patient had a pulseless distal upper extremity and immediate gross swelling of the elbow and forearm. As closed reduction was not possible, open reduction had to be performed through an anteromedial approach to the elbow. End-to-end suture of the brachial artery was successful. After fasciotomy and internal fixation of the distal radial fracture, the elbow was stabilized with an external fixator spanning the elbow joint. After two years, despite good function of the elbow, restoration of the hand function is not optimal owing to persistent motor deficit of the ulnar nerve.- - - - - - - - - - ranking = 4keywords = injury (Clic here for more details about this article) |
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