1/8. Traumatic hallux varus repair utilizing a soft-tissue anchor: a case report.hallux varus is usually iatrogenic in nature; however, congenital and acquired etiologies have been described in the literature. The authors present a case of traumatic hallux varus secondary to rupture of the adductor tendon. Surgical correction was performed using a soft tissue anchor for maintenance of the soft tissues utilized for repair.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/8. Complete, superior labral radial tear and type II slap tear associated with greater tuberosity fracture.This case report presents a unique variant of superior labral-bicep complex injury. The combination of a complete anterior-superior radial tear of the labrum and bicep anchor instability has not been described in previous classifications of these injuries. The injury was traumatic in nature and was associated with a displaced fracture of the greater tuberosity. The labral pathology was treated by an anatomic repair technique as described. Rationale for the repair performed, as well as implications of the injury treated by debridement alone, are discussed. Clinicians should be aware of different patterns of superior labral-bicep complex injuries and the implications on function and stability of the glenohumeral joint.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/8. Bilateral patellar tendon rupture without predisposing systemic disease or steroid use: a case report and review of the literature.Simultaneous bilateral patella tendon ruptures are very rare injuries of the knee extensor complex often associated with systemic disorders such as lupus erythematosus or rheumatoid arthritis. We describe the case of a 34-year-old man without concomitant systemic disease or steroid use and provide the most comprehensive review of the German and English literature. Furthermore, we discuss the predisposing factors and causal mechanisms as well as current diagnostic procedures and treatment options. In the literature review, only a few patients without systemic disorder or steroid medication present with potential predisposing factors that may be responsible for degenerative changes of the patella tendon, weakening its stability. In addition, in most of these cases, it remains difficult to explain the bilateral and simultaneous nature of this injury.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/8. Avulsion of the extensor carpi radialis brevis insertion: a case report and review of the literature.Injuries to the bases of the index finger and long finger metacarpals are unusual because of the stability of the carpometacarpal joints. Such stability is provided by the strong capsuloligamentous attachments and the unique bony architecture. Given the rare nature of these injuries, there is no consensus regarding the optimal management of avulsion fractures of the bases of the index finger and long finger metacarpals. Open reduction and internal fixation of the fracture, with anatomic repair of the extensor carpi radialis brevis or extensor carpi radialis longus, offers several advantages over closed treatment. A case report and a review of the literature are presented.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/8. Management of severe forearm injuries.A review of principles and an operative guideline for repair of severely mutilating injuries to the forearm have been set forth. These concepts and their application have been illustrated in a series of clinical cases. The following key concepts have developed from these clinical experiences: 1. The surgeon must evaluate each case based upon the potential for return of sensation and function. One cannot justify the statement that a replanted arm is always superior to a prosthesis, even if its only purpose is cosmetic. 2. Care must be taken in the emergency room to evaluate the entire patient, and not to ignore other injuries while concentrating on a mangled extremity. 3. The crush-avulsion nature of injuries seen in a large referral center necessitates aggressive debridement of damaged soft tissue and bone. Wounds that have avulsion of skin, muscle, and nerve throughout the length of the arm do not lend themselves to repair. Destruction of an elbow joint generally precludes repair. 4. A well stabilized skeleton is essential before definitive soft tissue repairs can be performed. 5. Vascular repairs are meticulously performed using magnification. All vessels are reconstructed in an effort to recreate the original anatomy. 6. Wide destruction of muscle and tendon is frequent necessitating ingenuity in connecting proximal motor units to distal tendon. After repair, early active motion of the extremity is emphasized. 7. Perhaps the strongest contraindication to reconstruction of a severely damaged upper limb is avulsion of the nerves throughout the length of the forearm. Sharply divided nerves can be repaired by group fascicular suture. Crushed, divided nerves do well with accurate epineural approximation. Crushed nerves with epineural continuity ar best treated by observation and secondary grafting as required. 8. Primary coverage of areas denuded of skin is by split graft of local transposition flaps. More sophisticated techniques may be used at a later time (myocutaneous flaps or free flaps) if further reconstruction is contemplated. 9. Dressing must be carefully applied without constricting the extremity. A protective plaster is applied beginning from above the elbow and ending in a bonnet over the hand; this allows the recovery room nurse to monitor the vascular status of the repair. 10. The physiotherapist and occupational therapist are integrated into the perioperative care. Active range of motion exercises are begun as soon as the third day after the operation. Lightweight static and dynamic splints help to restore mobility.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/8. omentum as gliding material after extensive forearm tenolysis.Tendon adhesion occurring after major replantation can be severe and extensive due to the nature of the trauma, ischaemia, prolonged oedema and/or infection. Therefore there is a high possibility of re-adhesion after tenolysis. In two cases of tenolysis after forearm replantation omentum was used as gliding material and good results were obtained.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/8. Irreducible dorsal dislocation of the distal interphalangeal joint: case report and literature review.An irreducible dorsal dislocation of the DIP joint is a rare injury. Irreducibility is primarily caused, in closed injuries, by the interposed volar plate, and in open injuries by the dislocated FDP tendon. It is important to recognize the complex nature of this dislocation and to limit attempts at closed reduction. Early surgical exploration, anatomic reduction, and early mobilization are prerequisites to good functional recovery.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/8. Posterior tibial tendon tears in young competitive athletes: two case reports.Unlike the achilles tendon, the posterior tibial tendon does not typically undergo acute rupture. We report two cases of posterior tibial tendon tears occurring in young, athletic individuals (<30 years old) that required operative intervention before the patients could return to competitive sports. We believe that these are the first two reports of posterior tibial tendon tears occurring in this population without the patient having a prior history of steroid injections in the tendon. The tears we observed and described at surgical exploration were chronic and degenerative in nature. We also comment on our approach to treatment of posterior tibial tendon injuries in the athletic population.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |