1/10. Nonunion of the isolated capitate waist fracture.We report a patient with nonunion of an isolated fracture of the capitate. A male 17-year-old high school student directly hit the dorsal aspect of the carpal with the wrist in flexion position against another player's shoulder during a rugby football game. Radiographs did not show a fracture of the capitate on the day after the injury, but nonunion was distinct across the waist at the middle one-third of the capitate 4 months later. The fixation using two cannulated Herbert-Whipple screws with iliac cancellous bone graft led to sound union of the capitate and the patient's ability to return to sporting activities. Although the initial plain radiographs do not show a fracture of the capitate, we should consider the capitate fracture and check the patient by repeated physical examinations and radiographs if the patient suffers from persistent localized pain and tenderness over the capitate.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/10. Secondary craniomaxillofacial deformities. Current principles of management.This article focuses on secondary reconstruction of naso-orbital frontal injuries. Pertinent clinical anatomy, physical examination/documentation, and radiographic imaging are examined first. Pretreatment planning, operative exposures, and case examples are discussed in the second part of the article.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/10. 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 = 1keywords = physical (Clic here for more details about this article) |
4/10. Arthroscopic reconstruction of an isolated avulsion fracture of the lesser tuberosity.Isolated avulsion fracture of the lesser tuberosity represents an extremely rare injury that occurs mainly in younger patients. This report outlines the case of a 35-year-old healthy man who sustained a bony avulsion of the subscapularis tendon during an abduction external rotation trauma to his left shoulder. The injury was diagnosed by physical examination, standard radiographs, and magnetic resonance imaging. An arthroscopic reconstruction including closed reduction and internal fixation using suture anchors was performed. After a follow-up of 6 months, the patient's Constant Score increased from 62.4 points preoperatively to 91.3 points. At the latest follow-up, the patient was completely pain free, had regained a full work activity level, and returned to overhead sports. On postoperative standard radiographs and magnetic resonance images, the bony fragment was shown to be consolidated in an anatomic position. In cases of displaced isolated fractures of the lesser tuberosity without significant subluxation or dislocation of the long head of the biceps arthroscopic reconstruction using suture anchors can lead to a good clinical and radiological result.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/10. Concomitant ipsilateral femoral neck and femoral shaft fracture nonunions: a report of three cases and a review of the literature.Ipsilateral femoral neck and femoral shaft fractures are rarely reported in the literature and represent a diagnostic and treatment challenge. Due to the possibility of missing a nonunion at either site, we recommend a high clinical suspicion and careful radiographic examination of both fracture sites. Because the development of nonunion at both sites is exceedingly rare, we report three cases of concomitant ipsilateral femoral neck and shaft nonunions that were treated by the senior author (KAE). Two patients were treated with a Pauwels osteotomy and a blade plate for the femoral neck nonunion and a reamed retrograde intramedullary nail for the shaft. One patient was treated with an antegrade reamed cephalomedullary intramedullary nail. All three patients' fractures united at a mean of 4.6 months and they are currently pain free and without physical limitations.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/10. Delayed healing of mandibular fracture in idiopathic myxedema.Lack of adequate amount of thyroid hormone may interfere with healing. A patient in whom a fracture of the mandible failed to heal in the 2 years following surgical treatment is presented. When thyroid hormone supplementation was introduced, the fracture progressed to union. The physical findings of hypothyroidism and the role of thyroid hormone in healing are discussed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/10. pseudarthrosis of the forearm bones. (Clinical and radiographic survey of 112 operated cases).There are two aims in the surgery of pseudarthrosis in the forearm; consolidation of the fracture, and restoration of function as nearly normal as possible in a part of the musculo-skeletal system which is mechanically controlled by extremely delicate, interdependent, structural units. These aims are, of course, the same as those in the treatment of fresh fractures. The following conclusions emerge from a clinical and radiographic study of 112 operated cases: (a) Sherman's plate has been shown to be an ideal means of synthesis, because of its metallurgical and physical qualities, which enable it to adapt excellently to an irregular bone surface. (b) Plate fixation is supplemented by an appositional cortical transplant. This also plays a definite mechanical role, both because of the firm grip that it affords to the screws when the bone stumps are atrophic, which they often are, and because it is isoelastic with the recipient's tissue. Two cortical grafts are sometimes used instead of a plate and graft. (c) The best functional results are obtained when the leverage of the forearm has been anatomically restored.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/10. Bilateral nonunited femoral neck fracture in a child with osteopetrosis.We report a case of osteopetrosis with bilateral nonunited femoral neck and coxa vara in a 7-year-old boy. There was a history of traumatic transcervical left femoral neck fracture unsuccessfully treated by internal fixation. We performed a bilateral subtrochanteric valgus osteotomy. K-Wire fixation failed on the right side due to hardness of the bone. Finally, internal fixation with an angular plate after predrilling of the femoral neck offered stability. Bone union was achieved on both sides, resulting in full recovery of normal physical activity.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/10. A 9-year-old girl with a bowed right forearm 6 months after a fracture.The following case is presented to illustrate the roentgenographic and clinical findings of a condition of interest to the orthopedic surgeon. Initial history, physical findings, and roentgenographic examinations are found on the first page. The final clinical and roentgenographic differential diagnoses are presented on the following pages.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/10. The Stener lesion revisited: a case report.Proximal displacement of a ruptured ulnar collateral ligament of the metacarpophalangeal joint of a thumb (Stener lesion) can result in chronic instability if left untreated. rupture without displacement generally leads to complete recovery. An associated fracture can give information about the position of the ruptured ligament. However, 2 cases are presented demonstrating that displacement of the ligament can occur in the absence of displacement of the bony fragment. This suggests that physical examination is required to determine stability with injuries to the ulnar structures of the thumb metacarpophalangeal joint.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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