Posterior lumbopelvic fixation with iliac screws is the most commonly used method for unstable spinopelvic injuries. It has certain limitations including inability to use distraction along the spinopelvic rod as an indirect reduction maneuver, need for complex 3-dimensional rod contouring and complications such as hardware prominence and soft tissue coverage. In the present case report, we described a surgical technique of lumbopelvic fixation with sacral alar screws for traumatic spinopelvic instability resulted from a unilateral Denis-III comminuted sacral fracture and the L5 burst fracture. On the opposite side of the sacral fracture, caudal screws were implanted into the pedicle of the S1, whereas on the side of sacral fracture, two sacral alar screws were placed parallel to the superior sacral endplate as well as the plane of sacroiliac joint. In addition, horizontal stabilization was conducted with cross-link connections to maintain the longitudinal traction. For sacral fracture associated with traumatic spinopelvic instability, this modified lumbopelvic fixation technique using sacral alar screws makes longitudinal reduction easier, requires less rod contouring, and reduces hardware prominence without compromising the stability.
Bone Screws ; Fracture Fixation, Internal ; Fractures, Bone ; surgery ; Fractures, Comminuted ; Humans ; Sacrum ; surgery ; Spinal Fractures ; surgery

Destructive injury is defined as a very serious damage both to the bone and the soft tissues. But in clinical practice we found that in some fracture cases, the damage to soft tissues is not as severe as "destructive injury" indicates, whereas comminuted fractures still cannot show the severity of bone damage. Therefore we proposed a new term "destructive fractures" after combining the definition of destructive injury with typical clinic cases. Destructive fractures refer to the fractures whose osseous tissues are damaged too seriously to be repaired, but soft tissues, nerves and veins are less severely injured and can be repaired. From the year 2001 to 2010, 75 cases of destructive fractures were admitted in our department. According to whether the fractures interlinked with the external environment, together with the fracture sites, they were divided into 6 types: a1 type, closed diaphysis destructive fracture; a2 type, open diaphysis destructive fracture; b1 type, closed joint-involved destructive fracture; b2 type, open joint-involved destructive fracture; c1 type, closed mixed destructive fracture; c2 type, open mixed destructive fracture. Corresponding clinical treatments were conducted for each type.The new classification criterion of destructive fracture is simple and practical and thus can be used as an important guide to make reasonable treatment plans for destructive fractures.
Fracture Fixation, Internal ; Fractures, Closed ; Fractures, Comminuted ; surgery ; Fractures, Open ; surgery ; Humans

Femoral head fractures without dislocation or subluxation are extremely rare injuries. We report a neglected case of isolated comminuted fracture of femoral head without hip dislocation or subluxation of one year duration in a 36-year-old patient who sustained a high energy trauma due to road traffic accident. He presented with painful right hip and inability to bear full weight on right lower limb with Harris hip score of 39. He received cementless total hip replacement. At latest follow-up of 2.3 years, functional outcome was excellent with Harris hip score of 95. Such isolated injuries have been described only once in the literature and have not been classified till now. The purpose of this report is to highlight the extreme rarity, possible mechanism involved and a novel classification system to classify such injuries.
Adult ; Arthroplasty, Replacement, Hip ; Femur Head ; injuries ; Fractures, Comminuted ; surgery ; Hip Fractures ; surgery ; Humans ; Male

Adult ; Fractures, Comminuted ; etiology ; surgery ; Humans ; Humeral Fractures ; etiology ; surgery ; Male ; Wrestling ; Wrist Joint ; physiology

A new injury pattern of comminuted fractures of ipsilateral radial head and distal radius of forearm in an adult was described. To the best of our knowledge, this type of injury pattern had not been previously reported in the English literature. The possible mechanisms of injury were that the rebound forces were volar to the distal radius as the fracture was dorsally angulated, with a continuation of the radial head fracture due to the longitudinal impaction of the radius against the capitellum. Open reduction and internal fixation can obtain excellent results within 7-12 days after injury. We hope that our experience will increase the awareness of the occurrence of a double injury of the forearm.
Adult ; Fracture Fixation, Internal ; methods ; Fractures, Comminuted ; surgery ; Humans ; Male ; Radius Fractures ; surgery

Hoffa fracture is an uncommon injury. In the literature, lateral condylar Hoffa fracture is mentioned as a more common injury pattern than medial condylar Hoffa fracture. The mechanism of injury and method of treatment is not very well described in the literature. We are presenting a rare case of comminuted medial condylar Hoffa fracture with ipsilateral patellar fracture. The mechanism of injury has not been described in the literature. Lag screw fixation, which is the most acceptable method of treatment, is not possible due to comminution. We explain the possible mechanism of injury and fix the fracture with L-buttress plate.
Bone Plates ; Bone Screws ; Femoral Fractures ; surgery ; Fracture Fixation, Internal ; Fractures, Comminuted ; surgery ; Humans

During imaging studies or surgical procedures, anomalous forearm and wrist muscles are occasionally encountered. Among them, the flexor carpi radialis brevis is very rare. Because the trend is growing toward treating distal radius fractures with volar plating, the flexor carpi radialis brevis is worth knowing. Here, we report two cases with a review of the literature.
Female ; Forearm/*abnormalities ; Fractures, Comminuted/surgery ; Humans ; Middle Aged ; Muscle, Skeletal/*abnormalities ; Radius Fractures/surgery ; Ulna Fractures/surgery ; Wrist/*abnormalities

OBJECTIVETo evaluate the effectiveness of the rigid internal fixation for comminuted and redisplaced zygomatic arch fractures by modified preauricular-temporal approach with the resorbable bone fixation.

METHODSTotally twenty patients aged from 14 to 68 years and admitted to our hospital between September 2006 and June 2011 were reviewed, of whom seventeen had a unilateral comminuted zygomatic arch fracture and three re-displaced arch fracture after failed closed reduction. The fracture segments were aligned to restore the preinjury form of the arch by rigid fixation with resorbable plates and screws through a modified preauricular-temporal incision.

RESULTSThe fractures were well reduced, preauricular-temporal scar and lateral facial contour were aesthetically satisfying, and no case had limited mouth opening as well as facial palsy. The resorbable plates were not palpated one year after the operation.

CONCLUSIONThe rigid internal fixation through the preauricular-temporal approach with the resorbable bone is an effective method for the comminuted and redisplaced zygomatic arch fractures.

This study retrospectively evaluated the effectiveness of an open reduction and internal fixation of a tension band wiring technique for treating displaced or unstable comminuted distal ulnar shaft fractures without a radial fracture. Ten patients were treated for an isolated distal ulnar shaft fracture. There were 6 cases of a fracture 2.5 cm below the lower end of the ulna, and 4 cases with the fracture being 2.5 cm to 5 cm away from the lower end of the ulna. The authors classified the fractures of the distal ulnar into 3 types: a type I-simple fracture, a type II-comminuted fracture without a distal radioulnar joint (DRUJ) involvement, and a type III- comminuted fracture with DRUJ involvement. There were 3 cases of a type I fracture, 4 of type II and 3 of type III. The open reduction and internal fixation using tension band wiring were performed in 10 of these cases. After the operation, the wrist was placed in a cast for six weeks before active movement was allowed. The clinical results were excellent in 7 cases, good in 2 and poor in 1. In conclusion, tension band wiring surgery is recommended for treating an isolated distal ulnar with unreduced displaced fractures, in a comminuted fracture that cannot be maintained by a closed reduction and when there is the potential encroachment of fracture fragments in the DRUJ.
Adolescent ; Adult ; Aged ; Dislocations/surgery ; Female ; Fracture Fixation, Internal/*methods ; Fractures, Comminuted/surgery ; Human ; Male ; Middle Age ; Ulna Fractures/*surgery

The study assessed the early functional outcomes with cemented titanium implants of radius in the treatment of comminuted fractures of radial heads. The functional outcomes of arthroplasty with cemented titanium implants of radius in the treatment of radial head fractures (Mason Type III: 6; Mason Type IV: 4) in 10 consecutive patients (mean age, 38 years) were evaluated over a mean time of 23.7 months (18-31 months). The patients were assessed on the basis of physical examination, functional rating (Mayo) and radiographic findings. The parameters evaluated included motion, stability, pain, and grip strength. Five patients were considered to have excellent results, 4 patients had good results and 1 patient had fairly good results. There were no cases of infection, prosthetic failure, heterotopic ossification or dislocation. When medial collateral ligament was injured, radial head became the main stabilizing structure of the elbow. Titanium radial head implant may provide the stability similar to that of native radial head. We believe that titanium radial head implants may be indicated for the Mason Type III and Mason Type IV radial head fractures.
Elbow Joint/surgery ; Fracture Fixation/*methods ; Fractures, Comminuted/*surgery ; Prostheses and Implants ; Radius Fractures/*surgery ; Titanium ; Treatment Outcome