No abstract available.
Carpal Bones/*injuries ; Female ; Fractures, Bone/*complications ; Hand Injuries/*complications ; Humans ; Male ; Radius Fractures/*complications

No abstract available.
Female ; Femoral Fractures/*surgery ; Fracture Fixation, Intramedullary/*methods ; Humans ; Male ; Osteoporosis, Postmenopausal/*pathology ; Osteoporotic Fractures/*surgery

Isolated trochlea fracture in adults is a rare surgical entity as compared to its capitellar counterpart. It has been only mentioned sporadically in the literature as case reports. Fracture of the trochlea is accompanied by other elbow injuries like elbow dislocation, capitellum fracture, ulnar fracture and extraarticular condylar fracture. Here we report a unique case of isolated displaced trochlea fracture associated with fractures of the lateral end clavicle and the distal end radius. We propose a unique mechanism for this rare combination of injuries: typical triad of injury, i.e. fracture of the distal end radius with trochlea and fracture of the lateral end of the clavicle. Nonoperative treatment is recommended for undisplaced humeral trochlea fractures; but for displaced ones, anatomical reduction and internal fixation are essential to maintain the congruous trochlea-coronoid articulation and hence to maintain the intrinsic stability of the elbow.
Accidents, Traffic ; Adolescent ; Clavicle ; diagnostic imaging ; injuries ; Fracture Fixation, Internal ; methods ; Humans ; Humeral Fractures ; diagnostic imaging ; surgery ; Male ; Radiography ; Radius Fractures ; diagnostic imaging ; surgery

Radial nerve palsy is the most common neurological involvement in humeral shaft fractures. But combined radial and median nerve injury in a closed diaphyseal fracture of the humerus is rare. Combined injury to both radial and median nerve can cause significant disability. A detailed clinical examination is therefore necessary following humeral shaft fractures. We report a patient with closed diaphyseal humeral fracture (AO 12A-2.3) together with radial and median nerve palsy, its management and review of the literature. As the patient had two nerves involved, surgical exploration was planned. Fracture was reduced and fixed with a 4.5 mm narrow dynamic compression plate. There was no external injury to both radial and median nerves on surgical exploration. Neurological recovery started at 3 weeks' follow-up. Complete recovery was seen at 12 weeks. Careful clinical examination is of the utmost importance in early diagnosis of combined nerve injuries, which allows better management and rehabilitation of the patient.
Bone Plates ; Humans ; Humeral Fractures ; surgery ; Humerus ; Median Nerve ; Radial Neuropathy

PURPOSESubtrochanteric fractures of the femur are being managed successfully with various intramedullary and extramedulary implants with reasonable success. However, these implants require precise placement under image intensifier guidance, which exposes the surgeon to substantial amount of radiation. It also restricts the management of these fractures at peripheral centers where facility of image intensifiers is not available. Keeping this in mind we designed this study to identify if contralateral reversed distal femoral locking plate can be used successfully without the use of image intensifier.

METHODSTwenty-four consecutive patients (18 men and 6 women) with a mean age of 28 years (range 19-47 years) suffering subtrochanteric fractures of the femur underwent open reduction and internal fixation with reversed contralateral distal femoral locking plate. The outcome was assessed at the mean follow-up period of 3.2 years (range 2-4.6 years) using the Harris hip score.

RESULTSTwenty-one fractures united with the primary procedure, with a mean time of consolidation being 11 weeks (range, 9-16 weeks). One patient developed superficial suture line infection, which resolved with oral antibiotics. Another patient had a fall 3 weeks after surgery and broke the plate. Repeat surgery with reversed distal femoral locking compression plate was performed along with bone grafting and the fracture united. Two cases had nonunion, which went in for union after bone grafting. The mean Harris hip score at the time of final follow-up was 90.63 (range 82-97).

CONCLUSIONThe reversed contralateral distal femoral plate is a biomechanically sound implant, which when used for fixation of the subtrochanteric fractures with minimal soft tissue stripping shows results comparable to those achieved by using other extramedullary implants as well as intramedullary devices. The added advantage of this implant is its usability in the absence of an image intensifier.

Adult ; Bone Plates ; Female ; Fracture Fixation, Internal ; methods ; Hip Fractures ; surgery ; Humans ; Male ; Middle Aged

Ulnar nerve injury in closed fracture of forearm in children is uncommon.Commonly, neurapraxia is the reason for this palsy but other severe injuries or nerve entrapment has been reported in some cases. The importance of diagnosis concerning the types of the nerve injury lies in the fact that they have totally different management.We present a case of ulnar nerve deficit in a child following a closed fracture of the forearm bones. It is imperative to diagnose exact cause of palsy as it forms the basis for treatment. MRI scan can help diagnosis and accordingly guide the management. Simple nerve contusion should be treated conservatively, and exploration with fixation of the fracture should be done in lacerations and entrapments of the nerve. Surgery is not the treatment of choice in cases that could be managed conservatively.
Accidental Falls ; Child ; Diagnostic Errors ; Fractures, Closed ; complications ; diagnosis ; therapy ; Humans ; Magnetic Resonance Imaging ; Radius Fractures ; complications ; diagnosis ; therapy ; Ulna Fractures ; complications ; diagnosis ; therapy ; Ulnar Nerve ; injuries ; Ulnar Neuropathies ; diagnosis ; etiology

STUDY DESIGN: Prospective cohort study. PURPOSE: Evaluation of the clinico-radiological outcome and complications of limited laminectomy and restorative spinoplasty in spinal canal stenosis. OVERVIEW OF LITERATURE: It is critical to achieve adequate spinal decompression, while maintaining spinal stability. METHODS: Forty-four patients with degenerative lumbar canal stenosis underwent limited laminectomy and restorative spinoplasty at our centre from July 2008 to December 2010. Four patients were lost to follow-up leaving a total of 40 patients at an average final follow-up of 32 months (range, 24-41 months). There were 26 females and 14 males. The mean+/-standard deviation (SD) of the age was 64.7+/-7.6 years (range, 55-88 years). The final outcome was assessed using the Japanese Orthopaedic Association (JOA) score. RESULTS: At the time of the final follow-up, all patients recorded marked improvement in their symptoms, with only 2 patients complaining of occasional mild back pain and 1 patient complaining of occasional mild leg pain. The mean+/-SD for the preoperative claudication distance was 95.2+/-62.5 m, which improved to 582+/-147.7 m after the operation, and the preoperative anterio-posterior canal diameter as measured on the computed tomography scan was 8.3+/-2.1 mm, which improved to 13.2+/-1.8 mm postoperatively. The JOA score improved from a mean+/-SD of 13.3+/-4.1 to 22.9+/-4.1 at the time of the final follow-up. As for complications, dural tears occurred in 2 patients, for which repair was performed with no additional treatment needed. CONCLUSIONS: Limited laminectomy and restorative spinoplasty is an efficient surgical procedure which relieves neurogenic claudication by achieving sufficient decompression of the cord with maintenance of spinal stability.
Asian Continental Ancestry Group ; Back Pain ; Cohort Studies ; Constriction, Pathologic* ; Decompression ; Female ; Follow-Up Studies ; Humans ; Laminectomy* ; Leg ; Lost to Follow-Up ; Male ; Prospective Studies ; Spinal Canal*

OBJECTIVEMetaphyseal-diaphyseal fractures of the distal radius are a major treatment dilemma and orthopaedic surgeons have to pay due consideration to restoration of anatomy of distal radius together with rotation of the radial shaft and maintenance of radial bow and interosseous space. We performed this study to evaluate the clinic-radiological outcome of metaphyseal-diaphyseal fractures of the distal radius treated with long volar locking plates.

METHODSThis prospective study involved 27 patients (22 males and 5 females) with metaphyseal-diaphyseal fracture of the distal radius. Their mean age was (30.12+/-11.48) years (range 19-52 years) and the follow-up was 26.8 months (range 22-34 months). All patients underwent open reduction and internal fixation with a long volar locking plate. According to AO/OTA classification, there were 7 type A3, 13 type C2 and 7 type C3 fractures. Subjective assessment was done based on the disabilities of the arm, shoulder and hand (DASH) questionnaire. Functional evaluation was done by measuring grip strength and range of motion around the wrist and the radiological determinants included radial angle, radial length, volar angle and ulnar variance. The final assessment was done according to Gartland and Werley scoring system.

RESULTSPostoperative radiological parameters were well maintained throughout the trial, and there was significant improvement in the functional parameters from 6 weeks to final follow-up. The average DASH scores improved from 37.5 at 6 weeks to 4.2 at final follow-up. Final assessment using Gartland and Werley scoring system revealed 66.67% (n equal to 18) excellent and 33.33% (n equal to 9) good results. There was one case of superficial infection which responded to antibiotics and another carpel tunnel syndrome which was managed conservatively.

CONCLUSIONVolar locking plate fixation for metaphyseal-diaphyseal fractures of distal radius is associated with excellent to good functional outcome, early rehabilitation and minimal complications.

Bone Plates ; Fracture Fixation, Internal ; Humans ; Prospective Studies ; Radius ; Radius Fractures

The combination of ipsilateral humeral fractures at three different levels namely proximal, shaft and supracondyle has been rarely defined in the literature. We present a case report on such a complex injury in a 10-year-old child after falling down from the second floor of his house while playing. To the best of our knowledge, no such case report exists in the English literature. We define it as double floating arm injury. Firstly, shaft of humerus was open reduced and fixed with 4.5 mm narrow dynamic compression plate. Then closed reduction and pinning of the supracondylar humerus under an image intensifier was obtained. Open reduction using deltopectoral approach to the proximal humerus was done and the fracture was fixed with three K-wires. Ipsilateral multiple fractures in children often result from high energy trauma. Immediate reduction and fixation is required. Usually surgeons need to treat simple fractures firstly, which makes the subsequent treatment of complex fractures easier.
Child ; Humans ; Humeral Fractures ; complications ; Male ; Shoulder Fractures ; complications