The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Jun 1984
Case ReportsTraumatic lateral displacement of the scapula: a radiographic sign of neurovascular disruption.
Scapulothoracic dissociation, as manifested by lateral displacement of the scapula and acromioclavicular separation, is a previously unreported injury in which there is a complete disruption of the scapulothoracic articulation without an overlying partial or complete amputation through the soft tissue. Associated with the disruption of the scapulothoracic articulation are injuries to the brachial plexus and the subclavian artery and vein; multiple open and closed fractures of the ipsilateral upper extremity are often present also. In the patient with severe multiple injuries, scapulothoracic dissociation may not be recognized immediately, with potentially fatal consequences. In this paper we present the cases of three patients with radiographic and pathological evidence of scapulothoracic dissociation and review the literature on related injuries.
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In a review of 160 mallet fingers, forty-four were found to have a fracture of the distal phalanx. Of these mallet fractures, twenty-one could be followed for a mean of 3.25 years (range, six months to eight years). Six had been treated surgically and fifteen had simply been splinted. ⋯ Surgical treatment was difficult and unreliable; it offered no advantage over conservative treatment and had a greater rate of morbidity. The major "complication" of both forms of treatment was a bone prominence on the dorsum of the distal interphalangeal joint. These findings suggest that most mallet fractures can be treated conservatively, ignoring joint subluxation and the size and amount of displacement of the bone fragment.
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J Bone Joint Surg Am · Jun 1984
Distal tibial physeal fractures in children that may require open reduction.
Fractures of the distal end of the tibia in children often involve the physis. They are of particular importance because partial growth arrest can occur and result in angular deformity, limb-length discrepancy, or incongruity of the joint surface (or a combination of these). We evaluated the cases of thirty-two children who had a fracture leading to established partial growth arrest of the distal end of the tibia. ⋯ We also evaluated the cases of thirty-three children who were seen by us for treatment of an acute fracture; most of these were Salter-Harris Type-III or Type-IV fractures of the distal end of the tibia. Nineteen of the twenty acute Type-III or Type-IV fractures that were treated with accurate open reduction of the physis and internal fixation healed without growth disturbance, while five of the nine fractures that were treated by closed means formed a bone bridge, presaging a disturbance in growth. This study suggests that Salter-Harris Type-III and Type-IV, and perhaps Type-II, fractures of the distal end of the tibia commonly cause disturbance of growth in the tibia, and that anatomical reduction of the physis by closed or open means may decrease the incidence of these disturbances of growth, including shortening and varus angulation of the ankle.