Journal of orthopaedic trauma
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Case Reports
Late-onset sternomanubrial dislocation with progressive kyphotic deformity after a thoracic burst fracture.
Fractures and dislocations of the sternum may be associated with flexion-compression injuries of the thoracic spine. Sternal injuries most commonly occur at or near the sternomanubrial joint. We present a patient with a known thoracic spine fracture who developed a subsequent late-onset, symptomatic sternomanubrial dislocation and progression of thoracic kyphosis, ultimately requiring operative fixation of both the sternum and the spine. Internal fixation of these sternal injuries should be considered in the setting of a flexion-compression thoracic spine fracture to possibly prevent a worsening kyphosis and neurological decline.
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We report the case of a 26-year-old man who sustained an elbow dislocation with an associated radial head fracture entrapped in the joint, preventing closed reduction. A posterolateral approach to the radial head was performed to reduce the dislocation. A comminuted fracture of the entire radial head was found that required excision. ⋯ The radial head can then be excised if the UCL is intact. In this case, no instability resulted with excision of the radial head because the UCL was intact. Failure to recognize and/or to treat an UCL rupture associated with radial head excision can result in elbow instability, increased elbow valgus deformity, and ulnohumeral arthritis.
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Review Case Reports
Bilateral posterior fracture-dislocation of the shoulders: management by bilateral shoulder hemiarthroplasties.
Bilateral posterior fracture-dislocation of the shoulders is rare, with only 26 reported cases in the literature. We present the case of a patient who sustained bilateral posterior fracture-dislocations after a first time seizure. Due to significant articular surface involvement, bilateral hemiarthroplasties were performed. The literature on this injury and current treatment options is also reviewed.
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Review Case Reports
Lumbosacral fracture-subluxation associated with bilateral fractures of the first sacral pedicles: a case report and review of the literature.
A case of an unusual lumbosacral fracture-subluxation associated with bilateral fractures of the first sacral pedicles is described. The authors are aware of only one reported case in the literature. ⋯ He also demonstrated L5 and S1 radiculopathies. He was successfully treated with surgical decompression of the L5 and S1 nerve roots with bilateral foraminotomies, followed by posterolateral arthrodesis at the lumbosacral junction using a transpedicular screw system that extended fixation into the ilia.
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Comparative Study
Early versus delayed treatment of severe ankle fractures: a comparison of results.
A retrospective review of 202 closed Weber B bimalleolar or bimalleolar equivalent ankle fractures treated using open reduction and internal fixation (ORIF) from January 1, 1991, through January 1, 1994 was completed at our institution. A total of 105 ankles (52%) were treated using ORIF within 5 days of injury (early group), with a mean 1.5 days from injury to surgery. A total of 97 ankles (48%) were treated after 5 days (delayed group), with a mean of 13.6 days from injury to surgery. ⋯ We conclude that the results and complications of early versus delayed treatment is not significantly different, except for a shorter median hospital stay in the delayed group. Delayed ORIF is an acceptable alternative when soft-tissue swelling, fracture blisters, or abrasions are present that offer an undesirable environment for surgical incisions. Using contemporary, a traumatic techniques, delayed surgery can provide anatomic reduction with minimal complications in severe ankle fractures.