Journal of orthopaedic trauma
-
An instrumented traction post was used to determine the magnitude and direction of the countertraction force applied to the perineum of 15 awake volunteers for a series of 12 positions used in fracture surgery and compared with their corresponding neutral position controls. The results demonstrated that adduction of the affected limb and abduction of the contralateral limb applied the greatest force to the perineum with ipsilateral and contralateral placement of the fracture post. These two maneuvers increased the perineal countertraction force 80% above their respective neutral readings. ⋯ Internal and external rotation of the affected limb had no effect on the perineal countertraction force for either placement of the post. There was a significant decrease in the perineal forces for the neutral positions after adduction of the affected limb and abduction of the contralateral limb with ipsilateral placement of the post, indicating that the volunteers shifted on the fracture table in response to pain. There was no significant difference in the direction of the countertraction force for the various positions.(ABSTRACT TRUNCATED AT 250 WORDS)
-
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.
-
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.
-
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.
-
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.