Effect of soft tissue injury and ulnar angulation on radial head instability in a Bado type I Monteggia fracture model

Effect of Vacuum Sealing Drainage on Soft Tissue Injury of Traumatic Fracture and Its Effect on Wound Recovery

Purpose

The current work is mainly to explore the effect of vacuum sealing drainage (VSD) on soft tissue injury (STI) caused by traumatic fractures (TFs) and its effect on wound recovery.

Methods

We first selected 90 patients with TF STI from May 2019 to May 2021, of which 40 patients (control group) received routine treatment, and the other 50 patients (observation group) were treated with VSD. The curative effect, rehabilitation (changing dressing frequency, healing time, and hospitalization time), pain severity, patient comfort, and complications were evaluated and compared.

Results

The observation group exhibited a higher total effective rate, lower dressing change frequency, complication rate, and shorter healing time and hospital stay than the control group, which are statistically significant. Statistically milder pain sensation and better patient comfort were also determined in the observation group.

Conclusions

VSD is effective and safe in the treatment of TF-induced sexually transmitted infections, which can effectively accelerate wound recovery while reducing pain sensation and improving patient comfort, with clinical promotion value.

Monteggia Fracture-Dislocation with Associated TFCC Injury and DRUJ Subluxation - A Very Rare Case Report

Introduction

Monteggia fracture-dislocation is defined as a proximal third ulna fracture with radiocapitellar joint dislocation. The term "Monteggia equivalent or variant" describes various injuries with similar radiographic patterns and injury biomechanics. Several isolated cases of unusual injuries associated with Monteggia fractures have been reported. However, an associated TFCC injury has not been described in the literature before. We present a rare report of a 24-year-old female with a Monteggia fracture and associated TFCC injury - a crisscross type of injury.

Case Report

A 24-year-old female was involved in a road traffic accident and presented to our level I trauma center with pain and deformity in the left forearm. On evaluation, she was found to have type I Monteggia fracture-dislocation. Intraoperatively, once the proximal ulna was fixed, she had clicking in the wrist during rotations. Fluoroscopic images showed DRUJ subluxation, but it was stable in supination. Hence was splinted in a reduced position. The patient continued to have persistent symptoms in the wrist despite adequate conservative measures. Hence, she underwent arthroscopic TFCC repair and DRUJ pinning. At her last follow-up (3 months), the patient was clinically better with a good range of motion and no pain.

Conclusion

In treating Monteggia fracture-dislocations, high index of suspicion is needed to diagnose radioulnar joint instability. If they are missed, they can result in long-term disability, so appropriate evaluation to diagnose TFCC and DRUJ injuries is required. DRUJ stabilization and TFCC repair can produce consistent results when treated adequately.

Heterotopic Ossification of annular ligament: A case report and review of literature

Heterotopic Osification (HO) commonly occurs in the hip and elbow joint post, trauma, surgery or dislocation. HO can occur anywhere in the body, and the term Heterotopic Ossification of Ligaments and Tendon (HOTL) is specifically used to denote HO occurring in ligaments and tendons. HOTL of an annular ligament is reported rarely in the literature. Here we describe a case of calcified annular ligament in a neglected monteggia fracture (Bado Type - 1), which was managed by excision and reconstruction of the same using triceps fascia. Post-op review after 2.5 years showed a stable elbow, with some restriction in pronation.

Two-stage strategy for neglected Monteggia fracture in children: A retrospective study of 51 patients

A neglected Monteggia fracture is defined as the fracture of the proximal ulna associated with radial head dislocation (RHD) without undergoing any treatment for 4 weeks or more after injury. One-stage operation of ulnar corrective osteotomy and open reduction of RHD might result in many complications. Therefore, a two-stage strategy, including ulnar osteotomy (UO) with or without annular ligament reconstruction (ALR), was adopted at our institute since 2010.We performed a retrospective review of 51 patients with neglected Monteggia fracture between January 2010 and January 2018. Patients with bilateral problems or concomitant injuries in the ipsilateral extremity were excluded. Radiological and clinical data were collected from Hospital Database and clinical visits. All patients were divided into 2 groups based on the status of the ALR: the UO alone (UO) group and the ALR group.There were 15 patients in the UO group and 36 patients in the ALR group. The age in the UO group (6.1 ± 2.3, year) was significantly younger than the ALR group (9.8 ± 2.8, year) (P < .001). Concerning the duration from initial injury to surgery, there was a significant difference between the UO group (8.6 ± 3.2 months) and the ALR group (23.3 ± 12.6 months, P < .001). Concerning the preoperative elbow function, there was no significant difference between the UO group (67.6 ± 5.0) and the ALR group (66.6 ± 4.4) according to the Mayo elbow performance score (MEPS) (P = .51). Concerning the postoperative parameters, including postoperative ROM of the joint, removal of external fixator (6.7 ± 0.8, 6.9 ± 0.9 weeks) (P = .55), lengthening (8.9 ± 2.5, 10.3 ± 2.5 mm) (P = .10) and MEPS (92.7 ± 2.1, 91.6 ± 2.1) (P = .08), there was no significant difference between the UO group and ALR group.Two-stage strategy is a reasonable choice for selected patients with long-lasting RHD with ulnar deformity.