Expanding the horizons of clinical applications of proximal humerus locking plates in the lower extremities: A technical note

Pre-contoured anatomical locking plates were designed to address the clinical need of fixing small epiphyseal segments with a larger number of screws. Those plates match the contour and shape of a variety of bones allowing for optimal buttress properties. The aim of this manuscript is to highlight the benefits of applying proximal humerus locking plates in the fixation of lower extremity bones. Although designed for the proximal humerus, the low-profile plate shape and anatomic contour also provides versatile use in certain areas of the lower extremity. This technical narrative highlights the versatile and reliable use of this plate for other anatomical areas than the one to which it has been originally conceived.

Calf Augmentation Implant Disruption Following a Tibial Plateau Fracture Fixation: An Extremely Rare Complication

Introduction:

Calf augmentation is a procedure to enhance leg contour, therefore, providing better aesthetic aspect. Patient satisfaction is extremely high, and reported complications following this procedure are rare.

Case Report:

The aim of this study is to report an as yet described complication related to calf implants: Prosthesis disruption in a 60-year-old female patient who fell downstairs and presented a closed bicondylar tibial plateau fracture on the right knee (Schatzker V).

Conclusion:

We believe this case report can alert orthopaedic surgeons to carefully evaluate leg images in traumatized extremities and look for calf augmentation implants, especially in unconscious patients.

Where is the true location of the femoral piriform fossa?

OBJECTIVE

To analyze knowledge of the anatomic location of the piriform fossa using a questionnaire with anatomic figures.

MATERIALS AND METHODS

Participants taking AO Trauma Brasil courses were requested to complete a questionnaire containing a photograph of the superior surface and a photograph of the lateral surface of the femur and answer a question asking which of four numbered points corresponded to the piriform fossa.

RESULTS

Just 4.5% of respondents correctly chose point 2 (the piriform fossa) in both images, while 75.4% of respondents chose point 4 (the trochanteric fossa) as the correct anatomic structure. The subset of 4th-year residents' answers was significantly different from those of the other subsets, with 7.5% of correct answers.

CONCLUSIONS

The low rate of correct answers indicates a tendency for the respondents to be influenced by illustrations in text books or examples in scientific publications that indicate the site of the piriform fossa incorrectly. Interest in the specialty of traumatology is possibly the reason why the subset of 4th-year residents had a better- than-average rate of correct answers.

Complications and outcomes of the transfibular approach for posterolateral fractures of the tibial plateau

OBJECTIVE

Evaluate complication rates and functional outcomes of fibular neck osteotomy for posterolateral tibial plateau fractures.

DESIGN

Retrospective case series.

SETTING

University hospital.

PATIENTS

From January 2013 to October 2014, 11 patients underwent transfibular approach for posterolateral fractures of the tibial plateau and were enrolled in the study. All patients who underwent transfibular approach were invited the return to the hospital for another clinical and imaging evaluation.

INTERVENTION

Transfibular approach (fibular neck osteotomy) with open reduction and internal fixation for posterolateral fractures of the tibial plateau.

MAIN OUTCOME MEASUREMENTS

Complications exclusively related to the transfibular approach: peroneal nerve palsy; knee instability; loss of reduction; nonunion and malunion of fibular osteotomy; and functional outcomes related to knee function.

RESULTS

Two patients failed to follow-up and were excluded from the study. Of the 9 patients included in the study, no patients demonstrated evidence of a peroneal nerve palsy. One patient presented loss of fracture reduction and fixation of the fibular neck osteotomy, requiring revision screw fixation. There were no malunions of the fibular osteotomy. None of the patients demonstrated clinically detectable posterolateral instability of the knee following surgery. American Knee Society Score was good in 7 patients (77.8%), fair in 1 (11.1%), and poor in 1 (11.1%). American Knee Society Score/Function showed 80 points average (60-100, S.D:11).

CONCLUSION

The transfibular approach for posterolateral fractures is safe and useful for visualizing posterolateral articular injury. The surgeon must gently protect the peroneal nerve during the entire procedure and fix the osteotomy with long screws to prevent loss of reduction.

LEVEL OF EVIDENCE

Therapeutic level IV.

Intrapartum Pubic Symphysis Disruption

During pregnancy, high progesterone and relaxin levels produce physiological ligament relaxation on the pelvis. Therefore, moderate pubic symphysis and sacroiliac joints relaxing provide birth canal widening, thereby facilitating vaginal delivery. Sometimes, functional pain or pelvic instability may occur during pregnancy or puerperium, which is defined as symptomatic pelvic girdle relaxation. In rare cases, a pubic symphysis disruption can occur during the labor, causing severe pain and functional limitations. The early recognition of this injury is crucial to prevent complications and improve clinical and functional outcomes. This study reports an acute symphyseal disruption resulting from childbirth in a primiparous patient who underwent open reduction and internal fixation with plate and screws. After a 6 months follow-up, the patient presented no pain and satisfactory functional recovery.

Effectiveness of intra-articular lidocaine injection for reduction of anterior shoulder dislocation: randomized clinical trial

CONTEXT AND OBJECTIVE

Shoulder dislocation is the most common dislocation among the large joints. The aim here was to compare the effectiveness of reduction of acute anterior shoulder dislocation with or without articular anesthesia.

DESIGN AND SETTING

Prospective randomized trial conducted in Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp).

METHODS

From March 2008 to December 2009, 42 patients with shoulder dislocation were recruited. Reductions using traction-countertraction for acute anterior shoulder dislocation with and without lidocaine articular anesthesia were compared. As the primary outcome, pain was assessed through application of a visual analogue scale before reduction, and one and five minutes after the reduction maneuver was performed. Complications were also assessed.

RESULTS

Forty-two patients were included: 20 in the group without analgesia (control group) and 22 in the group that received intra-articular lidocaine injection. The group that received intra-articular lidocaine had a statistically greater decrease in pain over time than shown by the control group, both in the first minute (respectively: mean 2.1 (0 to 5.0), standard deviation, SD 1.3, versus mean 4.9 (2.0 to 7.0, SD 1.5; P < 0.001) and the fifth minute (respectively: mean 1.0; 0 to 3.0; SD = 1.0 versus mean 4.0; 1.0 to 6.0; SD = 1.4; P < 0.001). There was one failure in the control group. There were no other complications in either group.

CONCLUSION

Reduction of anterior shoulder dislocation using intra-articular lidocaine injection is effective, since it is safe and diminishes the pain.

CLINICAL TRIAL REGISTRATION

ISRCTN27127703.

TREATMENT OF TRAUMATIC GLENOHUMERAL DISLOCATION: A CROSS-SECTIONAL STUDY

Objective: The aim of the present study was to investigate Brazilian orthopedists' opinions regarding the main aspects of the treatment of glenohumeral traumatic dislocation and compare these to literature's current concepts. Methods: Two hundred questionnaires containing 13 items were randomly distributed to orthopedists who were attending a Brazilian orthopedics congress; 158 were filled, in correctly and were considered in this study. Results: The preferred maneuver was traction-countertraction (60.8%). Among the respondents, 68.4% stated that glenohumeral dislocation reduction was achieved in the first attempt in 90% of the cases. The first attempt of reduction occurred mainly in the Emergency room (96.5%). Seventy-nine individuals (50%) reported that they do not use any analgesic prior to reduction. The majority of the participants immobilize their patients after the reduction (98.1%). 75.4% of them keep their patients immobilized from 2 to 3 weeks. Conclusion: Generally, Brazilian orthopaedists perform tractioncountertraction maneuvers, achieving reduction in the first attempt in more than 90% of the cases in the Emergency room. No previous analgesic agent is used prior to reduction. Immobilization of the patient is made with a Velpeau dressing or a sling for 2 to 3 weeks.