Trans-Scaphoid Transcapitate Perilunate Fracture-Dislocation

Trans-scaphoid transcapitate (TSTC) perilunate fracture-dislocation (PLFD) is a rare type of perilunate injury. Because of the rarity and complexity of this entity, initial diagnosis may be delayed and the extent of osseous and ligamentous lesions underestimated. Early surgical treatment by open reduction and fracture stabilization is recommended to avoid complications such as avascular necrosis, nonunion, posttraumatic arthritis, and functional impairment. In this article, we report the case of a 32-year-old man who sustained a TSTC-PLFD. We describe the radiographic and intraoperative findings, review the current surgical principles for reduction and stabilization of this injury, and assess the clinical and radiologic outcomes.

Traumatic tibialis anterior tendon rupture: treatment with a two-stage silicone tube and an interposition hamstring tendons graft protocol

A novel technique for managing ruptured tibialis anterior tendon complicated by infection and tendon substance loss in a young adult is described. A two-stage reconstruction technique with a silicon tube and tendon autograft was performed. At first, after local control of the infection, scar excision and placement of a silicone tube was performed. Ten weeks later, ipsilateral hamstrings tendons were harvested and bridged the 7 cm tendon gap. Eighteen months later, the patient has excellent clinical and functional outcome.

Internal fixation of proximal humerus fractures with the polarus intramedullary nail

The optimal treatment method for displaced proximal humeral fractures continues to be under debate. There are a variety of fixation techniques, none of which has been proven to be more effective. We retrospectively studied 24 patients with displaced proximal humerus fractures, treated with the Polarus intramedullary nail. All patients were followed radiographically and clinically for one year. Clinical outcome was assessed with the Constant score. All fractures went on to clinical and radiographic union. Mean time to union was 9.2 weeks (range: 9-16). Only one patient with a 3-part fracture had an asymptomatic malunion and one patient had iatrogenic radial nerve palsy, which spontaneously recovered. In total, 83.3% of the patients had an excellent or good clinical outcome. The Polarus nail appeared in this study as an effective device to treat proximal humeral fractures, with good overall functional results and a low complication rate.

Comparing two intramedullary devices for treating trochanteric fractures: a prospective study

BACKGROUND

Intertrochanteric fractures are surgically treated by using different methods and implants. The optional type of surgical stabilization is still under debate. However, between devices with the same philosophy, different design characteristics may substantially influence fracture healing. This is a prospective study comparing the complication and final functional outcome of two intramedullary devices, the intramedullary hip screw (IMHS) and the ENDOVIS nail.

MATERIALS AND METHODS

Two hundred fifteen patients were randomized on admission in two treatment groups. Epidemiology features and functional status was similar between two treatment groups. Fracture stability was assessed according to the Evan's classification. One hundred ten patients were treated with IMHS and 105 with ENDOVIS nail.

RESULTS

There were no significant statistical differences between the two groups regarding blood loss, transfusion requirements and mortality rate. In contrast, the number of total complications was significantly higher in the ENDOVIS nail group. Moreover, the overall functional and walking competence was superior in the patients treated with the IMHS nail.

CONCLUSIONS

These results indicate that the choice of the proper implant plays probably an important role in the final outcome of surgical treatment of intertrochanteric fractures. IMHS nail allows for accurate surgical technique, for both static and dynamic compression and high rotational stability. IMHS nail proved more reliable in our study regarding nail insertion and overall uncomplicated outcome.

[Treatment of trochanteric fractures by external fixator]

INTRODUCTION

The goal of this study was to report and evaluate the place of external fixation in the treatment of trochanteric fractures in patients with high unacceptable operative risk to withstand conventional osteosynthesis.

MATERIAL AND METHODS

From January 1990 to December 1991 (2 years period), 42 patients, 13 males and 29 female, mean age 84.1 years, suffering from trochanteric fracture and considered preoperatively as "poor medical status" were treated by external fixation and immediate mobilisation. The average operative time was 18 minutes and no blood transfusion was necessary per or post-operatively. The mean hospital stay was 19 days.

RESULTS

All patients were followed up for 6 months post-operatively. During this time 8 patients (19 per cent) died due to medical problems unrelated to the fracture. All fractures united in an acceptable position at an average time of 10.4 weeks with no loss of reduction, no pin breakage, no deep infection. All hips were painless.

COMPLICATIONS

proximal pin migration occurred in 3 patients (7 per cent) due to fracture impaction and superficial pin tract infection in 16 (38 per cent) with no further consequence.

DISCUSSION

External fixation in trochanteric fractures has been applied since 1957 with good results. This series confirms the advantages of the method in patients with a high operative risk; these are short operative time, minimal blood loss, early mobilisation and acceptable morbidity and mortality rates, considering the old and senile age group with poor medical condition, not allowing conventional treatment. The minor complications such as superficial pin tract infection and proximal pin migration are easily controlled.