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Subcapital stress fracture occurring after a previously healed intertrochanteric fracture is a rare event. One further case is reported. A new etiology and different ways of preventing such a complication are proposed.
The authors used a personal technique for the management of infected jaw fractures. If the fracture cleft was not wider than 1 cm, they performed a surgical revision (having made an incision through the mucoperiosteum of the oral vestibule) and replaced the excochleated gra-ulation tissue (including sequestrums) by lyophilized cartilage. The bone fragments were immoblized by bone sutures previously applied and also by additional plastic splints. The substitution of the cartilage by bone begun 6-8 weeks after the surgical intervention (as evidenced by radiographs); the process had terminated in about 6-10 months, the implanted cartilage being completely replaced by newly formed bone. The observation involved 16 cases. The method is also recommended for treatment on an out-patient basis.
Disruption of the ulnar styloid process is a frequent injury in concomitance with fractures of the distal end of the radius. Healing occurs in many cases in the form of pseudoarthritis. Evaluation of 222 cases of distal radius fracture showed involvement of the ulnar styloid process to have no impact upon long-term wrist function.
We are reporting the results in a consecutive series of forty adults in whom, between 1978 and 1984, forty-one tarsometatarsal fracture-dislocations were treated with open reduction followed by temporary internal fixation with AO screws. Ninety per cent of the patients had an intra-articular or a periarticular fracture. An anatomical or nearly anatomical reduction was achieved in all but a few patients, and there was no loss of fixation or displacement. For thirty-four patients (thirty-five injuries), the length of follow-up averaged 3.4 years, and a good or excellent functional result was obtained in all but two of the thirty in whom an anatomical reduction had been achieved. Of the six patients who had a fair or a poor result, five had an associated grade-II or grade-III open injury. The development of post-traumatic arthritis was directly related to damage to the articular surfaces or to inadequate reduction, or to both.
The most common injuries of the carpus are lunate and perilunate dislocations. The authors describe a complex dislocation of the carpus associated with fractures of the scaphoid, lunate, and styloid process of the radius. The pathogenesis of this dislocation is believed to be extreme hyperextension and radial deviation of the wrist. This mechanism can cause posterior dislocation of the carpus with fracture of scaphoid and lunate.
A previously undescribed type of fracture of the neck of femur occurred following intertrochanteric fracture fixation with a McLaughlin nail plate in an 80-year-old woman. This complication was probably caused by prolonged non-weight-bearing and inadequate fixation. The complication possibly could have been avoided by use of a dynamic hip screw and early weight-bearing.
Out of 31 patients with a comminuted fracture or fracture dislocation of the proximal humerus, 21 were followed up. Twelve patients were treated operatively by internal fixation or endoprosthesis and nine were treated conservatively. The best results were achieved after internal fixation, especially in the younger patients. In the older patients, implantation of a prosthesis gave a satisfactory result.
Vertebral fractures with incomplete paraplegia should be reduced immediately. If the myelogram still shows compression of the medulla, an anterior decompression should be performed. All severe injuries to the cervical spine are stabilised with anterior bone block and plate osteosynthesis. Generally fractures of the lumbar spine are treated conservatively with reduction and plaster jacket. Operative treatment is necessary in dislocations with locked facets, secondary instability, and in cases with traumatic spondylolisthesis. Reduction and stabilisation can be performed either by interbody fusion or posterior fusion.
Dynamic stabilizer DYNASTAB D-K for functional, ambulatory treatment of fractures is presented. The possibility to include an active hinge enabling physiological movement of the injured or remaining in the injured zone joint allows for an early mobilization of the limb concerned. Solid, spatial screws anchoring enables early axial dynamization within the union zone. Plastic cubes reduce the weight and prevent disturbance of electrophysiology of the fracture healing. The hydraulic chamber pressure measurement taken at the load will permit the assessment of bony union consolidation.
The authors report on a new case of dislocation of the tibialis posterior tendon which was associated with a fracture of the lateral malleolus. They postpone a mechanism of injury based on the fibular fracture and emphasize differential diagnosis with rupture of the deltoid ligament. A retinacular repair was performed.
The authors report on a case of fracture of the coracoid process associated with fracture of the clavicle. Open reduction and internal fixation of the coracoid process lead to a good clinical and radiographic outcome.
Immediate postoperative radiographs confirm the quality of reduction and fixation of fractures. This information is already available from the image intensifier and can be saved as hard copy thermal prints. If thermal prints give the surgeon the necessary patient and clinical information them immediate postoperative radiography should not be required. In this retrospective study of 20 hip fractures treated by dynamic hip screw (DHS) fixation, plain radiographs and thermal prints were compared for the patient and clinical information they contained. Thermal prints were found to be deficient in some areas but, nevertheless, can potentially replace postoperative radiographs in many orthopaedic procedures saving time, money and radiation exposure.
The result of treatment for pathologic femoral shaft fracture in case of disuse osteoporosis is presented. The patient is 15 years old male, paraplegic since the age of 2 due to traumatic lesion of the cervical spine. Femoral fracture has been reduced operatively and fixed with 2 Rush pins. Bony union was evident both in clinical and radiological assessment despite absence of mechanical and muscle related stresses on the bone.
Unstable intertrochanteric and subtrochanteric fractures in elderly patients are still a challenge in orthopedic surgery. The results of the present study show the importance of a rigid fixation to allow early mobilization and immediate weight bearing. The gamma nail has clearly brought an improvement to the treatment of such fractures, although there are complications associated to this implant which need to be reduced by further developments of the implant itself, the instruments, and/or the operative technique.
Internal plate osteosynthesis and lag-screw osteosynthesis are currently the preferred methods of fixation in the treatment of mandibular fractures. Rigid internal fixation (RIF) provides for functionally stable immobilization of the segments, avoiding the need for postoperative intermaxillary fixation (IMF) by "dental wiring" in the majority of cases. Reduction and fixation can be provided by so-called compression plates (type AO/ASIF). Non compressive mini-plates are more extensively used, however, because their size and malleability facilitate their transoral application. Peroperative problems may arise with the anatomical reduction of the fragments. We present a simple fracture reduction-compression technique that can be used in combination with either compression and non-compression mini-plate fixation. Its use can be extended to reduction and fixation in selected areas of difficult surgical access.
Fracture healing is a complex process regulated by numerous growth and adhesive factors expressed at specific stages during healing. The naturally occurring, cell surface-expressed sugar, heparan sulfate (HS), is known to bind to and potentiate the effects of many classes of growth factors, and as such, may be a potential candidate therapy for enhancing bone repair. This study investigated the local application of bone-derived HS in the repair of rat femoral fractures. After 2 weeks, there was a significant increase in the callus size of rats administered with 5 microg HS compared to the control and 50 microg HS groups, presumably due to increased trabecular bone volume rather than increased cartilage production. In addition, 5 microg HS increased the expression of ALP, Runx2, FGF-1, IGF-II, TGF-beta1, and VEGF. It is hypothesized that these increases resulted from changes in HS-mediated receptor/ligand interactions that increase local growth factor production to augment bone formation. The findings of this study demonstrate the anabolic potential of HS in bone repair by recruiting and enhancing the production of endogenous growth factors at the site of injury.
Sixty patients have undergone surgical reconstruction of the injured thoraco-lumbar spine during the period 1968 to 1978 at the Spinal Unit of the National Murayama Hospital. The aim of treatment of any fracture, dislocation, or fracture-dislocation of the spine is to render it stable and painfree. This is best achieved by reduction and stabilisation of the involved segment of the spinal column. Where the posterior ligaments and intervertebral disc are ruptured healing of these structures with return to normal stability cannot be anticipated. In order to obtain permanent stability at the affected vertebral level we elect to perform anterior intervertebral fusion.
Twenty-five cases of unstable fractures and fracture-dislocations of the spine are reviewed. They were treated at the Catholic Medical College and Centre in a 3-year period, 1975 to 1978. 1. Eleven of the 25 patients were treated by anterior interbody fusion performed at 6 to 8 weeks from injury or initial surgery. 2. Eleven patients had neurological deficits, 3 with incomplete lesions and 8 with complete lesions. Open reduction and decompression laminectomies were performed on patients having neurological deficits prior to anterior interbody fusion. Two patients with incomplete paraplegia showed marked neurological recovery whilst one with complete paraplegia regained some sensation. 3. Solid clinical fusion was obtained in all but one patient within four months of interbody fusion. 4. Amongst the 18 patients with kyphosis at the time of admission 10 had a final improvement of their kyphosis ranging from 3 to 10 degrees (average 6 degrees). Three had no change and 5 demonstrated a mild increase of kyphosis (average 4 degrees). 5. Pain was relieved in 21 patients out of 25. The advantages of this technique include effective stabilization, prevention of late deformity and relatively early mobilization without internal fixation.