Complex Fracture-dislocations Research Articles

Decision-Making in Complex-Fracture Dislocation of the Hip with Acetabulum Involvement and Sciatic Nerve Palsy

Decision-Making in Complex-Fracture Dislocation of the Hip with Acetabulum Involvement and Sciatic Nerve Palsy

Three-Dimensional Quantitative Study and Functional Outcome Analysis of Coronoid Fracture in Different Elbow Injury Patterns

BackgroundCoronoid fractures are often part of a complex fracture-dislocation of the elbow. For an optimum prognosis, it is important to understand the characteristics of coronoid fractures in different elbow injury patterns. Significant differences in these characteristics have been observed in various studies, but these previous studies have suffered from limitations, such as insufficient quantification and unknown prognostic differences among different injury patterns. Therefore, we aimed to quantitatively analyze coronoid fracture characteristics and functional outcomes in different elbow injury patterns using 3D-CT. MethodsAll patients with coronoid fractures surgically treated at our hospital between January and December 2017 were categorized into three groups according to elbow injury pattern: PLRI, VPMRI and OFD. 3D models were reconstructed using Mimics 17.0, and the total volume (TV) and number of coronoid fragments (NCF) were measured. The coronoid process edge was classified into different anatomical regions, and each region was assigned a number to quantify the distribution of fracture lines. At the last follow-up, the ROM, VAS, MEPS, complications and reoperations were recorded. ResultsThe ninety-two patients enrolled had an average age of 42±15 years and a male-to-female ratio of 66:26. The median TV in PLRI patients was less than that in VPMRI patients [431 (132, 818)mm3 vs. 1125 (746,1421)mm3,adjusted P<0.001] and OFD patients [431 (132, 818) mm3 vs. 2565 (381, 4076)mm3, adjusted P =0.001]. The median NCF in PLRI patients was also less than that in VPMRI patients [1 (1, 2) vs. 2 (1, 3), adjusted P=0.043]. Most of the PCFL-Rs (79%) were located around the volar edge of the lesser sigmoid notch. Compared with that of PLRI, the PCFL-Us of the VPMRI and OFD tended to be located on the more ulnodorsal side of the coronoid process edge. The median ROM [110 (90, 133), P=0.001] and the median MEPS [85 (68, 95), P=0.038] of patients with OFD were significantly less than those of patients with the other two patterns. The incidence of elbow stiffness (56%, 5/9, P=0.001) and implant-related irritation (44%, 4/9, P<0.001) in the OFD group was significantly higher than that in the other two groups. ConclusionCoronoid fractures differ significantly in fragment volume, comminution severity and fracture line distribution among different elbow injury patterns. OFD has the worst functional outcomes among complex elbow injury patterns.

Lisfranc injuries

Lisfranc injuries are rare but severe injuries of the foot. They range from ligament sprain to complex fracture dislocations. Etiologically, adistinction is made between indirect and direct force and between high-energy and low-energy trauma. Inadequate diagnostics (injuries overlooked or misinterpreted) can lead to painful posttraumatic osteoarthritis, chronic instability and deformity of the foot. Afracture, malalignment and unclear findings in conventional radiological diagnostics necessitate computed tomography imaging including 3D reconstruction. Lisfranc injuries are often associated with accompanying pathologies of the foot that also need to be addressed. Only stable non-displaced fractures can be treated conservatively. Depending on the injury pattern, surgical treatment is performed percutaneously, minimally invasive or open. The prognosis following Lisfranc injury is determined by the severity of damage and the quality of reconstruction.

Comparison of hamate versus second or third toe osteochondral graft using magnetic resonance imaging for reconstruction of proximal interphalangeal fracture-dislocations.

Hemi-hamate arthroplasty is a method used to reconstruct complex fracture-dislocations of the proximal interphalangeal joint of the fingers. Other graft sites, including the toe second and third phalanges, have been proposed as alternatives to hemi-hamate arthroplasty due to variable clinical outcomes and anatomy. Through a prospective magnetic resonance imaging (MRI)-based study in asymptomatic individuals, we aimed to characterize the anatomy of the proximal interphalangeal joint and compare this with the hamate, second and third toes to determine the closest anatomical match using pre-determined measurements. Our results show that the second and third toes have greater anatomical similarity to the proximal interphalangeal joint of the fingers compared to the hamate. High-resolution MRI is a reliable method of characterizing the anatomy of these structures and could be a useful clinical tool in determining reconstructive options in the management of this challenging injury.Level of evidence: II.

Primary Hinged External Fixator for Complex Fracture Dislocations of the Elbow (Systematic Review/Meta-Analysis)

Background High-energy and fracture dislocations with compromise of the medial and lateral ligamentous complex, the joint capsule, and potentially the tertiary stabilizers (i.e., the flexor pronator, extensor supinator masses, and brachialis) often demonstrate residual instability after osseous and ligamentous stabilization. The optimal management of a complex elbow injury should results in restoring joint stability and its full range of motion. However, this is often difficult to achieve by surgical means and a marked restriction of movement remains a frequent con- sequence of severe elbow injury. Aim of the Study The aim of this study is to discuss the results of using a lateral hinged external fixator as an adjunct stabilizer in the treatment of a variety of acute destabilizing elbow injuries as a primary method of fixation not only in chronic or complicated cases. Patients and Methods Types of studies: Randomized controlled trials, including cluster RCTs, controlled (non-randomized) clinical trials or cluster trials, prospective and retrospective comparative cohort studies, and case-control or nested case-control studies. Types of participants: Only studies on human subjects with acute complex elbow fracture dislocation treated by hinged elbow external fixator. Types of interventions: Surgical treatment of acute complex elbow fracture dislocation with hinged external fixation of elbow. Types of outcome measures: Operative details, intra and postoperative complications and final clinical outcome. Literature searches will be conducted using the following databases:” PubMed, Ovid, Web of Science, ScienceDirect, Scopus, Cochrane Library, Google Scholar, Medline” using the following Keywords: acute complex elbow fracture dislocation, hinged external fixator, unstable elbow, terrible triad and long term for published studies from 2010-2021. Results Regarding studies done on the use of a lateral hinged external fixator on the elbow for complex fracture dislocation which are numerous in the last 11 years, we have reviewed the most applicable studies in our review. Regarding the mean flexion-extension arc and pronation-supination arc, the results were 121.5 º and 81 º respectively. Regarding the complications, wound infection was found in 10 patients out of 69 cases (14.4%) including pin tract infection and ORIF wound infection. Secondary humeral and ulnar shaft fractures were found in 3 patients out of 69 cases (4.3%) as a recognized complication of the shanz screws application in both humerus and ulna. Another complication founded was elbow joint incongruity in 5 patients among 69 cases (7.2%) which leads to series consequences like arthritis, progressive pain and instability. Instability as a postoperative complication was found in 1 patient out of 69 cases (1.4%) which shows the huge effect of adding a hinged external fixator to the ORIF construct. In fact, this was the only reason to add a hinged external fixator in the past where it was used in cases of recurrent and chronic instability. Non union was found in 2 patients out of 69 patients (2.8%) while heterotrophic calcification was found in 8 patients out of 69 cases (11.5%). Iordens et al in 2015 was the only paper to calculate the quick-dash score where among 27 patients the score were 30 at 6 weeks and 7 at 1 year. Regarding the mayo elbow performance score (MEPS), among the 69 patients 21 patients (30.4%) were not affiliated while the score was poor in 1 patient (1.4%), fair in 7 patients (10.1%), good in 18 patients (26%) and excellent in 22 patients (31.8%) which shows that above 50% of cases where good to excellent showing the effect of early protected range of motion gained by the addition of a hinged external fixator. Conclusion The best management for complex elbow fracture dislocations is still controversy but the additional use of a hinged external fixator to the ORIF repair shows better outcomes as described.

Surgical Treatment of Monteggia-Like Lesions With a Modified Boyd Approach.

Monteggia-like lesions are rare injuries in adults that include a wide spectrum of complex fracture-dislocations of the proximal ulna and radius. In this retrospective study, we performed a modified Boyd approach and a standard surgical protocol for the treatment of these lesions. Our aim was to evaluate the results of the operative treatment for patients with Monteggia-like lesions, using a modified Boyd approach. We present a retrospective study of 14 patients who underwent surgical treatment for Monteggia-like lesions. Preoperative clinical and radiological evaluation was performed. In 5 cases radial head prosthesis was placed, and in 3 cases the radial fracture was stabilized with the use of interfragmental screws. Regarding the proximal ulnar fracture, ORIF-anatomical plate and ORIF-straight plate was used in 12 and 2 cases, respectively. Average clinical follow up was 16.9 months. Postoperatively, the mean Mayo Elbow Performance score was 83.4 points (range 70-100) and the mean visual analog scale was 1.7 (range 0-14). Mean flexion and loss of extension were 122.1° (range 80°-140°) and 21.4° (range 5°-40°), respectively. Mean supination of the forearm was 66.8° (range 50°-80°) and the mean pronation was 67.5° (range 60°-75°). Heterotopic ossification was observed in 3 patients (21.4%) and 1 patient developed stiffness (7.1%). The patient who developed stiffness underwent reoperation for plate removal and arthrolysis, with satisfactory results. The surgical treatment of Monteggia-like lesions in adults remains a challenge. In the present study, the use of a standard surgical protocol, with a modified Boyd approach, successfully restores the movement and stability of the elbow, with a low complication rate.

Surgical controversies and current concepts in Lisfranc injuries.

Lisfranc injuries, not as rare as previously reported, range from ligamentous to complex fracture-dislocations. Anatomical studies have identified a complex of discrete structures, and defined the anatomical characteristics of the Lisfranc joint. A narrative evidence-based review encompassed and analyzed published systematic reviews. Outcomes included clinical and surgical decision-making, including clinical-presentation, diagnosis, pathological-assessment, surgical-management techniques and indications, post-surgical care and comparative outcomes. Better understanding of the Lisfranc complex anatomy aids surgical treatment and tactics. Prognosis is related to injury severity, estimated by the number of foot columns affected. Surgical outcome is determined by anatomical reduction for most fixation and fusion techniques. Appropriate treatment allows return to sport, improving outcome scores. Identification of Lisfranc injuries may be improved by imaging modalities such as weight-bearing computer tomography. Recent evidence supports dorsal plate fixation as a result of better quality of reduction. In complex injuries, the use of combined techniques such as trans-articular screw and plate fixation has been associated with poorer outcomes, and fusion may instead offer greater benefits. Open reduction is mandatory if closed reduction fails, highlighting the importance of understanding surgical anatomy. If anatomical reduction is achieved, acute arthrodesis is a safe alternative to open reduction internal fixation in selected patients, as demonstrated by comparable outcomes in subgroup analysis. The current controversies in surgical treatment remain around techniques and outcomes, as randomized controlled trials are infrequent.

Complex Dorsal Dislocation of the Metacarpophalangeal Joint: A Case Report and Comprehensive Review

Complex dorsal dislocations of the metacarpophalangeal joint are usually a complication of hyperextension injury and are irreducible to closed maneuvers. The volar plate displaced between the dorsum of the metacarpal head and the volar base of the proximal phalanx is the obstacle that prevents reduction. While the pathophysiology of complexity is relatively clear, such injuries are uncommon and reduction requires experience. We describe a case of complex fracture dislocation of the index metacarpophalangeal joint with a review of the literature on relative anatomy and treatment armamentarium.

Acute complex instability of the elbow treated with internal joint stabilizer IJS-E System

IntroductionTreatment of acute complex fracture-dislocation of the elbow has been associated with a high rate of complications. Internal Joint Stabilizer of the Elbow (IJSE) device appears as a valid option to optimise and improve our results. Material and methodsWe present a retrospective case series of five patients treated at our institution with IJS-E System (Skeletal DynamicsR) from February 2019 to 2020. Our inclusion criteria was: patients over 18 years old surgically treated with IJS-E due to persistent elbow instability despite of a suitable osteoligamentous surgical repair. ResultsWe obtained a total of five patients (4 males and 1 female) with an average age of 37.4 years old (24–71). The Injury pattern was posterolateral instability, TTIE in all cases. The mean final postoperative MEP score was 94 points (85–100) and the postoperative DASH score was 11.78 points (4.2–20.6) with an average follow-up of 9.8 months (6–12). We described a final arc of motion of 134° with a range of flexion between 120° and 140° and a mean lack of extension of 12° (5°–20°), with a complete arc of pronosupination. As complications we found one case of heterotopic ossification and one case of elbow stiffness. However, no complications device-related or articular incongruence were reported during follow-up. ConclusionsThe IJS-E device appears as an effective alternative instead of external fixation. Nevertheless, a high rate of reoperation up to 100% is associated with IJS-E. A larger series, longer follow-up and prospective studies are needed to define properly his role in the surgical treatment of acute elbow instability.

Tratamiento de la inestabilidad aguda compleja de codo con fijador interno IJS-E System

IntroductionTreatment of acute complex fracture-dislocation of the elbow has been associated with a high rate of complications. Internal Joint Stabilizer of the Elbow (IJSE) device appears as a valid option to optimize and improve our results. Material and methodsWe present a retrospective case series of five patients treated at our institution with IJS-E System (Skeletal DynamicsR) from February 2019 to 2020. Our inclusion criteria was: patients over 18 years old surgically treated with IJS-E due to persistent elbow instability despite of a suitable osteoligamentous surgical repair. ResultsWe obtained a total of five patients (4 males and 1 female) with an average age of 37.4 years old (24-71). The Injury pattern was posterolateral instability, TTIE in all cases. The mean final postoperative MEP score was 94 points (85-100) and the postoperative DASH score was 11.78 points (4.2-20.6) with an average follow-up of 9.8 months (6-12). We described a final arc of motion of 134° with a range of flexionbetween 120° and 140° and a mean lack of extension of 12° (5°-20°), with a complete arc of pronosupination. As complications we found one case of heterotopic ossfication and one case of elbow stiffnes. However, no complications device-related or articular incongruence were reported during follow-up. ConclusionsThe IJS-E device appears as an effective alternative instead of external fixation. Nevertheless, a high rate of reoperation up to 100% is associated with IJS-E. A larger series, longer follow-up and prospective studies are needed to define properly his role in the surgical treatment of acute elbow instability.

Complex Fracture-Dislocations of the Elbow in the Pediatric Population.

Complex fracture-dislocations of the elbow, including terrible triad of the elbow, are serious injuries with guarded outcomes in adults. Although described extensively in adults, little is known about similar complex fracture-dislocations of the elbow in the pediatric population. The purpose of this study was to describe patterns of elbow dislocations with associated fractures in children and report the outcomes of these injuries. This was a retrospective review of patients who presented to a level I trauma center from 2007 to 2019 with an elbow dislocation and at least 2 associated fractures. Demographic data, fracture locations, and treatment modality were recorded. Operative reports and radiographs were reviewed to determine clinical outcomes and complications. A total of 26 patients (mean age, 9.8 y) were identified. The majority of patients sustained an elbow dislocation and a medial epicondyle fracture (n=16). The most common third fractures involved the lateral condyle (n=8) or radial neck (n=7). At mean 6.03±3.11 months follow-up, 3 patients lacked ≥10 degrees of extension, and 2 patients lacked ≥15 degrees of flexion. Most patients had a Flynn score of "excellent" (n=20, 76.9%) or "good" (n=2, 7.7%). One patient with significant residual stiffness (>30 degrees flexion contracture) eventually underwent open contracture release. The most common complex elbow fracture-dislocation pattern in this series was an elbow dislocation with fracture of the medial epicondyle and lateral condyle or radial neck. In contrast to adult terrible triad injuries, most patients had a favorable clinical outcome, with nearly 80% excellent results and a low rate of complications. Therapeutic Level IV-case series.

The adjunct use of lateral hinged external fixator in the treatment of traumatic destabilizing elbow injuries.

The purpose of this study is to evaluate the results of using a lateral hinged external fixator as an adjunct stabilizer in the treatment of a variety of acute destabilizing elbow injuries. A retrospective review was performed on the medical records of patients in whom a lateral monolateral elbow hinged external fixator was applied by the senior author. The indication to apply the fixator corresponded to a variety of acute injury patterns ranging from simple elbow trauma or dislocation to complex fracture-dislocation, and the decision was based on either the presence of recurrent or persistent instability in any direction and/or to secure a vulnerable or weak bony fixation or soft tissue repair as intra-operatively judged by the surgeon. The fixator was inserted in the same setting after the repair of the associated ligamentous and/or bony structures. Patients operated after one month of the trauma and those presented with open elbow injury or associated humeral or ulnar shaft fracture were excluded. Rehabilitation was immediately started and the fixator removed at six to eightweeks with elbow testing and gentle manipulation under general anaesthesia, and resuming of rehabilitation after removal. Clinical assessment was performed for all patients according to the Mayo Elbow Performance Score (MEPS) with evaluation of range of motion at regular intervals till the end of the post-operative first year, then at final follow-up for the purpose of the study with radiographic assessment for evaluation of elbow reduction and concentricity. There were 13 patients with a mean age of 42 years. Two patients had instability secondary to LCL rupture; one patient had redislocation because of associated coronoid process fracture; one patient had radial head fracture with rupture of both collateral ligaments; five patients had terrible triad injury with variable association of collateral ligaments lesions; and four patients had posterior Monteggia fracture-dislocation. The mean MEPS was 90 at a mean follow-up of seven years with six excellent, six good, and one fair result. All patients had a concentrically reduced and stable elbow as assessed clinically and radiologically with a mean functional arc of motion of 132° for extension-flexion and 178° for pronation-supination. The hinged elbow external fixator represents a valuable adjunct in the therapeutic arsenal for the treatment of unstable elbows after bony and soft tissue repair. It provides satisfactory results in terms of stability and function and should be available in the operating room when a surgeon treats a complex elbow dislocation or fracture-dislocation.

A study of functional and radiological outcome of complex fracutre dislocation of proximal humerus treated with proximal humeral internal locking system (Philos) plate

Fracture dislocations of the proximal humerus are extremely rare and have poor functional and radiological outcome regardless of many available surgical interventions. There has been a wide variation in optimum modality of treatment of proximal humerus fractures ranging from conservative treatment, open reduction and internal fixation to total and reverse shoulder arthroplasty. We have evaluated the outcome of efficacy of proximal humeral internal locking system (PHILOS) plate in complex fracture dislocation of the proximal humerus. A total of 20 patients with fracture dislocation of proximal humerus were included in the study after careful inclusion and exclusion criteria. All fracture dislocations were fixed with proximal humeral internal locking system (PHILOS) plate and patients were followed up at regular intervals. Final evaluation was done based on Neer's scoring system. Open reduction and internal fixation of proximal humeral fracture dislocation with the PHILOS plate was associated with good functional and radiological outcomes provided the correct surgical technique was used.

Orthoplastic Management of Open Midfoot Injuries: Is Functional Limb Salvage Possible?

High energy open midfoot injuries are uncommon but devastating injuries. A combination of complex fracture dislocations and soft tissue injury patterns render reconstruction challenging. The aim of this study was to assess the surgical and patient reported outcomes following orthoplastic management of open midfoot injuries in a Major Trauma Center. A retrospective review of all open midfoot fractures admitted to our unit between January 2015 and December 2016 was undertaken. Demographics, operative details, complications, additional surgeries, and patient reported outcomes in the form of EQ-5D and Enneking scores were collected. Fifteen patients were identified (13 male, mean age 39.2 years). One patient underwent amputation at initial debridement and 8 required additional debridement. Of these 8 patients, 3 had an amputation during their index admission. In the limb salvage group (11 patients), definitive soft tissue cover involved free flaps in 6 patients, split skin graft in 3 patients, and delayed primary closure in 2 patients. Definitive orthopedic treatment was internal fixation in 8 and external fixation in 3 patients. Two patients required a Masquelet procedure for bone loss. One patient had a toe amputation and 1 had a below knee amputation for deep infection. The median EQ-5D score was 66 (interquartile range 43), and the median Enneking score was 20.5 (interquartile range 9). Limb salvage following open midfoot fractures is technically possible in most cases, however this often involves multiple procedures and the outcomes are variable and difficult to predict. Patients should be carefully counseled, and amputation considered in all such cases.

Short and medium term functional outcome of hemi-replacement in complex proximal humerus fracture

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Complex proximal humerus fractures are common injuries are common just because of high incidence of road traffic accidents and old age population. The aim of this study was to evaluate the functional outcome in hemi-replacement in complex 3and 4 part of proximal humerus fracture.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This prospective study was conducted in the Department of Orthopaedics, Sir. T. Hospital, Bhavnagar from August 2010 to April 2014. Out of 30 patients 27 turned up for follow up 3 was lost. Functional and clinical assessments using the age and gender specific Constant-Murley score.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Excellent to good outcome as per Constant-Murley score was seen in 16 patients, moderate outcome in 8 patients and poor outcome in 3 patients.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; To spare proximal humerus in younger patients there should be do osteosynthesis procedure with every effort. In the elderly, especially with more complex four-part fractures and fracture dislocations, hemiarthroplasty and reverse total shoulder arthroplasty are specified to decrease complication rates and improve functional outcomes.&lt;/p&gt;

Acute and chronic elbow instability: a review of mechanisms, patho-anatomy and management

Acute elbow instability ranges from simple dislocation with soft tissue lesions alone to complex dislocations involving fractures of the coronoid and radial head (‘terrible triad’). Simple dislocations for the most part are stable after reduction, managed with early mobilization and have good outcomes with relatively low complication rates. In contrast, complex fracture-dislocations render the elbow very unstable and therefore surgical intervention is usually necessary to restore bony and ligamentous stability to allow early range of movement. The risk of complications, including stiffness, chronic instability, heterotopic ossification and arthrosis, are high and clinical outcomes have traditionally been suboptimal. Detailed knowledge of the relevant anatomy is crucial in the understanding of injury patterns and in the application of successful systematic treatment algorithms that will minimize complications and improve outcomes. Chronic instability is most commonly posterolateral, due to incompetence of the lateral ulnar collateral ligament (LUCL) leading to recurrent episodes of subluxation or dislocation. Most symptomatic patients require surgical reconstruction of the LUCL (using tendon autografts or allografts) which produces favourable clinical results.

High-Energy Proximal Humerus Fractures in Geriatric Patients: A Review.

High-energy proximal humerus fractures in elderly patients can occur through a variety of mechanisms, with falls and MVCs being common mechanisms of injury in this age group. Even classically low-energy mechanisms can result in elevated ISS scores, which are associated with higher mortality in both falls and MVCs. These injuries result in proximal humerus fractures which are commonly communicated via Neer’s classification scheme. There are many treatment options in the armamentarium of the treating surgeon. Nonoperative management is widely supported by systematic review as compared to almost all other treatment methods. ORIF is particularly useful for complex patterns and fracture dislocations in healthy patients. Hemiarthroplasty can be of utility in patients with fracture patterns with high risk of AVN and poor bone quality risking screw cut-out. Reverse total shoulder arthroplasty is a popular method of treatment for geriatric patients also, with literature now showing that even late conversion from nonoperative management or ORIF to rTSA can lead to good clinical outcomes. Prevention is possible and important for geriatric patients. Optimizing medical care including hearing, vision, strength, and bone quality, in coordination with primary care and geriatricians, is of great importance in preventing fractures and decreasing injury when falls do occur. Involving geriatricians on dedicated trauma teams will also likely be of benefit.

Hemiarthroplasty for proximal humerus fractures

Proximal humerus fractures are common injuries that are increasing in incidence with the increasing life expectancy and associated rise in osteoporosis. Majority of the proximal humerus fractures are minimally displaced and can be treated non-operatively with good functional results. However unstable displaced fractures have high morbidity especially in older patients. These unstable and displaced fractures may require operative intervention to ensure a successful outcome. Evaluation of both patient and fracture characteristics is important in deciding the appropriate type of surgical intervention. The aim of surgical fixation is to restore articular congruency, alignment and the proper positioning of tuberosities with respective to humeral head. Hemiarthroplasty is indicated in fracture dislocations, head splitting fractures and some three or four part fractures. In the elderly, especially with more complex four-part fractures and fracture dislocations, hemiarthroplasty and reverse total shoulder arthroplasty are indicated to decrease complication rates and improve functional outcomes. Restoration of proper humeral height, version and tuberosity position are key to success in hemiarthroplasty. Fractures in which the tuberosities are unlikely to unite or cannot be reconstructed well, reverse total shoulder arthroplasty should be considered.

Assessment of olecranon fractures treated through open reduction and internal fixation surgery using pre-contoured locking compression plates

Background: Fractures of the olecranon process constitute approximately 10% of fractures around the adult elbow and range from simple nondisplaced fractures to complex fracture–dislocations of the elbow. [2] The highest incidence is seen usually in middle aged adults with men sustaining the injury at a younger age than women. Ground-level falls are responsible for most of these fractures. Associated injuries include ipsilateral proximal radius fractures in 17% and open injuries in 6.4% [3]. Materials and Methods: A retrospective study was conducted in the Department of Orthopaedic Surgery, Grant Medical Foundation-Ruby Hall Clinic, Pune, India on 22 cases of closed olecranon fractures in patients between the age of 18-65 years who underwent surgical treatment through open reduction and internal fixation with pre-contoured olecranon locking compression plate between January 2014 - March 2019. These patients were followed for 12 months (minimum for 6 months) and evaluated based on union rate through xray radiograph, any complications (infections, mal/nonunion, implant impingement, elbow stiffness) and functionally by Mayo Elbow Performance Score (MEPS).Conclusion: Open reduction and internal fixation with pre contoured olecranon LCP should be the treatment of choice in majority of the olecranon fractures as it restores the anatomy, biomechanics and contact loading characteristics of the elbow joint and is associated with least complication rates due to static nature of fixation.

Concomitant old complex fracture–dislocation of the first metatarsophalangeal, Lisfranc, and naviculocuneiform joints

Old simultaneous complex fracture–dislocation of the first metatarsophalangeal (MTP), Lisfranc, and naviculocuneiform joints as an overwhelming injury has not been reported in the literature yet. In a 29-year-old man, 6 months following the trauma, the medial column of foot was reconstructed using iliac tricortical bone graft from navicular to the first metatarsal. Arthrodesis of the second and third tarsometatarsal joints and resection arthroplasty of the first MTP joint were done. His clinical and radiographic evaluation after 18 months revealed an acceptable function with returning to pre-injury job but with some limitations in recreational activities. Level of evidence: level 4