Facet Fracture Research Articles

The radiological findings in complex elbow fracture-dislocation injuries.

Elbow fracture-dislocation is a complex injury which can lead to significant bony and soft tissue damage. Surgical intervention is guided towards restoring joint stability, allowing early mobilization and preventing long-term joint stiffness. The most common types are posterolateral, posteromedial, Monteggia type (and variants), and anterior trans-olecranon fracture-dislocations. Posterolateral fracture-dislocation is characterized by a radial head fracture (± anterolateral coronoid fracture) and typically capsuloligamentous disruption (lateral collateral ligaments injury is the most common). A posterolateral fracture-dislocation with radial head and coronoid anterolateral facet fractures is termed a terrible triad injury. In posteromedial fracture-dislocation, there is a fracture of the anteromedial facet of the coronoid, typically with proximal avulsion of the lateral collateral ligaments (± injury to the posterior bundle of the ulnar collateral ligament). Monteggia fracture-dislocation injuries demonstrate proximal ulnar fracture (with possible involvement of the olecranon and the coronoid) and radial head dislocation. These can be divided into apex anterior or apex posterior variants. The latter are commonly associated with radial head fractures and lateral ligamentous injury, and have a worse prognosis. In trans-olecranon fracture-dislocation, there is significant disruption of the greater sigmoid notch and the olecranon, with various involvement of the coronoid and the proximal ulna. The article describes the radiological findings and outlines the management principles in complex elbow fracture-dislocation injuries.

Management of thoracic spinal cord injury in a professional American football athlete: illustrative case.

BACKGROUNDA case of catastrophic thoracic spinal cord injury (SCI) sustained by a professional American football player with severe scoliosis is presented.OBSERVATIONSA 25-year-old professional football player sustained an axial loading injury while tackling. Examination revealed a T8 American Spinal Injury Association Impairment Scale grade A complete SCI. Methylprednisolone and hypothermia protocols were initiated. Computed tomography scan of the thoracic spine demonstrated T8 and T9 facet fractures on the left at the apex of a 42° idiopathic scoliotic deformity. Magnetic resonance imaging (MRI) demonstrated T2 spinal cord hyperintensity at T9. He regained trace movement of his right lower extremity over 12 hours, which was absent on posttrauma day 2. Repeat MRI revealed interval cord compression and worsening of T2 signal change at T7-T8 secondary to hematoma. Urgent decompression and fusion from T8 to T10 were performed. Additional treatment included high-dose omega-3 fatty acids and hyperbaric oxygen therapy. A 2-month inpatient spinal cord rehabilitation program was followed by prolonged outpatient physical therapy. He currently can run and jump with minimal residual distal left lower limb spasticity.LESSONSThis is the first known football-related thoracic SCI with idiopathic scoliosis. Aggressive medical and surgical intervention with intensive rehabilitation formed the treatment protocol, with a favorable outcome achieved.

Clinical comparison of the over-the-top and flexor carpi ulnaris split approaches for the treatment of anteromedial facet fracture of the coronoid process.

The flexor carpi ulnaris (FCU)-split approach and the over-the-top approach have been used frequently for the fixation of anteromedial facet (AMF) fractures of the coronoid process. Clinical studies have not compared functional recovery and complication rates associated with these approaches. This study aimed to compare the clinical effectiveness of the over-the-top and FCU-split approaches for the treatment of AMF fractures of the coronoid process. Thirty-two patients who underwent surgery for AMF fractures between January 2013 and August 2019 were divided into the FCU-split and over-the-top groups. The FCU-split approach was used from January 2013 to March 2016, and the over-the-top approach was used from April 2016 to August 2019. Bony union, radiographic signs of osteoarthritis (Broberg and Morrey classification), and development of heterotopic ossification were evaluated. Postoperative pain score (visual analog scale at 2 days after the operation), surgical time (minutes), range of motion of the elbow, elbow function (Mayo Elbow Performance Score [MEPS]), and the presence of postoperative ulnar neuropathy were also compared between the 2 groups. The FCU-split and over-the-top approaches were performed in 15 and 17 patients, respectively. The mean age was 46 ± 13 years (range, 22-67 years), and the mean follow-up duration was 19± 6.7 months (range, 13-38 months). All coronoid fractures had a solid osseous union during the follow-up, and no subluxation or dislocation was observed in the 2 groups. The occurrence of heterotopic ossification and the grade of post-traumatic arthritis did not differ significantly between the groups (all P > .05). There were also no significant differences between the groups in terms of postoperative pain score, range of motion, and MEPS (all P > .05). However, the surgical time was shorter for the over-the-top approach than that for the FCU-split approach (79± 23 vs. 101 ± 14, P = .008), and the surgical time was significantly associated with the fracture classification and surgical approach (P = .001 and .003, respectively). In addition, postoperative ulnar neuropathy occurred less with the over-the-top approach than with the FCU-spilt approach (5.9% vs. 46%, P = .013). Both the FCU-split and over-the-top approaches were appropriate for performing the buttress plate fixation for AMF fractures of the coronoid process and for restoring the elbow stability. The fixation of AMF fractures through the over-the-top approach was technically easier and had less incidence of postoperative ulnar neuropathy.

Calcaneal insufficiency fractures following ipsilateral total knee arthroplasty

IntroductionOnly a few reports have described calcaneal insufficiency fractures (IFs) following total knee arthroplasty (TKA). Herein, we describe nine cases of calcaneal IFs following ipsilateral TKA. The purpose of this study was to investigate the incidence of calcaneal fractures following TKA and determine the characteristics of patients with IFs. Patients and methodsWe retrospectively investigated cases of calcaneal IF that occurred following TKA. We collected and analyzed radiographic and magnetic resonance imaging (MRI) findings as well as patient demographic data. We compared the demographic data, bone mineral density (BMD), and preoperative hip-knee-ankle angle (HKA) between cases with a calcaneal fracture following TKA and 100 cases without a fracture following TKA. ResultsWe performed a total of 1548 knee arthroplasties at our clinic from 2011 to 2020. Nine calcaneal IFs in eight patients were diagnosed following ipsilateral TKA. All patients were women with varus knee osteoarthritis (mean age, 71.8 years). The average change in the alignment angle was 14.7° ± 5.4°. In eight cases, dysfunction was observed in the opposite lower limb. The postoperative onset of hindfoot pain started at an average of 5.6 months. In seven patients, calcaneal fractures occurred idiopathically, but in one patient, two fractures occurred after long-distance walking. No abnormal findings on a calcaneus radiograph were seen for six fractures. MRI demonstrated a definite fracture line and bone marrow edema in all patients. All patients, except one with type 2 diabetes mellitus (T2DM), had osteoporosis. Fractures healed without complications in eight patients; however, the calcaneal anterior facet fracture became displaced and caused a flat foot in one case. The calcaneal IF rate was 0.58% among all cases. Besides one case with T2DM, significant differences were observed in preoperative HKA and BMD between cases with a calcaneal fracture following TKA and those without a fracture. ConclusionsA change in the load on the calcaneus due to changes in the alignment of the lower extremities after TKA may cause calcaneal IFs. Orthopedic surgeons should be aware of the possible occurrence of calcaneal IFs following TKA, especially in women with osteoporosis and severe varus knee.

Accuracy and reliability of the AO Spine subaxial cervical spine classification system grading subaxial cervical facet injury morphology.

A classification system was recently developed by the international association AO Spine for assessing subaxial cervical spine fractures. Significant variability exists between users of the facet component, which consists of four morphological types (F1-F4). The primary aims of this study were to assess the diagnostic accuracy and reliability of this new system's facet injury morphological classifications. A survey consisting of 16 computed tomography (CT) scans of patients with cervical facet fractures was distributed to spine surgeon members of AO Spine Latin America. To provide a gold standard diagnosis for comparison, all 16 injuries had been classified previously by six co-authors and only were included after total consensus was achieved. Demographic and surgical practice characteristics of all respondents were analyzed, and diagnostic accuracy calculated. Inter- and intra-observer agreement rates were calculated across two survey rounds, conducted one month apart. A total of 135 surgeons completed both surveys, among whom the mean age was 41.6years (range 26-71), 130 (96.3%) were men, and 83 (61.5%) were orthopedic surgeons. The mean time in practice as a spine surgeon was 9.7years (1-30). The overall diagnostic accuracy of all responses was 65.4%. Inter-observer and intra-observer agreement rates for F1/F2/F3/F4 were 55.4%/47.6%/64.0%/94.7% and 60.0%/49.1%/58.0%/93.0%, respectively. This study evaluates the AO Spine Classification System specifically for facet injuries involving the subaxial cervical spine in a large sample of spine surgeons. There was significant variability in diagnostic accuracy for F1 through F3-type fractures, whereas almost universal agreement was achieved for F4-type injuries.

Variation in global treatment for subaxial cervical spine isolated unilateral facet fractures

PurposeTo determine the variation in the global treatment practices for subaxial unilateral cervical spine facet fractures based on surgeon experience, practice setting, and surgical subspecialty.MethodsA survey was sent to 272 members of the AO Spine Subaxial Injury Classification System Validation Group worldwide. Questions surveyed surgeon preferences with regard to diagnostic work-up and treatment of fracture types F1–F3, according to the AO Spine Subaxial Cervical Spine Injury Classification System, with various associated neurologic injuries.ResultsA total of 161 responses were received. Academic surgeons use the facet portion of the AO Spine classification system less frequently (61.6%) compared to hospital-employed and private practice surgeons (81.1% and 81.8%, respectively) (p = 0.029). The overall consensus was in favor of operative treatment for any facet fracture with radicular symptoms (N2) and for any fractures categorized as F2N2 and above. For F3N0 fractures, significantly less surgeons from Africa/Asia/Middle East (49%) and Europe (59.2%) chose operative treatment than from North/Latin/South America (74.1%) (p = 0.025). For F3N1 fractures, significantly less surgeons from Africa/Asia/Middle East (52%) and Europe (63.3%) recommended operative treatment than from North/Latin/South America (84.5%) (p = 0.001). More than 95% of surgeons included CT in their work-up of facet fractures, regardless of the type. No statistically significant differences were seen in the need for MRI to decide treatment.ConclusionConsiderable agreement exists between surgeon preferences with regard to unilateral facet fracture management with few exceptions. F2N2 fracture subtypes and subtypes with radiculopathy (N2) appear to be the threshold for operative treatment.

Investigating the Effect of Axial Compression and Distraction on Cervical Facet Mechanics During Supraphysiologic Anterior Shear.

Bilateral cervical facet dislocation (BFD) with facet fracture (Fx) often causes tetraplegia but is rarely recreated experimentally, possibly due to a lack of muscle replication. Intervertebral axial compression (due to muscle activation) or distraction (due to inertial loading), when combined with excessive anterior translation, may influence interfacet contact or separation and the subsequent production of BFD with or without Fx. This paper presents a methodology to produce C6/C7 BFD+Fx using anterior shear motion superimposed with 300 N compression or 2.5 mm distraction. The effect of these superimposed axial conditions on six-axis loads, and C6 inferior facet deflections and surface strains, was assessed. Twelve motion segments (70 ± 13 yr) achieved 2.19 mm of supraphysiologic anterior shear without embedding failure (supraphysiologic shear analysis point; SSP), and BFD+Fx was produced in all five specimens that reached 20 mm of shear. Linear mixed-effects models (α = 0.05) assessed the effect of axial condition. At the SSP, the compressed specimens experienced higher axial forces, facet shear strains, and sagittal facet deflections, compared to the distracted group. Facet fractures had similar radiographic appearance to those that are observed clinically, suggesting that intervertebral anterior shear motion contributes to BFD+Fx.

CT Scan in Subaxial Cervical Facet Injury: Is It Enough for Decision-Making?

Cross-sectional survey. Assessment of subaxial cervical facet injuries using the AO Spine Subaxial Cervical Spine Injury Classification System is based on CT scan findings. However, additional radiological evaluations are not directly considered. The aim of this study is to determine situations in which spine surgeons request additional radiological exams after a facet fracture. A survey was sent to AO Spine members from Latin America. The evaluation considered demographic variables, routine use of the Classification, as well as the timepoint at which surgeons requested a cervical MRI, a vascular study, and/ or dynamic radiographs before treatment of facet fractures. There was 229 participants, mean age 42.9 ± 10.2 years; 93.4% were men. Orthopedic surgeons 57.6% with 10.7 ± 8.7 years of experience in spine surgery. A total of 86% used the Classification in daily practice. An additional study (MRI/vascular study/and dynamic radiographs) was requested in 53.3%/9.6%/43.7% in F1 facet injuries; 76.0%/20.1%/50.2% in F2; 89.1%/65.1%/28.4% in F3; and 94.8%/66.4%/16.6% in F4. An additional study was frequently required: F1 72.5%, F2 86.9%, F3 94.7%, and F4 96.1%. Spine surgeons generally requested additional radiological evaluations in facet injuries, and MRI was the most common. Dynamic radiographs had a higher prevalence for F1/F2 fractures; vascular studies were more common for F3/F4 especially among surgeons with fewer years of experience. Private hospitals had a lower spine trauma cases/year and requested more MRI and more dynamic radiographs in F1/F2. Neurosurgeons had more vascular studies and dynamic radiographs than orthopedic surgeons in all facet fractures.

Low-temperature tensile properties of Cu-Fe laminated sheets with various number of layers

The Cu-Fe laminated sheets with various number of layers were produced by the accumulative roll bonding process, and the effects of the number of layers on the microstructure and low-temperature tensile properties of the sheets were elucidated. Then the reason for the excellent low-temperature tensile properties in dual-phase materials of Cu and Fe was discussed. The tensile properties of the pure Cu and Fe sheets used for fabricating the Cu-Fe laminated sheets exhibited the typical temperature dependence seen in the case of face-centered cubic (fcc) and body-centered cubic (bcc) metals. The layered structure of the laminated sheets was maintained till the number of layers was 100 but broke in the case of the 1000-layer sheet, which showed a network-like structure. The electrical conductivity of the sheets was independent of the number of layers and significantly higher than that of a Cu-Fe alloy, indicating that Fe had neither dissolved nor precipitated in the Cu layers of the laminated sheets. In the case of the 50-, 100- and 1000-layer sheet, the strength increased with lowering the temperature, while its elongation remained constant. A facet fracture surface was observed until the number of layers was 7, while in the case of the sheets consisting of more than 50-layers, fine dimples were observed on the fracture surfaces of both layers, indicating that ductile fracturing occurred. The strain in the Cu layers around the strain concentration sites of the Fe layers was high in the 50-layer laminated sheet when it was subjected to tensile deformation at 77 K. The strain concentration in the Fe layers might be accommodated by the surrounding soft Cu layers, resulting in the suppression of the nucleation of cleavage cracks in the Fe layers. This should be one of the reasons that the Cu-Fe layered sheets exhibited excellent elongation at low temperatures. Thus, the Cu-Fe layered structure take an important role for the excellent low-temperature tensile properties in the fcc and bcc dual-phase materials.

Minimally displaced unilateral facet fracture of cervical spine can lead to spinal cord injury: a report of two cases

BackgroundAccording to most of the commonly used classification systems for subaxial spine injuries, unilateral and minimally displaced facet fractures without any sign of a spinal cord injury would be directed to non-operative management. However, the failure rate of non-operative treatment varies from 20 to 80%, and no consensus exists with regard to predictors of failure after non-operative management.Case presentationCase 1 is a patient with a unilateral facet fracture. The patient had only numbness in the right C6 dermatome but failed non-operative treatment, which resulted in severe spinal cord injury. Case 2 is a patient who had a similar injury pattern as case 1 but presented with immediate instability and underwent fusion surgery. Both patients had a minimally displaced unilateral facet fracture accompanied by disc injury and blunt vertebral artery injury, which are possible signs indicating significant instability.ConclusionsThis is the first report of an isolated unilateral facet fracture that resulted in catastrophic spinal cord injury. These two cases illustrate that an isolated minimally displaced unilateral facet fracture with disc injury and vertebral artery injury were associated with significant instability that can lead to spinal cord injury.

Establishing the Injury Severity of Subaxial Cervical Spine Trauma: Validating the Hierarchical Nature of the AO Spine Subaxial Cervical Spine Injury Classification System.

Study Design.Global cross-sectional survey.Objective.The aim of this study was to validate the AO Spine Subaxial Cervical Spine Injury Classification by examining the perceived injury severity by surgeon across AO geographical regions and practice experience.Summary of Background Data.Previous subaxial cervical spine injury classifications have been limited by subpar interobserver reliability and clinical applicability. In an attempt to create a universally validated scheme with prognostic value, AO Spine established a subaxial cervical spine injury classification involving four elements: injury morphology, facet injury involvement, neurologic status, and case-specific modifiers.Methods.A survey was sent to 272 AO Spine members across all geographic regions and with a variety of practice experience. Respondents graded the severity of each variable of the classification system on a scale from zero (low severity) to 100 (high severity). Primary outcome was to assess differences in perceived injury severity for each injury type over geographic regions and level of practice experience.Results.A total of 189 responses were received. Overall, the classification system exhibited a hierarchical progression in subtype injury severity scores. Only three subtypes showed a significant difference in injury severity score among geographic regions: F3 (floating lateral mass fracture, P = 0.04), N3 (incomplete spinal cord injury, P = 0.03), and M2 (critical disk herniation, P = 0.04). When stratified by surgeon experience, pairwise comparison showed only two morphological subtypes, B1 (bony posterior tension band injury, P = 0.02) and F2 (unstable facet fracture, P = 0.03), and one neurologic subtype (N3, P = 0.02) exhibited a significant difference in injury severity score.Conclusion.The AO Spine Subaxial Cervical Spine Injury Classification System has shown to be reliable and suitable for proper patient management. The study shows this classification is substantially generalizable by geographic region and surgeon experience, and provides a consistent method of communication among physicians while covering the majority of subaxial cervical spine traumatic injuries.Level of Evidence: 4

Atypical hangman’s fracture with concomitant subaxial fracture–dislocation treated with circumferential fusion of C2–C5—a case report

Atypical hangman's fractures are coronally-oriented vertical fractures of the posterior body of C2. Though these are not uncommon injuries, there is a paucity of data investigating the management of these fractures, especially when they occur in association with subaxial fracture dislocations. A 50-year-old male suffered a cervical extension injury when he dove into a shallow swimming pool while intoxicated. Initial examination demonstrated 2/5 strength in the right deltoid and biceps and 3/5 strength in the left deltoid and biceps with no motor or sensory function distal to the C5 level. Cervical CT scan revealed a C2 atypical hangman's fracture and a C4 right-sided facet fracture with traumatic spondylolisthesis at C4/5. We performed C2-C5 anterior cervical discectomy and fusion followed by a C3-C5 posterior instrumented fusion. At the patient's two year postoperative visit, the patient has had minimal improvement in neurologic function with 4/5 strength in bilateral deltoids and biceps and 2/5 strength in right wrist extension. Radiographs show a solid arthrodesis on flexion-extension radiographs. To our knowledge, this is the first case report discussing the operative management of an atypical hangman's fracture with a concomitant subaxial fracture-dislocation. This case report adds to our current knowledge by demonstrating a novel anterior-posterior approach for treating these complicated injuries.

Morphological characteristics of fractures of the anteromedial facet of the coronoid in posteromedial rotatory instability of the elbow: a three-dimensional CT remodeling study

Fractures of the anteromedial facet of the coronoid in posteromedial rotatory instability of the elbow are classified into 3 subtypes based on their location. The purpose of this study was to analyze the fracture morphology of anteromedial facet fractures in their 3 subtypes (anteromedial rim, anteromedial rim + tip, and anteromedial rim + sublime tubercle [±tip]). Three-dimensional computed tomography remodeling was used to evaluate anteromedial facet fractures in a consecutive series of 40 patients, all of whom were affected by posteromedial rotatory instability of the elbow. Characteristics of the fractures, including the number of fragments, size of fragments, plane of the fracture line, and involvement of the sublime tubercle and radial notch, were measured for each subtype of the anteromedial facet fractures. Each subtype had a typical fracture pattern and distinct size. The fracture subtype 1 showed a single-fragment fracture, subtype 2 showed either a single- or dual-fragment fracture, and subtype 3 showed either a dual- or triple-fragment fracture. The angle between the fracture line and the coronal plane was greatest in subtype 3 fractures. The surface area of the fragment was largest in subtype 3 fractures. The percentages of articular involvement of the sublime tubercle were 0% in subtype 1, 47% in subtype 2, and 79% in subtype 3. The percentages of articular involvement of the radial notch were 0% in subtype 1, 7% in subtype 2, and 8% in subtype3. Analysis with quantitative 3-dimensional computed tomography showed the characteristic morphology of each subtype of anteromedial facet fracture. Subtype 1 comprised 1 fragment with the smallest fragment size. Subtype 2 was a single- or dual-fragment fracture, the size of which should be considered in the treatment plan. Subtype 3 was a large fragment comprising the sublime tubercle. Our findings are significant because they highlight unique fracture morphology that may help surgeons to distinguish one fracture subtype from another in clinical practice.

The effect of mechanical alloying time on the microstructural and mechanical properties of spark plasma sintered Ta–10W

The effect of mechanical alloying time on the microstructure, hardness and tensile properties of spark plasma sintered (2000 °C, 5 min) Ta-10 (wt%)W alloy were studied. The XRD data's were shown the increase of micro strain and decrease in crystallite size by increasing in mechanical alloying time, before sintering. The unalloyed and heterogeneous microstructure, was more pronounced in blended powders, and the amount of heterogeneity decreased as the milling time increased. The hardness of samples is decreased by increase in mechanical alloying time. Tensile data determined the significant improvement in both strong and elongation by increasing in mechanically alloying time. The fracture mechanism is changed from facet fracture to dimple fracture by increase in mechanically alloying time. It was concluded that the mechanical alloying by means of increase in micro strain and decrease in crystallite size made a sharp decrease on diffusion activation energy. therefor, faster diffusion occurs in eliminated time during spark plasma sintering, preventing formation of carbides. More over faster diffusion made a complete homogeny alloys of refractory metals which are difficult to make a high density with high homogeneity.

Acute instability of the patella: is magnetic resonance imaging mandatory?

Acute dislocations of the patella represent 2 to 3% of traumatic injuries of the knee. When patients are seen in the emergency department with a dislocated patella clinical diagnosis is often very evident. However, in cases of short-lived subluxation or dislocations that have reduced spontaneously, the diagnosis can be challenging. The aim of this study was to evaluate the utility of MRI in the evaluation of acute patellar instability. This was a prospective study of 39 cases of acute patellar instability. The study protocol included a clinical examination by an emergency medicine doctor, a standardised series of radiographs and an MRI scan within 15days after injury. The series included 15 female and 24 male patients aged on average 23 ± 10.5years (11-46). Twenty-four cases were following sporting accidents and 15 cases following domestic accidents. In ten cases, a blow to the medial side of the patella led to the injury and in 29 cases, a twisting mechanism with a valgus and external rotation force was responsible. Six patients presented with a clinically dislocated patella and 31 patients were deemed to have a "swollen knee". Nineteen patients described an episode of subluxation of the patella and 14 an odd sensation within the knee without being able to specifically describe what had happened. Radiographs demonstrated trochlear dysplasia in 97.5% of cases and osteochondral lesions in 20.5% of cases. MRI scan confirmed the diagnosis of acute patellar instability in 37 cases giving a sensitivity of 95%. MRI findings included 25 MPFL lesions, 31 patella lesions of which 25 were bone oedema and six medial facet fractures, 31 lateral femoral condyle bone oedema type lesions, 11 chondral lesions of which seven were osteochondral in nature and also three acute associated ACL injuries and two MCL injuries. MRI scan is an important tool in the diagnosis and management of acute patellar dislocation and subluxation. When symptoms are subtle, MRI facilitates a diagnosis with relative ease. MRI is particularly useful in identifying the exact nature of lesions most notably chondral lesions which are frequently of significant size and therefore often require expedited surgical treatment.

Implication de la facette lunaire palmaire dans les fractures articulaires du radius distal

BackgroundSmall fracture fragments of the palmar lunate facet of the distal radius can be difficult to stabilize and may cause loss of reduction and even subluxation of the radiocarpal joint. Material and methodsThe aims of the study were to investigate fracture patterns of the intermediate column in 101 intra-articular distal radius fractures with three-dimensional computed tomography, and to determine the prevalence of palmar lunate facet fracture fragments. The size of the fragments was measured to find out how many fragments were small. ResultsThe palmar lunate facet fragment was present in 61 fractures. Mean length of the palmar cortex measured 13.5mm (range: 3 to 26.9) and mean area of the lunate facet 115mm2 (range: 31 to 267). Seventeen percent of intra-articular distal radius fractures had a palmar lunate facet fragment with a short palmar cortex. ConclusionWith accurate analysis of the preoperative computed tomography scans the typical fracture patterns of the palmar lunate facet are recognisable and adequate fixation technique can be chosen to avoid loss of reduction. Level of evidenceIV.

Volar plate fixation in intra-articular distal radius fractures with a volar lunate facet fragment

The aims of the study were to determine whether a volar lunate facet fragment is present in 67 displaced intra-articular distal radius fractures and to investigate which factors are associated with reduction loss after treatment with a volar plate and locking screws. The fractures were analyzed preoperatively with three-dimensional computed tomography. The volar lunate facet fragment was present in 42 fractures. Reduction loss occurred in five wrists and in two of those, the carpus was subluxated. Loss of reduction was associated with a short palmar cortex (9mm or less) of the volar lunate facet fragment. This study has shown that measuring the length of the palmar cortex of a volar lunate facet fracture fragment may be useful for identifying distal radius fractures that have a higher risk of displacement after treatment with a standard volar plate and locking screws.

Involvement of the palmar lunate facet in intra-articular distal radius fractures

BackgroundSmall fracture fragments of the palmar lunate facet of the distal radius can be difficult to stabilize and may cause loss of reduction and even subluxation of the radiocarpal joint. Material & methodsThe aims of the study were to investigate fracture patterns of the intermediate column in 101 intra-articular distal radius fractures with three-dimensional computed tomography, and to determine the prevalence of palmar lunate facet fracture fragments. The size of the fragments was measured to find out how many fragments were small. ResultsThe palmar lunate facet fragment was present in 61 fractures. Mean length of the palmar cortex measured 13.5mm (range: 3 to 26.9) and mean area of the lunate facet 115 mm2 (range: 31 to 267). Seventeen percent of intra-articular distal radius fractures had a palmar lunate facet fragment with a short palmar cortex. ConclusionWith accurate analysis of the preoperative computed tomography scans the typical fracture patterns of the palmar lunate facet are recognisable and adequate fixation technique can be chosen to avoid loss of reduction. Level of evidenceIV.

Anterior-Alone Surgical Treatment for Subaxial Cervical Spine Facet Dislocation: A Systematic Review.

Study Design:Systematic review.Objective:Anterior-alone surgery has gained wider reception for subaxial cervical spine facets dislocation. Questions remain on its efficacy and safety as a stand-alone entity within the contexts of concurrent facet fractures, unilateral versus bilateral dislocations, anterior open reduction, and old dislocation.Methods:A systematic review was performed with search strategy using translatable MESH terms across MEDLINE, EMBASE, VHL Regional Portal, and CENTRAL databases on patients with subaxial cervical dislocation intervened via anterior-alone approach. Two reviewers independently screened for eligible studies. PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) flow chart was adhered to. Nine retrospective studies were included. Narrative synthesis was performed to determine primary outcomes on spinal fusion and revisions and secondary outcomes on new occurrence or deterioration of neurology and infection rate.Results:Nonunion was not encountered across all contexts. A total of 0.86% of unilateral facet dislocation (1 out of 116) with inadequate reduction due to facet fragments between the facet joints removed its malpositioned plate following fusion. No new neurological deficit was observed. Cases that underwent anterior open reduction did not encounter failure that require subsequent posterior reduction surgery. One study (N = 52) on old dislocation incorporated partial corpectomy in their approach and limited anterior-alone approach to cases with persistent instability.Conclusions:This systematic review supports the efficacy and success of anterior reduction, fusion, and instrumentation for cervical facet fracture dislocation. It is safe from a neurological standpoint. Revision rate due to concurrent facet fracture is low. Certain patients may require posteriorly based surgery or in specific cases combined anterior and posterior procedures.

Clinical outcomes of arthroscopic lateral ulnar collateral ligament repair with or without intra-articular fracture.

The pathoanatomy and biomechanics of elbow instability have been previously reported; however, few researchers have dealt with the operative management and clinical consequence of recurrent elbow instability. Recent studies on arthroscopic lateral collateral ligament (LCL) complex repair have reported successful outcomes similar to those achieved by open repair. We aimed to determine the validity of arthroscopic repair of the LCL complex in elbows with unstable dislocation with or without intra-articular fracture. Eighteen consecutive patients who had undergone arthroscopic repair of the LCL complex for unstable dislocation of the elbow with or without intra-articular fracture and who were followed for at least 12 months were included in the study. Ligament injury combined with coronoid and/or radial head fractures were treated with arthroscopic technique. Pain, range of motion, clinical outcomes based on the Mayo Elbow Performance Score (MEPS), and surgical complications were evaluated. At 12 months follow-up, all 18 patients demonstrated complete settlement of the instability and mean (and standard deviation) extension of 1.7 ± 3.8°, flexion of 138.3 ± 3.8°, supination of 88.6 ± 5.3°, and pronation of 88.2 ± 5.6°. The average MEPS was 97.7 ± 3.9 points and according to this validated outcome score. However, slight widening (2 mm) of the radiocapitellar joint space was accompanied in one patient, although the varus stress test and pivot shift test were not observed. One patient showed delayed union of the anteromedial facet fracture, and two patients showed pin site irritation, which was a complication of arthroscopic coronoid fracture fixation and was fully resolved after pin removal. In patients with unstable elbow dislocation, with or without an intra-articular fracture, arthroscopic repair of the LCL complex is an effective and alternative treatment option that can restore elbow stability and have satisfactory clinical and radiographic results.