Rim Fractures Research Articles

Prevalence of Asymptomatic Acetabular Labrum Abnormalities in the Active Pediatric Population.

The prevalence of labral tears in asymptomatic active adults has been reported, but the prevalence of labral tears and other incidental hip lesions in the asymptomatic active pediatric population remains unclear. The purpose of this study was to determine the prevalence of hip abnormalities detected on 3T MRI in an active pediatric population with no hip symptoms and to compare with hip abnormalities found in children and adolescents who underwent an MRI for a hip-related condition. After IRB approval, pediatric patients self-reporting as athletes and presenting with isolated, acute-onset knee pain requiring knee MRI were prospectively recruited to undergo 3T MRI of their asymptomatic contralateral hip (ASx). A comparison group of pediatric subjects who underwent an MRI for hip pain was enrolled retrospectively (Sx). All MRI scans were anonymized and randomized. Fifty subjects were enrolled for each cohort. Two fellowship-trained musculoskeletal radiologists independently evaluated MRIs for abnormal hip lesions, including labral tears. Inter-reader reliability was evaluated using Cohen Kappa. χ2 or Fisher exact test was used to compare the prevalence of hip lesions between the 2 cohorts. The average patient age was 14.9 years for both cohorts (range 9 to 18y) and 48% were male. In the ASx group, incidental labral tears were found in 18%, labral/paralabral cysts 6%, cartilage lesion 0%, subchondral cyst 0%, ligamentum teres tear 0%, femoral fibrocystic change 0%, cam lesion 30%, acetabular bone edema 0%, acetabular rim fracture 0%. The prevalence of labral tears (30%, P-value 0.16) and cam lesion (36%, P-value 0.52) in the Sx group was not significantly different from the ASx cohort. No significant correlation was found between the presence of femoral neck osseous bump and labral tear, labral cyst, or paralabral cyst in either cohort. Labral tears were present on 3T MRIs of active pediatric patients with and without hip pain. Although MRI is essential to confirm the surgeon's suspicion and to detect unexpected pathology, clinical examination and history are crucial in pinpointing clinically relevant abnormal imaging findings. Level III.

Treatment of anterior rim fractures of the distal radius with an anterior rim plate: A retrospective study.

Treatment of distal radial fractures that include small anterior rim fragments can be difficult. We retrospectively reviewed 19 patients in whom an anterior rim plate with locking screws was used. After a median follow-up of 18 months (range 6-32; interquartile range (IQR) 14, 26), the median wrist flexion and extension arc was 70° (range 50-80; IQR 60, 70), the median grip strength was 80% of the contralateral side (range 52-104; IQR 77, 88), the median visual analogue scale score for pain was 0 (range 0-5; IQR 0, 1), the median disabilities of the arm, shoulder and hand score was 2 (range 0-59; IQR 0, 11) and the median modified Mayo wrist score was 80 (range 35-100; IQR 75, 85). Two patients exhibited loss of reduction; one was treated conservatively and the other underwent revision surgery. Our findings support anterior rim plates as a treatment option for anterior rim fractures if they are properly placed.Level of evidence: IV.

Management of Distal Radius Rim Fractures-Technical Pearls.

Distal radius fractures are common and vary based on their fracture pattern. Fractures distal to the watershed line are called rim fractures or marginal fractures. In addition to challenges already faced when treating distal radius fractures at other sites, rim fractures pose particular challenges in proper identification, reduction, and stabilization. This article reviews this specific subset of distal radius fractures and its management.

Treatment Effectiveness of Volar Plates in Distal Radius Dorsal Rim Fractures.

Objective To assess the efficacy of distal radius volar plates in cases involving dorsal fragments at the Ulnar Corner (UC) and Lister Tubercle (LT). Methods A retrospective study that included patients with distal radius fractures (DRFs) featuring UC and LT dorsal fragments treated with volar plates. The exclusion criteria comprised lunate facet fractures, UC fragment ratio below 25%, and patients treated with dorsal plates. Radiographic and tomographic measurements included radial length (RL), radial inclination (RI), ulnar variance (UV), palmar tilt (PT), fragment areas, UC fragment ratio, and displacement. The scores on the Gartland Werley (GW) classification and on the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, as well as grip strength, and range of motion (ROM), were assessed. Results The study involved 17 male and 5 female subjects (mean age: 39.7 ± 10.7 years). The UC and LT fragments displayed mean areas of 1.6 ± 0.7cm 2 and UC fragment ratio of 0.4 ± 0.1. The fixation rates for UC and LT fragments were of 18.2% and 31.8% respectively. Improved RI, UV, and PT were noted postoperatively. The mean GW and DASH scores were of 2.1 ± 2.0 and 4.3 ± 3.2 respectively. Grip strength on the operated side was of 89.5 ± 9.8% of the healthy side, and at least 90.9% of the patients achieved adequate ROM. Conclusion While volar plates are the standard treatment for intra-articular DRFs, displaced dorsal fragments can impact the outcomes. Mini dorsal incisions may aid in the fixation of UC fragments that are challenging to secure with volar plates, preserving joint health.

Objective analysis of orbital rim fracture CT images using curve and area measurement

The orbital bone presents a closed curve, and fracture results in disfigurement. An image analysis procedure was developed to examine before and after corrective surgery. An ellipse and circumscribed contour embodied the closed curve. Three-dimensional (3D) computed tomography (CT) images were collected from 25 patients. Orbital rim data were generated, and binary images were created to facilitate closed curve analysis. Various indices, including the solidity value (closed curve area/convex hull area) and ellipse distance (discrepancy between the closed curve and the ellipse traversing the curve), were utilized. The ratios of various indices—including the number of vertices, solidity value, and ellipse distance—between the affected and unaffected sides showed postoperative values that were closer to 1, which would indicate perfect symmetry, than the preoperative measurements (P < 0.05). The solidity value increased, while both the ellipse distance and curvature values decreased, reflecting the transformation of bends into smooth contours following reduction surgery (P < 0.05). Significant correlations were observed between 1-solidity, ellipse distance, and curvature using the Pearson correlation test (P < 0.05). This study validated postoperative changes in various indices and established correlations among multiple values, specifically solidity, ellipse distance, and curvature. Employing multiple indices with mutual complements has provided objective information confidently.

Computed tomography of the equine caudal spine and pelvis. Pathological findings in 56 clinical cases (2018-2023).

Computed tomography (CT) of the axial skeleton is increasing across many equine hospitals. CT of the pelvis and caudal spine in a large group of clinical cases has not been reported previously. To describe the pathological lesions identified in the caudal spine/pelvis in horses and ponies undergoing CT spine of this region. A retrospective case series. Horses with CT imaging of the caudal spine/pelvis were included. Horses aged under 6 months and those with CT examinations performed post-mortem were excluded. Fifty-six horses met the inclusion criteria. Ages ranged from 8 months to 20 years and bodyweights from 85 to 680 kg (mean 488 kg). Horses presented predominantly for lameness (30/56) and poor performance (18/56). Osseous pathology was identified in 41/56 horses; including osteoarthritis of the sacroiliac joint(s) (n: 28), pathology of the intervertebral disc joint(s) (n: 12), pelvic fractures (n: 9), osteoarthritis of the coxofemoral joint(s) (n: 8), ventral spondylosis (n: 6), acetabular rim fracture (n: 2), dislocation of coxofemoral joint(s) (n: 2), and dorsal dermal sinus of the sacrum (n: 1). The relationship between CT imaging findings and clinical signs in horses remains unclear. Further work is required to describe the relationship between congenital, developmental, and acquired changes in the caudal spine and pelvis, and clinical signs. CT of the caudal spine and pelvis can be utilised in horses and ponies for diagnosing a range of clinical disorders that may be causing 'lumbosacroiliac pain', poor performance, hindlimb lameness, and stiffness. The pathologies we observed were diverse and many patients had multiple lesions.

Surgical management and results of glenohumeral combination fractures of the anterior glenoid rim and the proximal humerus

IntroductionThe combination of anterior large glenoid rim fractures (GRF) and proximal humerus fractures (PHF) is rare, with limited data available on specific treatments for these glenohumeral combination fractures (GCF). This study aimed to evaluate the treatment approaches for GCF, analyze patient outcomes, and outline surgical management strategies for different fracture types.Materials and methodsThis retrospective study included patients with GCF, excluding those with fossa glenoidalis fractures, isolated greater tuberosity fractures, or small glenoid rim fractures (< 5 mm). Preoperative radiographs, CT scans, and follow-up radiographs were reviewed. Clinical outcomes were assessed using the Constant-Murley Score (CMS), Western Ontario Shoulder Instability Index (WOSI), Rowe Score (RS), and Oxford Shoulder Score (OSS).ResultsSixteen patients with 17 GCFs (mean age 62 years) were followed for an average of 39 months. PHFs were categorized into three-part (76%), four-part (12%), and two-part fractures (12%). The average medial displacement of GRF was 5 mm, with an average dehiscence of 4 mm in the sagittal plane. Fourteen patients (88%) underwent surgical treatment; 35% had only the PHF surgically addressed, while 53% had both lesions surgically treated. Two patients (12%) received non-operative treatment. Complications were observed in 29% of cases, primarily involving the humeral side. The average CMS was 68 points, WOSI was 75%, RS was 77 points, and OSS was 41 points.ConclusionTreating GCF is complex and routinely necessitates surgical intervention, with or without GRF refixation. CT imaging is crucial for precise assessment of fracture morphology. The involvement of the minor tuberosity is critical in selecting the optimal surgical approach and managing the subscapularis muscle.

Arthroscopic repair of anteroinferior glenoid rim fractures: mean 10-year clinical and radiologic results

BackgroundTo date, long-term results of the arthroscopic repair of glenoid rim fractures are missing. The aim of this study was, to evaluate clinical and radiographic results following arthroscopic repair of anteroinferior glenoid fractures using anchors or bioabsorbable compression screws after a mean follow-up period of ten years. MethodsClinical outcome measures included evaluation of recurrent instability, the Constant Score (CS), Subjective Shoulder Value (SSV), Rowe Score (RS), Western Ontario Shoulder Instability Score (WOSI) and Melbourne Instability Shoulder Score (MISS). X-ray images were obtained for assessment of an instability arthropathy (IA). Results23 patients (7 female and 16 male, mean (± SD) age 48 ± 15 years) who underwent arthroscopic repair of an acute substantial solitary or multifragmented anteroinferior glenoid rim fracture were enrolled. After a mean follow-up period of 10 ± 2 years, patients reached a mean CS of 92 ± 10 points, SSV of 93 ± 11%, RS of 84 ± 20 points, WOSI of 98 ±2% and MISS of 91 ± 11 points. No patient suffered recurrent dislocation. Radiographic results were obtained of 18 patients. Signs of IA were noted in nine patients (50%) with progression of IA in all cases in comparison to the preoperative status. Patients with IA were significantly older (52 versus 38 years, p = 0.04). Clinical score results did not show a significant difference in patients with versus without IA except for the RS (74 versus 94 points, p = 0.02). No intra- or postoperative complications were observed, and no patient required revision endoprosthetic surgery. ConclusionArthroscopic repair of acute anteroinferior glenoid rim fractures shows good clinical long-term results. High rates of IA were observed especially in older patients. However, the presence of IA did not seem to influence the subjective shoulder score outcomes.

Arthroscopic suture anchor fixation results in similar clinical outcomes, less range of motion limitation, but poorer quality of reduction compared to open screw fixation for acute large anterior glenoid rim fractures

BackgroundThe purpose of the present study was to retrospectively compare the clinical and radiological outcomes of arthroscopic suture anchor fixation and open screw fixation for acute large anterior glenoid rim fractures. MethodsThis study enrolled patients with acute large anterior glenoid rim fractures treated with arthroscopic suture anchor fixation (group A) or open screw fixation (group O) from January 2013 to June 2020 with a minimum follow-up of＞2 years. The Subjective Shoulder Value (SSV), American Shoulder and Elbow Surgeons (ASES) score, Rowe score, Constant score, range of motion (ROM), recurrent instability rate, and complications were recorded as clinical results. The quality of the postoperative reduction, reconstructed glenoid sizes, rate of fracture healing, and progression of osteoarthritis (OA) were evaluated as radiological outcomes. ResultsThis retrospective study included 66 patients, including 37 in Group A and 29 in Group O with a mean follow-up of 46.9 (range, 24.3-94.2) months and a mean patient age of 46.8 (range, 21-69) years. No significant differences were found in the clinical outcomes between the two groups. A significant ROM limitation in all planes was found in both groups and group O showed more limitations in external rotation at the side (ERs) (18° vs. 10°, P = 0.002). The reduction quality was better in group O (P < 0.001). However, there was no significant difference between the two groups in terms of reconstructed glenoid size (101.6% ± 4.6% vs. 100.6% ± 7.1%, P = 0.460) and the rate of OA progression (26.9% vs. 20%, P = 0.525). ConclusionArthroscopic suture anchor fixation and open screw fixation achieved similar clinical outcomes, reconstructed glenoid sizes, and OA progression in patients with acute large anterior glenoid rim fractures. Arthroscopic suture fixation showed a poorer quality of reduction but less ERs limitations.

Clinical Significance of the Inferomedial Orbital Strut in Orbital Blowout Fractures: Incidence of Symptomatic Diplopia in a Fractured vs. Intact Strut.

Background/Objectives: This study aims to compare the clinical findings, particularly symptomatic diplopia, associated with an inferomedial orbital strut fracture versus intact strut and to determine the clinical significance of the inferomedial orbital strut in patients with orbital floor and medial orbital wall fractures. Methods: A 10-year retrospective observational study involving orbital blowout fracture cases was conducted in our institution. Patients with fractures of the orbital floor medial to the infraorbital groove and medial orbital wall, as seen on computed tomography (CT) scans, were included in this study. Patients with concomitant orbital rim fracture and those with old orbital fractures were excluded. Fracture of the inferomedial orbital strut was diagnosed via coronal CT images and patients were classified into those with an inferomedial orbital strut fracture and those without. Results: A total of 231 orbits from 230 patients was included in the study (fractured strut on 78 sides and intact strut on 153 sides). Approximately 2/3 of patients in both groups had the field of binocular single vision in primary position upon first examination (p = 0.717). Patients with strut fractures demonstrated only comminuted or open fractures, while those without strut fractures showed diverse fracture patterns (p < 0.001). Conclusions: Inferomedial orbital strut fracture does not automatically result in diplopia in patients with orbital blowout fractures. The integrity of the orbital periosteum plays a more essential role in hampering extraocular muscle displacement, thereby preventing symptomatic diplopia in these patients.

Biomechanical analysis using finite element analysis of orbital floor fractures reproduced in a realistic experimental environment with an anatomical model.

Introduction: In this study, we attempted to demonstrate the actual process of orbital floor fracture visually and computationally in anatomically reconstructed structures and to investigate them using finite element analysis. Methods: A finite element model of the skull and cervical vertebrae was reconstructed from computed tomography data, and an eyeball surrounded by extraocular adipose was modeled in the orbital cavity. Three-dimensional volume mesh was generated using 173,894 of the 4-node hexahedral solid elements. Results: For the cases where the impactor hit the infraorbital foramen, buckling occurred at the orbital bone as a result of the compressive force, and the von Mises stress exceeded 150MPa. The range of stress components included inferior orbital rim and orbital floor. For the cases where the impactor hit the eyeball first, the orbital bone experienced less stress and the range of stress components limited in orbital floor. The critical speeds for blowout fracture were 4m/s and 6m/s for buckling and hydraulic mechanism. Conclusion: Each mechanism has its own fracture inducing energy and its transmission process, type of force causing the fracture, and fracture pattern. It is possible to determine the mechanism of the fracture based on whether an orbital rim fracture is present.

Incidence of Pure Orbital Fractures with Concomitant Lacrimal Drainage System Injury in the Japanese Population: A Retrospective Study

ABSTRACT Purpose This study aims to determine the incidence of pure orbital fractures with concomitant lacrimal drainage system injuries. Methods A retrospective observational study involving 956 sides from 940 pure orbital blowout fracture patients was conducted in our institution. Patients with concomitant orbital rim fracture and those with old orbital fractures were excluded. Results A total of 13 sides (1.4%) from 13 patients were included in the study. Canalicular laceration, bony nasolacrimal canal fracture, and lacrimal sac wall laceration were found in 9, 4, and 1 patients, respectively (one overlapping). Majority of the injuries resulted from either sports or falls. Inferomedial orbital strut fracture (23.1% vs. 7.6%; p = .075) and orbital floor fracture occurring lateral to the infraorbital groove (30.8% vs. 9.9%; p = .035) tended to be higher in patients with lacrimal drainage system injuries. Conclusion There is a 1.4% incidence rate of pure orbital fractures with concomitant lacrimal drainage system injuries among the Japanese population included in this study. Inferomedial orbital strut fractures and orbital floor fracture lateral to the infraorbital groove were found to have higher association with lacrimal drainage system injuries.

Epidemiology, treatment, and mortality of 3973 scapula fractures from the Swedish fracture register

BackgroundScapula fractures are relatively uncommon, accounting for <1% of all fractures and approximately 3-5% of shoulder girdle fractures. This study comprehensively describes the epidemiology, fracture classification, treatment, and mortality associated with scapula fractures within a large adult Swedish population. MethodsThis observational study included all patients ≥18 years old at the time of injury with a scapula fracture (ICD S42.1) registered in the Swedish Fracture Register between March 2011 and June 2020. Variables studied were age, sex, and injury mechanism, including energy level, fracture classification, associated fractures, treatment, and mortality. ResultsWe included 3,930 patients (mean age 58 years, SD 18, 64% men) with 3,973 scapula fractures. Some 22% of the fractures were caused by high-energy trauma and 21% had at least one associated fracture. High energy-injuries were most common in glenoid neck (44%) and scapular body (35%) fractures. However, same-level falls were the most common cause of glenoid rim (62%) and intra-articular glenoid (55%) fractures. Clavicle fractures (9%) and proximal humerus fractures (5%) were the most commonly associated fractures. The most common fracture types were the glenoid rim (n=1,289, 32%) and scapular body (n=1,098, 28%) fractures. Nonoperative treatment was performed in 81% of patients. Glenoid rim and intra-articular glenoid fractures were treated operatively in over 30% of cases. The mortality rate for the whole cohort was 4% at 1 year. ConclusionsScapula fractures are predominately sustained by men. High energetic injuries and associated fractures are present in one in five patients. Nonoperative treatment is chosen in four of five patients, but for some fracture types one in three undergo surgery.

Arthroscopic suture bridge fixation for acute bony Bankart with anterior glenohumeral instability: a case report and narrative review.

Anterior shoulder dislocations can result in acute glenoid rim fractures that compromise the bony stability of the glenohumeral joint. Adequate fixation of these fractures is required to restore stability, decrease shoulder pain, and facilitate return to activity. The double-row suture bridge is a relatively novel fixation technique, first described in 2009, that accomplishes internal fixation with sufficient stability using an all-arthroscopic technique to restore the glenoid footprint. A 40-year-old female with recurrent anterior shoulder instability in the setting of seizure disorder was found to have a bony Bankart lesion of 25% to 30% with a concomitant superior labral tear. The patient was treated with a double-row bony Bankart bridge and labral repair. At six months follow-up, she has progressed to a full recovery with no recurrence. A search was conducted in May 2023 in PubMed, EMBASE, and CINAHL with the search terms bony Bankart, bone Bankart, osseous Bankart, acute, bridge, suture bridge, double row. Double-row suture bridge repairs result in improvement in shoulder function as determined by ASES (93.5), QuickDASH (4.5), SANE (95.9), and SF-12 (55.6). The overall recurrence rate of anterior instability after a bony Bankart bridge repair is 8%. When examining the return to prior level of function, 81.4% of patients were able to do so with only 7.9% of patients reporting significant modifications to their activity level. In mid-term results, double row suture bridge demonstrates similar outcomes to other all-arthroscopic fixation methods of bony Bankart injuries. Importantly, bony Bankart bridge remains a viable option for critical glenoid lesions over the 20% cutoff used in other all arthroscopic techniques. Biomechanically, the double-row suture bridge offers distinct benefits over its single-row counterpart including increased compression, reduced displacement, and reduced step-off. Although there is limited data, the studies discussed and the demonstrative case show the potential benefit of all-arthroscopic double-row suture bridge fixation including increased compression, decreased displacement, and a lower complication rate in patients with large bony Bankart lesions traditionally requiring bony augmentation. However, more robust studies are necessary to determine the long-term success of the double-row suture bridge.

Clinical and radiological assessment of open and closed reduction of inferior orbital rim fracture

Clinical and radiological assessment of open and closed reduction of inferior orbital rim fracture

Adjunctive dorsal spanning plate fixation for challenging distal radius injuries

BackgroundDistal radius fractures with severely osteoporotic bone or articular comminution can provide challenges to fixation with traditional volar locked plating alone. The purpose of this study was to evaluate the clinical, radiographic, and patient reported outcomes of patients undergoing distal radius fixation with volar locked plating and adjunctive dorsal bridge plating. MethodsWe retrospectively identified 16 patients with distal radius fractures who underwent our preferred surgical technique for fixation. Patients underwent volar locked plate fixation as well as dorsal bridge fixation at time of surgery. Seven patients were indicated for severe articular comminution with volar rim fragmentation (44%), three patients were revised for nonunion after previous volar locked late fixation (19%), and six patients had severely osteoporotic bone with articular comminution (38%). Two patients (13%) sustained AO/OTA 23-A3 distal radius fracture, two patients (13%) had a 23-B3 fracture, two patients (13%) had a 23-C2 fracture and ten patients (63%) had a 23-C3 fracture. ResultsThe average patient age was 51.8 years ± 20.6. Patients were followed for an average of 12.2±6.3 months. The dorsal bridge plate was removed at an average of 11.1±2.4 weeks. The average post-operative radial inclination was 18.9±2.4°, radial height 12.4 mm ± 2.6 mm, and volar tilt 7.1±1.9°. There were no cases of deep or superficial infection. After dorsal bridge plate removal, patients demonstrated an average wrist extension of 55.3±9.5°, flexion 54.4±12.8°, radial deviation 15.7±3.2°, 25.2±3.9 degrees of ulnar deviation. ConclusionDistal radius fractures in the setting of severely osteoporotic bone, salvage procedures, articular comminution, volar rim fractures, and revision surgery present uniquely difficult surgical challenges. Volar locked plating with adjunctive dorsal bridge plating can be used with good short- and long-term results.

Lateral Tarsoplasty Combined with a Full-Thickness Skin Graft for Managing Severe Lower Eyelid Ectropion Following the Subciliary Approach for Infra-Orbital Rim Fracture: A Retrospective Observational Study.

Subciliary incision is a common approach for facial fracture surgery; however, it has a higher incidence of lower lid ectropion, which can be particularly challenging for beginning surgeons to manage. This study reports the usage of lateral tarsoplasty combined with a full-thickness skin graft (FTSG) to correct severe ectropion following the subciliary approach for infra-orbital rim fractures. We retrospectively reviewed all facial fracture cases involving infra-orbital rim fractures through a subciliary approach treated in our department between March 2021 and May 2023. Electronic medical records and clinical digital photographs of patients who met the inclusion criteria were reviewed. After reviewing 196 cases that used the subciliary approach, we found 6 patients (3.06%; 4 males and 2 females; mean age, 68.5 ± 4.89 years) with postoperative severe ectropion managed using lateral tarsoplasty and FTSG. The mean ectropion development and correction times after facial fracture surgery were 0.78 ± 0.24 and 0.91 ± 0.37 months, respectively. At the 12-month follow-up, all patients showed favorable outcomes, and the position of their lower eyelids was well maintained without ectropion recurrence. Based on these successful outcomes, lateral tarsoplasty combined with FTSG is proposed to be an effective and straightforward method for managing lower eyelid ectropion caused by facial fracture surgery.

Perforating Ocular Sickle Knife Trauma: a Case report

Introduction : Perforating ocular injury can lead to disability or even mortality. Most individuals sustaining eye injuries are male in young age. This is a report of an extreme case when a sickle knife stabbed in the right eye of a young male cause perforating of the eyeball.&#x0D; Case Illustration : Seventeen years old young male presented to Emergency Room of Sukabumi Regional Public Hospital with pain and bleeding in his right eye an hour before. He had been hacked during a brawls. There was a wound in the right supraorbita area and a big sickle knife stuck in the head and tear the eye ball. Visual acuity was no light perception in his right eye. Anterior segment examination of the right eye revealed perforated sclera and cornea. X-ray examination showed fracture of the roof of the right orbit and a metal object had stuck into the Orbits. The sickle knife extraction, enucleation and superior orbit reconstruction of the right eye was done.&#x0D; Discussion : Identification of wounds caused by sharp metal foreign body is very important for the subsequent treatment of injuries. If the eyeball cannot be preserved, then enucleation can't be avoided. In this case, hard impact of sharp object around of the eye are also cause fracture of superior orbital rim. Reconstruction of the orbital roof using titanium and micro screws given the most stable and effective results.&#x0D; Conclusion : Removing a metal foreign body and anatomical defect management is important for a good outcome.

Arthroscopic Fixation of Acute Large Bony Bankart with Suture-assisted Reduction and Screw Fixation - Surgical Technique.

Glenoid rim fractures with Bankart lesions are called bony Bankart lesions and are associated with persistent glenohumeral joint instability. Acute bony Bankart lesions can be treated by various arthroscopic techniques. Here, we present a technique of arthroscopic bony Bankart repair using suture-assisted reduction and screw fixation. The conventional suture anchor repair does not provide compression of the fractured fragment, and the bony piece may tilt because of the single-point fixation. This procedure can achieve firm compression between the bony fragments and prevent rotation of fragment during screw fixation to the glenoid. The capsular plication distributes the loads to the surrounding soft tissues. Hence, this procedure should be offered to all patients presenting acutely with a large bony Bankart of size >25% of glenoid width, as it is minimally invasive as well as provides excellent outcomes and anatomical union.

Intermediate to Long-Term Results Following Traumatic Hip Dislocation: Characteristics, CT-Based Analysis, and Patient-Reported Outcome Measures.

Traumatic hip dislocation is a rare yet severe injury. As the long-term morbidity, subsequent complications, and clinical outcomes are nearly unknown, we aimed to analyze traumatic hip dislocations and identify specific factors that may predict the clinical outcome. Data on injury-related characteristics and computed tomographic (CT) scans for all consecutive adult patients who had been managed for traumatic hip dislocation between 2009 and 2021 were analyzed. At the time of follow-up, the patients were assessed with regard to osteonecrosis, posttraumatic osteoarthritis (OA), further operations and complications, return to sports and work, and patient-reported outcome measures (PROMs), including the Tegner Activity Scale and modified Harris hip score. One hundred and twelve patients (mean age [and standard deviation], 43.12 ± 16.6 years) were included. Associated acetabular rim and femoral head fractures (Pipkin Type I to IV) were observed in 44% and 40% of patients, respectively. Concomitant injuries occurred in 67% of the patients, most commonly involving the knee (29% of patients). Sixty-nine patients (61.6%) were available for follow-up; the mean duration of follow-up was 6.02 ± 3.76 years. The rates of osteonecrosis and posttraumatic OA were 13% and 31.9%, respectively, and were independent of the timing of hip reduction, leading to subsequent total hip arthroplasty (THA) in 19% of patients. Sciatic nerve injury occurred in 27.5% of the patients who were available for follow-up. Both THA and sciatic nerve injury were associated with posterior acetabular rim or Pipkin Type-IV fractures (p < 0.001). Only 33.3% of the patients returned to their pre-injury level of sports, 24.6% did not return to work, and 27.5% reported having sexual dysfunction. PROMs (Tegner Activity Scale, modified Harris hip score) were significantly worse in patients with osteonecrosis, posttraumatic OA, or residual sciatic nerve injury (p < 0.05). Traumatic hip dislocations are predominantly associated with Pipkin and acetabular rim fractures, leading to overall limitations of activities of daily living, sports, and sexual function at intermediate to long-term follow-up. Patients with associated acetabular rim or Pipkin Type-IV fractures are most likely to require THA for the treatment of osteonecrosis or posttraumatic OA and are at greater risk for sustaining sciatic nerve injury. Prognostic Level IV . See Instructions for Authors for a complete description of levels of evidence.