Full Range Of Motion Research Articles

Length Unstable Pediatric Tibial Shaft Fracture Treated With Cerclage Augmented Elastic Intramedullary Nails: A Novel Technique

Introduction: Tibial shaft fractures are common injuries in the pediatric population that can reliably be treated with conservative treatment. However, unstable tibial shaft fractures in the pediatric population have limited operative treatment options because the skeletal immaturity of these patients makes rigid intramedullary devices contraindicated in this population, and external fixation strategies are associated with a high complication rates. Elastic nailing with cerclage is a minimally invasive, and relatively soft tissue sparing technique that can decrease wide dissection and periosteal stripping associated with plating. However, treating long oblique length unstable femur fractures with elastic nails has been shown yield good result; EIN in length unstable tibia shaft fractures with elastic nails has not been explored. Materials and Methods: Review of 2 patients receiving novel cerclage augmented elastic nailing technique. Results: Patients included had complete follow-up to fracture union, had no surgical complications postoperatively, and no failure of fixation. Patients achieved full range of motion and strength compared with the contralateral uninjured limb. Both patients returned to preinjury activity levels with no limitations. Discussion: We present a novel technique using elastic nails in unstable long oblique tibia fractures with a cerclage augment. This can expand EIN indications to provide a load-sharing construct with relative stability to length unstable tibia fractures that EIN use would typically be contraindicated. This in turn affords the benefits of EIN such as reliable fracture healing, excellent functional and cosmetic results with a safe and reproducible surgical technique.

Biomechanical evaluation of a novel biomimetic artificial intervertebral disc in canine cervical cadaveric spines.

Cervical disc replacement (CDR) aims to restore motion of the treated level to reduce the risk of adjacent segment disease (ASD) compared with spinal fusion. However, first-generation articulating devices are unable to mimic the complex deformation kinematics of a natural disc. Thus, a biomimetic artificial intervertebral CDR (bioAID), containing a hydroxyethylmethacrylate (HEMA)-sodium methacrylate (NaMA) hydrogel core representing the nucleus pulposus, an ultra-high-molecular-weight-polyethylene fiber jacket as annulus fibrosus, and titanium endplates with pins for primary mechanical fixation, was developed. To assess the initial biomechanical effect of the bioAID on the kinematic behavior of the canine spine, an ex vivo biomechanical study in 6-degrees-of-freedom was performed. A canine cadaveric biomechanical study. Six cadaveric canine specimens (C3-C6) were tested in flexion-extension (FE), lateral bending (LB) axial rotation (AR) using a spine tester in three conditions: intact, after C4-C5 disc replacement with bioAID, and after C4-C5 interbody fusion. A hybrid protocol was used where first the intact spines were subjected to a pure moment of ±1Nm, whereafter the treated spines were subjected to the full range of motion (ROM) of the intact condition. 3D segmental motions at all levels were measured while recording the reaction torsion. Biomechanical parameters studied included ROM, neutral zone (NZ), and intradiscal pressure (IDP) at the adjacent cranial level (C3-C4). The bioAID retained the sigmoid shape of the moment-rotation curves with a NZ similar to the intact condition in LB and FE. Additionally, the normalized ROMs at the bioAID-treated level were statistically equivalent to intact during FE and AR while slightly decreased in LB. At the two adjacent levels, ROMs showed similar values for the intact compared to the bioAID for FE and AR and an increase in LB. In contrast, levels adjacent to the fused segment showed an increased motion in FE and LB as compensation for the loss of motion at the treated level. The IDP at the adjacent C3-C4 level after implantation of bioAID was close to intact values. After fusion, increased IDP was found compared with intact but did not reach statistical significance. This study indicates that the bioAID can mimic the kinematic behavior of the replaced intervertebral disc and preserves that for the adjacent levels better than fusion. As a result, CDR using the novel bioAID is a promising alternative treatment for replacing severely degenerated intervertebral discs.

Titanium elastic nail treatment for a humeral shaft fracture of an adolescent arm wrestler: A case report and literature review

Arm wrestling is a sport where two people take opposing positions at a table and put their elbows on the table with their palms together, the aim being to make the opponent’s hand touch the table. Arm wrestling, which seems harmless, may become a show of strength for adolescents and young adults. Muscle and tendon injuries and bone fractures may occur due to arm wrestling. Fractures of the humeral shaft and distal third region can also occur due to arm wrestling. Here, we present the contribution of closed reduction and titanium intramedullary nail treatment to early return to school for a 14-year-old male patient with an AO 12.A1 fracture of the humeral shaft that occurred during arm wrestling. Our treatment reduced the duration of immobilization, provided complete union at the fracture site along with full range of motion of shoulder and elbow joints at 3 months after the injury.

Congenital Knee Dislocation: Help for Neonatologists and Pediatricians

Congenital knee dislocation is relatively rare pathology of the musculoskeletal system. Timely diagnosis and treatment onset allow us to achieve full range of motion in the knee joint. However, low awareness of physicians in these topics and, as a result, diagnostic errors lead to pseudo-correction and motor deficit in the knee joint. This article describes correct examination of a child with congenital knee dislocation directly in the delivery room, management after discharge, and subsequent patient's routing with the assistance of orthopedic traumatologist.

Posterior osteosynthesis with a new self-designed lateral mass screw-plate system for unstable atlas burst fractures

BackgroundIn the treatment of unstable atlas fractures using the combined anterior–posterior approach or the posterior monoaxial screw-rod system, factors such as severe trauma or complex surgical procedures still need to be improved despite the favourable reduction effect. This research described and evaluated a new technique for the treatment of unstable atlas fracture using a self-designed lateral mass screw-plate system.MethodsA total of 10 patients with unstable atlas fractures using this new screw-plate system from January 2019 to December 2021 were retrospectively reviewed. All patients underwent posterior open reduction and internal fixation (ORIF) with a self-designed screw-plate system. The medical records and radiographs before and after surgery were noted. Preoperative and postoperative CT scans were used to determine the type of fracture and evaluate the reduction of fracture.ResultsAll 10 patients were successfully operated with this new system, with an average follow-up of 16.7 ± 9.6 months. A total of 10 plates were placed, and all 20 screws were inserted into the atlas lateral masses. The mean operating time was 108.7 ± 20.1 min and the average estimated blood loss was 98.0 ± 41.3 ml. The lateral mass displacement (LMD) averaged 7.1 ± 1.9 mm before surgery and almost achieved satisfactory reduction after surgery. All the fractures achieved bony healing without reduction loss or implant failure. No complications (vertebral artery injury, neurologic deficit, or wound infection) occurred in these 10 patients. At the final follow-up, the anterior atlantodens interval (AADI) was 2.3 ± 0.8 mm and the visual analog scale (VAS) was 0.6 ± 0.7 on average. All patients preserved almost full range of motion of the upper cervical spine and achieved a good clinical outcome at the last follow-up.ConclusionsPosterior osteosynthesis with this new screw-plate system can provide a new therapeutic strategy for unstable atlas fractures with simple and almost satisfactory reduction.

Efficacy of transcranial direct current stimulation (tDCS) on pain and shoulder range of motion in post-mastectomy pain syndrome patients: a randomized-control trial

BackgroundPost-mastectomy pain syndrome (PMPS) is a highly prevalent complication after surgical treatment for breast cancer, and it affects the patient’s quality of life in aspects of losing shoulder full range of motion, pain, and depression. Transcranial direct current stimulation (tDCS) is non-invasive brain stimulation technique that was used in numerous clinical applications and in pain reduction in cancer patients. However, the effectiveness of tDCS on PMPS has never been evaluated in an experimental study.AimTo investigate the effect of bilateral anodal tDCS of motor cortex (M1) on pain, depression, and shoulder range of motion (ROM) in post-mastectomy pain syndrome.Study designRandomized controlled trial.MethodsA total of 30 female patients with post-mastectomy neuropathic pain were randomized into two groups; the intervention group which received bilateral tDCS on motor cortex (M1) and the control group that received sham bilateral tDCS on M1. As pain affects shoulder range of motion (ROM), shoulder ROM was measured by electronic goniometer pre- and post-tDCS application. In addition, the levels of pain and depression have been measured pre and post treatment. Pain has been measured with visual analogue scale (VAS) and depression with Beck-Depression-Inventory-BDI questionnaire (BDI).ResultsA significant difference was noted in group A regarding pain, depression and shoulder ROM (p= 0.001, p= 0.003, and p= 0.003, respectively). Between group comparison revealed a significant difference of VAS scores and shoulder flexion ROM between groups, the study group and the control group (p=0.041 and 0.048, respectively). Pain decreased by 32% and Shoulder flexion increased by 4.8% post-treatment while there were no significant difference in group B (p=0.567 and p=0.866, respectively).ConclusionsThe application of tDCS decreases the severity of pain and improves shoulder range of motion suffered by breast cancer patients after total mastectomy surgery.

Clinical Outcomes ofFixation ofDepressed Posterolateral Tibial Plateau Fractures Using a Direct Lateral Approach.

Fixation of plateau posterolateral fracture (PLF) is challenging because the fracture site is mostly covered by vital neurovascular structures. We operated on 15 cases of PLF using a direct lateral approach. This study aims to report on clinical results. Between 2017 and 2019, 15 cases of PLFs were fixed with a direct lateral approach and a tricortical autologous bone graft from the iliac crest. A depression of more than 2mm was indicated for the surgical treatment. Clinical evaluation included Lysholm score, International Knee Documentation Committee Score (IKDC) score, and Tegner activity scale after two years follow-up. The last follow-up was at 24months after the operation. The mean postoperative Tegner activity scale did not change significantly compared to before the injury (6.5 (6-7) vs. 7 (6-8, p = 0.5)). The postoperative IKDC and Lysholm scores improved significantly compared to before the operation (p < 0.001). The full range of motion was seen in all patients except one who was manipulated after three months. Surgical treatment using a direct lateral approach is a safe procedure for PLFs that results in good, short-term clinical and radiologic outcomes without fibular osteotomy or compromising the important neurovascular structures. IV.

EPIPHYSIS INJURY AROUND KNEE (FLEXION TYPE, SALTER-HARRIS TYPE 1)

Introduction: Fractures of the proximal tibial and distal femur epiphysis rare. It has been estimated that fractures of the upper tibial and distal femur epiphysis account for 0.5-3.1% of all epiphyseal injuries. Who had no neurovascular decit, with xed extension deformity at the left knee was treated early with closed reduction techniques. We present a case of a adolscent child who develops injury while playing. The patient p Case Series: resented in emergency room with extremely swollen knee and soft tissue swelling (hemarthrosis), he was unable to lift his leg actively due to severe pain because of hamstrings spasm, and he had no wound over his left knee and had no other associated injuries. Plain radiographs were taken which revealed, separated proximal tibial and distal femur epiphysis (salter harris Type 1 injury) The epiphysis was anteriorly displaced fracture line extending beyond growth plate through metaphysis and tibial tuberosity also displaced anteriorly, no patellar fracture, radiograph also revealed no intra-articular fracture as joint appears congruent. Under spinal anesthesia, under all aseptic precautions traction was applied for few minutes, the fracture was reduced closed as the hamstring spasm gave way, reduction was conrmed under image intensier in both AP and lateral planes, and joint congruity was examined. Post-operative patient was immobilized with nil weight bearing for 4 weeks, check X-rays taken, he was mobilized in wheelchair. After 4 weeks slab was removed, K-wires were removed, and partial weight bearing was started with rehabilitation for full range of motion of the left knee. At 6 weeks, both the knee joints appeared symmetrical with no abnormalities or limb length discrepancy or instability with knee from 0° to 140°, with full weight bearing. Although Conclusion: less commonly seen, Salter-Harris Type 1 injuries to proximal tibial and dista femur physis, if managed early with closed reduction and xation, excellent long-term results can be achieved

Successful Use of WALANT in Local and Regional Soft Tissue Flaps: A Case Series.

A retrospective review was performed. Twenty-one patients who underwent a local or regional soft tissue flap surgery using the WALANT technique from February 2, 2018 to February 25, 2022 were included in our analysis. Overall, one Louvre flap, two posterior tibial artery perforator propeller flaps, two reverse radial forearm flaps, two Quaba flaps, six cross finger flaps, one reverse homodigital island flap, three first dorsal metacarpal artery flaps, two thenar flaps, and two Moberg flaps were performed. Patients were followed up for an average of 11.9 ± 8.1 weeks. During this time, no postoperative complications occurred. All patients demonstrated appropriate healing at donor and recipient sites. Full range of motion was regained for all patients. WALANT is safe and effective for use in local and regional soft tissue flap surgery. Surgeons should consider this technique for more involved procedures such as flap surgery, as preliminary results demonstrate positive outcomes and potentially superior recovery for patients.

BEDA PENGARUH ANTARA PEMBERIAN CONTRACT RELAX DENGAN HOLD RELAX TERHADAP PENINGKATAN FLEKSIBILITAS OTOT HAMSTRING PADA ATLET SMAN 18 MAKASSAR

Background: Flexibility is the ability of a tissue or muscle to experience maximum lengthening so that the body can move with the full range of motion of the joints, without the onset of pain. Decreased hamstring flexibility can be caused by several factors, such as shortening of the hamstring muscles, acute or chronic injury to the hamstring muscles, decreased hip joint, excessive activity, and improper training patterns.Methods: This study was a quasi-experimental study using a two-group pre-test and post-test design. The aim was to determine the different effects of the Contract Relax intervention compared to the Hold Relax on increasing the flexibility of the Hamstring muscles. This research was conducted at SMA N 18 Makassar, with the sample being students who fit the inclusion criteria. The number of samples was 20 people who were randomly divided into 2 groups, namely the treatment group I who were given Contract Relax as many as 10 people and the treatment group II who were given Hold Relax as many as 10 people.Results: Based on the analysis of the paired sample t-test in the treatment group I obtained a p value &lt;0.05 with pre and post test results of 0.00 for the Sit and Reach value which means that Contract Relax can result in a significant increase in Hamstring muscle flexibility. While the treatment group II also obtained a p value &lt;0.05 with pre and post test results of 0.00 for the Sit and Reach value which means that holding Relax can result in a significant increase in Hamstring muscle flexibility. Then based on the Independent sample t-test, a p value &lt;0.05 was obtained for the Sit and Reach value, which means that Hold Relax is significantly more effective than Contract Relax for increasing hamstring muscle flexibility.Conclusion : Hold Relax is better than Contract Relax in increasing the flexibility of the Hamstring musclesKeywords: Contract Relax, Hold Relax, Hamstring Flexibility

Autologous semitendinosus meniscus graft significantly improves knee joint kinematics and the tibiofemoral contact after complete lateral meniscectomy

PurposeThe purpose of this study was to investigate the potential of a doubled semitendinosus (ST) and a single gracilis tendon (GT) lateral meniscus autograft to restore the knee joint kinematics and tibiofemoral contact after total lateral meniscectomy (LMM).MethodsFourteen human knee joints were tested intact, after LMM and after ST and GT meniscus autograft treatment under an axial load of 200 N during full range of motion (0°–120°) and four randomised loading situations: without external moments, external rotation, valgus stress and a combination of external rotation and valgus stress using a knee joint simulator. Non-parametric statistical analyses were performed on joint kinematics and on the tibiofemoral contact mechanics.ResultsLMM led to significant rotational instability of the knee joints (p < 0.02), which was significantly improved after ST autograft application (p < 0.04), except for knee joint flexions > 60°. The GT autograft failed to restore the joint kinematics. LMM significantly increased the tibiofemoral contact pressure (p < 0.03), while decreasing the contact area (p < 0.05). The ST autograft was able to restore the contact mechanics after LMM (p < 0.02), while the GT replacement displayed only an improvement trend.ConclusionThe doubled ST lateral meniscus autograft improved the knee joint kinematics significantly and restored the tibiofemoral contact mechanics almost comparable to the native situation. Thus, from a biomechanical point of view, ST meniscus autografts might be a potential treatment alternative for patients who are indicated for meniscus allograft transplantation.

One Step Tenotomy in Congenital Torticollis: A Case Report

BACKGROUND: Congenital muscular torticollis (CMT) is a common pediatric abnormality involving sternocleidomastoid (SCM) muscle. The pathogenesis of CMT has yet to be elucidated, but intrauterine abnormalities seem to be a plausible explanation. This condition, if left untreated, may result in craniofacial asymmetry, neck pain, and limited neck movement. We reported a case of an 11-year-old girl with CMT, which symptoms were first noticed at the age of 4, but were neglected by her parents, the patient was then treated with a complete unipolar SCM release. CASE PRESENTATION: An 11-year-old girl presented with neck stiffness and limited head movement, first noticed at the age of 4, but was neglected. These symptoms worsened within the last few weeks. Physical examination revealed tension and tightness in the left SCM muscle. The patient then underwent complete unipolar release of SCM muscle and proceeded to aggressive physiotherapy for 3 months and put to rigid collar neck for the next 3 weeks. Follow-up was done in the fourth week and a full range of motion (ROM) of the neck was achieved. DISCUSSION: The timing of surgery could yield a good result if performed within 1–4 years of age. However, another literature stated that surgical intervention in the older patient with CMT could still result in better outcomes. Therefore, in this case, we proceeded to perform a complete unipolar release on the left SCM muscle. Post-operative results were satisfying, with significant improvement in neck ROM. CONCLUSION: Surgical approach in adolescents with CMT may still carry a favorable outcome, in terms of better ROM and neck motion. Subsequent physiotherapy and brace placement were crucial to maintaining the results of the surgery.

Acupuncture for treating adhesive capsulitis (frozen shoulder): A Case report

This case study discloses acupuncture treatment performed on a patient who presented with adhesive capsulitis (frozen shoulder) for a period of 4 months. After 15 treatment sessions which also included two sessions of aquapuncture, the patient was pain free and achieved a full range of motion of the glenohumeral joint.

Nontuberculous Mycobacterial Tenosynovitis of the Hand: A 10-Year Experience at Two Centers in South Korea.

The aim of this study was to investigate the clinical characteristics of nontuberculous mycobacterial tenosynovitis and to report the process of diagnosis and the outcomes of surgical debridement and drug administration in South Korea. Between 2010 and 2019, 23 patients (10 men and 13 women) with nontuberculous tenosynovitis of the hand were treated at two centers. Their average age was 64 years, and the average duration of symptoms was 8 months (range, 1-36 months). Eight patients had a history of trauma or surgery. The average number of corticosteroid injections before diagnosis was 2.6 for 7 patients. All 23 patients were treated with a combination of extensive tenosynovectomy and antibiotics. Of the 23 patients, 20 were available for the final follow-up (1, lost to follow-up; 1, transferred to another hospital; and 1, died from a comorbidity). The most common species was Mycobacterium intracellulare (70%), followed by Mycobacterium abscessus (10%). The frequency of involvement of the extensor/flexor tendon was similar to that of the wrist/finger. The mean number of surgical debridement operations was 2.2. The average duration of antibiotic administration was 9.8 months. At the last follow-up, 3 patients were symptom-free with full range of motion at the involved site, 1 patient complained of localized swelling or pain with full range of motion, 1 patient was found to have a recurrence of infection in a finger, and 15 complained of restricted joint motion. The most common species noted in patients with nontuberculous mycobacterial tenosynovitis was M. intracellulare. Patients with only 1 finger involved showed good range of motion at the final follow-up. Most patients experienced delayed wound healing and adverse effects from drug therapy during treatment and limited joint motion at the final follow-up.

Radiographic Investigation of Lumbar Vertebrae in Patients with Flexion and Extension Movement Disorder Syndrome.

The kinesiopathology model is a new rehabilitation model classifying, evaluating, and treating patients with non-specific back pain. Sahrmann proposed this model based on movement disorder syndromes. The present cross-sectional study aimed to evaluate the radiograph of the linear and angular displacement of the lumbar spine in patients with lumbar flexion impairment syndrome (LFIS) and lumbar extension impairment syndrome (LEIS). In this study, 50 adults aged 18-46 years were enrolled, including 25 patients with LFIS and 25 with LEIS. The eligible participants were referred to the radiology department for radiography in the common position of neutral, full extension, and full flexion position while standing. The White and Panjabi's method was used to measure the linear and angular displacements. Moreover, pain intensity was assessed using the visual analogue scale, and functional disability was investigated using a modified Oswestry Disability Questionnaire. The parameter of the linear displacement at the L3-L4 level was significantly different between the two groups (P=0.02). The mean duration of low back pain was longer in the LEIS, compared to the LFIS group (P=0.01). In patients with LEIS, compensatory responses occur that cause less linear displacement at the L3-L4 level, compared to the patients with LFIS. Therefore, it is important to design appropriate exercises to better control the linear displacement at the L3-L4 level during the full range of motion in patients with LFIS.

A pediatric forearm fracture case with delayed union, re-fracture, and COVID-19 pandemics-related surgical delay

While several complications are described after intramedullary fixation using Titanium Elastic Nails (TEN) for pediatric forearm fractures, delayed union rates are reported to be around 4%. A 12-year-old patient, who underwent TEN after a forearm fracture, was recommended to have a secondary surgery due to nonunion at the ulna after 16 weeks of follow-up. Unfortunately, the existing callus formation was lost after the patient received a second blow during the preoperative preparation process. Moreover, the family refused the operation because of the fear of the COVID-19 pandemic. The patient’s family gave consent after 35 weeks, and the patient was taken under the operation. The complete union was achieved with a full range of motion after 6 months of follow-up. In conclusion, in pediatric forearm fractures, one should be careful about the delayed union, carry out close follow-up and thorough evaluation, and secondary surgery should not be avoided when necessary.

PCL Reconstruction Surgery in Third Grade PCL Rupture: A Case Series

Objective: The PCL is the largest and strongest intraarticular ligament of the knee joint, comprising of 2 functional bundles: the larger anterolateral bundle (ALB) and the smaller posteromedial bundle (PMB). Posterior cruciate ligament (PCL) tears comprise 3% of outpatient knee injuries. The treatment of complete, isolated PCL tears remains controversial. Some studies have reported good outcomes after conservative treatment of partial PCL tears, while others have reported poor results at long-term follow-up with disabling symptoms and functional limitations. This case series reported the first experience of PCL reconstruction in our institution and its associated outcome. Methods: This prospective case series was conducted from January to December 2021. Two patients were included in this case series. All the patients were diagnosed with PCL tear by an Orthopaedic surgeon. clinical examination, knee radiograph, and MRI were obtained in both patients. All patients underwent arthroscopic PCL reconstruction by a single senior Orthopaedic surgeon. Physical therapy was performed after the surgery. Clinical evaluation was followed up for 9 months. The outcome in this case series was the posterior drawer test and range of motion. Result: Two patients were included in this case series. A favorable outcomes were noted following PCL reconstruction surgery. There were negative posterior drawer test, posterior sag sign, and full range of motion in both patients. Conclusion: A PCL reconstruction surgery provided a satisfactory clinical outcome in terms of posterior drawer test, posterior sag sign, and range of motion. PCL reconstruction surgery is recommended in patients who present with grade 3 PCL injury.

A comparative study of functional outcome of criss-cross pinning vs parallel pinning for Gartland type III supracondylar humeral fractures in children in tertiary care centre

Introduction: Supracondylar fracture of the humerus is the most frequently encountered elbow injuries among children that occupies around 60% of all elbow injuries in the initial ten years of life. Trouble in reduction and its maintenance, recurrent association of neurovascular structures injury are the common complications of displaced supracondylar fractures.Methods: Around 64 patients with displaced type III supracondylar fractures of humerus were selected who fulfilled our inclusion criteria. The method of patient selection for criss-cross pinning (GROUP-1) or parallel pinning (GROUP-2) be random. All the children with suspected supracondylar fractures of the humerus were assessed for vascular and neurological status. Clinical evaluation was graded according to carrying angle and elbow range of motion using the criteria of Flynn. Radiographic evaluation was performed at 3rd week, 6 week and at 3 and 6 months. In the 3rd week, the pins were removed. At 3- and 6-month follow-up, the children were evaluated for full function, minor limitation of function and major loss of function. Result: All the 64 subjects in our study had full range of motion postoperatively. The carrying angle in group 1 Vs group 2 was 11.18±1.99 Vs 11.96±1.92. The Baumann’s angle in group 1 Vs group 2 was 71.59±3.10 Vs 71.65±2.23. Flynn et al. in group 2 with parallel all the 100% had excellent score whereas in group 1, 94% had excellent Conclusion: From our study, we concluded that the lateral pinning technique provides better functional outcome as cross pinning technique in the management of displaced supracondylar fracture of humerus in children. When compared to crossed wire pinning, lateral pinning avoids the risk of nerve injury, reduces operation time and have Flynn excellent scores.

A Case Report of Ring Tourniquet Syndrome: A Paradigm of Danger

Ring Tourniquet Syndrome (RTS) is a rare but potentially serious condition that occurs when a small, tight object such as a hair, thread, or string becomes wrapped around a finger, toe, or other body part, creating a tourniquet-like effect. This can lead to tissue damage, swelling, a bluish colour of the finger, and in severe cases, loss of the affected digit or limb. Here, we present a case of an 11-year-old female patient who was diagnosed with RTS due to a metallic latch on the left index finger. The patient was managed with the removal of the latch under local anaesthesia in the operating theatre and regained full range of motion without any signs of ischemia on a 2-week follow-up. This case report highlights the successful salvage of a finger affected by RTS through prompt recognition and appropriate intervention.

Stabilizacija preloma distalnog okrajka ključne kosti Neer IIB tipa upotrebom Tightrope sistema - prikaz slučaja

Introduction: Fractures of the distal end of the clavicle account for 10% - 30% of all fractures of this bone, however, they account for as many as 50% of nonunions and malunions in clavicle fractures. Of all distal clavicle fractures, the highest percentage of complications appertain to Neer type IIB fractures. The aim of this paper is to describe the case of a female patient with a Neer type IIB clavicle fracture treated by fracture reduction and flexible stabilization of the coracoclavicular joint using the TightRope system. Case report: A 48-year-old female patient, injured in a traffic accident while driving a car, suffered a Neer type IIB fracture of the distal edge of the left clavicle. Three days after the injury, the patient underwent indirect stabilization surgery of the coracoclavicular joint by fixation, with the application of the TightRope system. Rehabilitation began on the first postoperative day and was completed three months after surgery, with the achievement of full range of motion in the left shoulder, return of muscle tone and strength of the shoulder muscles, followed by a return to everyday life and work activities, as before the injury. Conclusion: Although no gold standard exists in the operative treatment of the above-described injuries, the indirect method of stabilization and flexible fixation of the coracoclavicular joint, using different types of sutures, achieves good to excellent results. Comparing this method with other described techniques indicates that it has a better functional result, which is achieved faster with a lower complication rate. Our patient's functional results contribute to literature data and yet again demonstrate the effectiveness of this type of treatment for these complex injuries.