Posterior Fracture-dislocation Research Articles

Usefulness of multiple bioabsorbable Mg screws/K‑wires for comminuted radial head fractures.

We hypothesized that multiple absorbable screws/K-wires would be effective for native head preservation in comminuted radial head fracture fixation (com-RHFs). Seventeen patients who met the inclusion criteria between 2018 and 2020 were included. Radiologic findings indicating proper union and clinical outcomes such as the range of elbow motion, visual analog scale score, and Mayo Elbow Performance Score were assessed prospectively after surgery and at least threeyears of follow-up. The mean follow-up period was 4.6years. Eleven, one, three, and two patients presented with isolated com-RHFs, type 2 (accompanied injury of medial collateral ligament), type 4 ("terrible triad") fractures, and type 5 posterior olecranon fracture-dislocations, respectively. Union was achieved after a mean of nineweeks postoperatively. The head and shaft angles did not differ significantly from the contralateral normal values (p = 0.778 and 0.872, coronal and sagittal, respectively). At the final follow-up, the mean flexion-extension/pronation-supination arcs were 126.47 ± 4.92°/135.59 ± 10.13°, and thus were significantly different from those on the contralateral side (p < 0.001, both), however the arcs were functional ranges for ordinary daily life. Also, functional status was satisfactory in all individuals. The arthritis grade and extent of heterotrophic ossification were satisfactory in all cases, and there were no serious complications requiring revision surgery. Absorbable screw/K-wire fixation for com-RHFs is an option before radial head arthroplasty associated with a low complication rate and no need for revision.

Locking plate fixation in comminuted coronoid fractures with partial loss of the articular cartilage – Of basal-1 type according to the O'Driscoll classification –

BackgroundWe have attempted to restore the arc of motion by considering trochlear-coronoid articulation as a complete circle during fixation of the coronoid, even for comminuted coronoid fractures with partial loss of articular cartilage (CCFPLAC), using various kinds of locking plates. Herein, we report the radiological and clinical outcomes after fixation of the basal-1 type of CCFPLAC (O'Driscoll classification) using our method. MethodsThirty-one patients diagnosed with CCFPLAC were admitted between January 2012 and December 2020. Sixteen of these patients met the inclusion/exclusion criteria and were enrolled in this study. Surgically, the lost area (defect of articular cartilage) was never compressed or minimized, but the original height and shape of the coronoid were preserved as is. Provisionally, a few K-wires were used to maintain the original shape and position of the CCFPLAC, and various kinds of locking plates/screws were used to fix the fragment anatomically and firmly. If needed, the plate was bent to ensure stable compression of the coronoid according to its size. In a few cases, locking plates were adjusted by cutting extra screw holes. ResultsAmong the 16 patients, the mean age was 46.2 years, and the male:female ratio was 10:6. The mean follow-up period was 3.63 years. 8, 6, and 2 patients were designated as group 1 (isolated CCFPLAC), 2 [CCFPLAC in type 4 (terrible triad) injury), and 3 (CCFPLAC in type 5 posterior olecranon fracture-dislocations), respectively. Complete union was achieved after a mean of 8.94 weeks. The mean flexion-extension and pronation-supination arcs were 127.19 ± 4.46° and 135.31.59 ± 8.06°, respectively, which were significantly different from those on the contralateral (normal) side (p < 0.001); however, the arcs were within the functional ranges for ordinary daily living. Additionally, the functional status was satisfactory in all patients. However, Mayo Elbow Performance Score and the degree of arthritis were statistically poor in group 2. ConclusionsCCFPLAC of the basal-1 type (O'Driscoll classification) can be treated satisfactorily if already designed and widely distributed locking plates are properly manipulated to maintain the original geometry of the coronoid according to the individual joint characteristics. Level of evidenceLevel IV, Retrospective case series

Poor midterm clinical outcomes and a high percentage of unsatisfying results are reported after seizure-related shoulder injuries, especially after posterior proximal humerus fracture-dislocations

Treating seizure-related shoulder injuries is challenging, and an evidence-based consensus to guide clinicians is lacking. The aim of this prospective single-center observational clinical trial was to evaluate the clinical results of a cohort of patients undergoing treatment of seizure-related shoulder injuries, to categorize them according to the lesion's characteristics, with special focus on patients with proximal humerus fracture-dislocations (PHFDs), and to define groups at risk of obtaining unsatisfactory results. We hypothesized that patients with a PHFD, considered the worst-case scenario among these injuries, would report worse clinical results in terms of the quick Disabilities of the Arm, Shoulder, and Hand questionnaire (qDASH) as compared to the other patients. Patients referred to a tertiary epilepsy center who have seizure-related shoulder injuries and with a minimum follow-up of 1 year were included. A quality-of-life assessment instrument (EQ-5D-5L), a district-specific patient-reported outcome measure (qDASH), and a pain assessment tool (visual analog scale [VAS]) were used for the clinical outcome evaluation. Subjective satisfaction and fear of new shoulder injuries was also documented. Categorization and subgroup analysis according to the presence and features of selected specific lesions were performed. A total of 111 patients were deemed eligible and 83 were available for follow-up (median age 38 years, 30% females), accounting for a total of 107 injured shoulders. After a median follow-up of 3.9 (1.6-8.2) years, overall moderate clinical results were reported. In addition, 34.1% of the patients reported a VAS score ≥35 mm, indicating moderate to severe pain, and 34.1% a qDASH score ≥40 points, indicating severe disability of an upper limb. These percentages rose to, respectively, 45.5% and 48.5% in the subgroup of patients with PHFDs and to 68.8% and 68.8% in patients experiencing posterior PHFD. Overall, 46.9% of the patients considered themselves unsatisfied with the treatment and 62.5% reported a persistent fear of a new shoulder injury. Patients with seizure-related shoulder injuries reported only moderate clinical results at their midterm follow-up. Older age, male sex, and absence or discontinuation of antiepileptic drug (AED) treatment were identified as characterizing features of patients with posterior dislocation episodes. In patients with PHFD, a tendency to worse clinical results was observed, with posterior PHFD patients emerging as a definite subgroup at risk of reporting unsatisfying results after treatment.

Modified McLaughlin procedure in posterior locked fracture-dislocation of the shoulder

The posterior shoulder dislocation is very uncommon scenario with incidence ranging from 3% - 5% of all different types shoulder dislocations and Locked posterior fracture dislocation of shoulder can be missed due to improper radiological investigations though patient have pain and difficulty in range of movements. The modified McLaughlin procedure in which both the tendon of Subscapularis along with Lesser tuberosity bone chunk were displaced and transferred into the Reverse Hill-Sachs lesion for stabilization.The procedure is aimed to achieve a stable Gleno-humeral joint as well as early and full functional recovery in cases of an acute posterior locked fracture-dislocation of the shoulder. Here, we discuss a posterior locked fracture dislocation which has been missed initially at a peripheral institute even though patient have pain and restricted range of movements. The patient was investigated thoroughly. The surgical note and physiotherapy protocol have been discussed in detail in the case report where the patient returned to pre-injury status in 3 months post-surgery.

Bilateral Locked Posterior Fracture-Dislocation of the Shoulder After Epileptic Seizures Secondary to Cavernous Hemangioma: A Case Report and Literature Review.

BACKGROUND Posterior shoulder dislocation is an uncommon injury, accounting for less than 5% of all glenohumeral dislocations. Bilateral locked posterior shoulder fracture-dislocation is an extremely rare entity with an incidence of 0.6 cases/100 000 people/year. A few reports have been published in the literature, predominantly associated with epileptic seizures. CASE REPORT We present a rare case of a 55-year-old male patient with a history of epileptic seizures, who presented with bilateral, locked, posterior fracture-dislocation of the shoulder following an epileptic seizure. The patient was diagnosed with a cavernous hemangioma, which caused his epileptic episode. He was treated operatively, with a modified McLaughlin procedure performed on both sides, at 1 stage, by 2 surgical teams. The cavernous hemangioma was also resected 2 months later. After a follow-up period of 18 months, no recurrent episodes of instability or dislocation were identified. Full range of motion was present on both sides, with good clinical and radiological outcomes. We also conducted a literature review to elucidate the causes of this rare incidence, along with diagnostic workup and treatment options. We were able to identify 36 cases, involving 72 shoulders of bilateral posterior fracture-dislocations in 30 case reports and 2 case series. CONCLUSIONS Bilateral posterior fracture-dislocation of the shoulder is uncommon. Treatment strategy depends on the chronicity, involvement of the humeral head, and the patient's age and functional level. The target is to restore shoulder anatomy and maintain a functional range of motion.

Humeral Head Three-Part Posterior Fracture-Dislocation Reduced through a Posterior Approach and Fixed with Blocked Threaded Wires: A Consecutive Case Series.

Background and Objectives: Posterior fracture dislocations are rare. There is currently no uniformity regarding treatment. Therefore, outcomes are difficult to compare. We evaluated clinical and radiological outcomes of patients with humeral head posterior fracture dislocation treated with an open posterior reduction and then fixed with a biomechanically validated configuration of blocked threaded wires. Materials and Methods: 11 consecutive patients with humeral head three-part posterior fracture dislocation were treated by reduction through a posterior approach and fixed with blocked threaded wires. All patients were clinically and radiographically evaluated after a mean follow-up of 50 months. Results: The mean irCS was 86.1% (range: 70.5-95.3%). No significant difference was found between irCS at 6 and 12 months postoperatively and the final follow-up. Six patients noted their pain intensity as 0/10, three as 1/10, and two as 2/10. The postoperative reduction was considered as excellent in eight patients (Bahr's criteria) and good in the remaining three; at the final follow-up, reduction was excellent and good in seven and four patients, respectively. The mean neck-shaft angles at FU 0 and at the final FU were 137° and 132°, respectively. No signs of avascular necrosis, non-union, and arthritis progression were seen. No recurrence of dislocation or posterior instability symptoms were reported. Conclusions: We believe that our very satisfactory results stem from: (1) the manual reduction of the dislocation through a vertical posterior surgical approach, which does not produce further osteocartilaginous damage of the humeral head; (2) no multiple perforations of the humeral head are performed; (3) the threaded wires have a smaller diameter than the screws, therefore they preserve the bone tissue of the humeral head; (4) deperiostization or further detachment of soft tissues are not expected; (5) the adopted and validated system is stable and limits translation, torsion, and the collapse of the humeral head.

Recognition of the pattern of complex fractures of the elbow using 3D-printed models.

This study aimed to answer the following questions: do 3D-printed models lead to a more accurate recognition of the pattern of complex fractures of the elbow?; do 3D-printed models lead to a more reliable recognition of the pattern of these injuries?; and do junior surgeons benefit more from 3D-printed models than senior surgeons? A total of 15 orthopaedic trauma surgeons (seven juniors, eight seniors) evaluated 20 complex elbow fractures for their overall pattern (i.e. varus posterior medial rotational injury, terrible triad injury, radial head fracture with posterolateral dislocation, anterior (trans-)olecranon fracture-dislocation, posterior (trans-)olecranon fracture-dislocation) and their specific characteristics. First, fractures were assessed based on radiographs and 2D and 3D CT scans; and in a subsequent round, one month later, with additional 3D-printed models. Diagnostic accuracy (acc) and inter-surgeon reliability (κ) were determined for each assessment. Accuracy significantly improved with 3D-printed models for the whole group on pattern recognition (acc2D/3D = 0.62 vs acc3Dprint= 0.69; Δacc = 0.07 (95% confidence interval (CI) 0.00 to 0.14); p = 0.025). A significant improvement was also seen in reliability for pattern recognition with the additional 3D-printed models (κ2D/3D = 0.41 (moderate) vs κ3Dprint = 0.59 (moderate); Δκ = 0.18 (95% CI 0.14 to 0.22); p ≤ 0.001). Accuracy was comparable between junior and senior surgeons with the 3D-printed model (accjunior = 0.70 vs accsenior = 0.68; Δacc = -0.02 (95% CI -0.17 to 0.13); p = 0.904). Reliability was also comparable between junior and senior surgeons without the 3D-printed model (κjunior = 0.39 (fair) vs κsenior = 0.43 (moderate); Δκ = 0.03 (95% CI -0.03 to 0.10); p = 0.318). However, junior surgeons showed greater improvement regarding reliability than seniors with 3D-printed models (κjunior = 0.65 (substantial) vs κsenior = 0.54 (moderate); Δκ = 0.11 (95% CI 0.04 to 0.18); p = 0.002). The use of 3D-printed models significantly improved the accuracy and reliability of recognizing the pattern of complex fractures of the elbow. However, the current long printing time and non-reusable materials could limit the usefulness of 3D-printed models in clinical practice. They could be suitable as a reusable tool for teaching residents.Cite this article: Bone Joint J2023;105-B(1):56-63.

Bilateral Posterior Fracture-Dislocation of the Shoulders Secondary to Uremic Encephalopathy.

Bilateral posterior fracture-dislocation of the shoulder is an uncommon injury pattern usually caused by epileptic seizures. The cause of the seizure activity remains unknown in most cases, although the injury has been associated with several conditions. A 59-year-old man with uncontrolled hypertension presented with new-onset generalized tonic-clonic seizures. He was diagnosed with uremic encephalopathy and bilateral posterior fracture-dislocation of his shoulders. His medical condition required stabilization leading to a delay in definitive surgery and a subsequent poor outcome. This case highlights the previously unknown association between bilateral fracture-dislocation of the shoulders and seizures caused by uremic encephalopathy. In these complex situations with competing clinical priorities, it is important to initiate prompt treatment of the cause in any new-onset seizures, to facilitate expedient surgical management of the orthopaedic injury.

A retrospective study of hip posterior fracture-dislocation: closed reduction at the emergency department or in the operation theater?

BackgroundFor hip posterior fracture-dislocation, the current consensus is to perform joint reduction within 6 h to prevent sequelae. However, whether a closed reduction (CR) should be performed at the emergency department (ED) or in the operation theater (OT) remains debatable. We aimed to assess the incidence and factors predictive of CR failure at the ED in patients with hip posterior fracture-dislocation.MethodsPatients with hip posterior fracture-dislocation between 2009 and 2019 were included. Age, sex, body mass index (BMI), injury severity score, new injury severity score, time from injury to first reduction attempt (TIR), presence of associated femoral head fracture, posterior wall marginal impaction, and posterior wall fragment size were compared between patients with CR success and patients with CR failure at the ED.ResultsFifty-five patients with hip posterior fracture-dislocation experienced CR attempts at the ED and were enrolled in the study. Thirty-eight (69.1%) hips were reduced successfully at the ED, and 17 (30.9%) experienced failure. No significant differences in age, sex, BMI, presence of femoral head fracture, marginal impaction, or size of the posterior wall fragment were found between the groups. TIR was significantly shorter in the successful CR group (2.24 vs. 4.11 h, p = 0.01). According to receiver operating characteristic curve analysis, 3.5 h was the cut-off time.ConclusionsFor patients with hip posterior fracture-dislocation, TIR was a critical factor for successful CR. If the time interval exceeds 3.5 h from injury, the success rate of bedside CR at the ER is likely to decrease, and the OT should be prepared in case of failed bedside CR.Level of Evidence III.

Treatment of Delayed Acetabular Fractures by Periacetabular Osteotomy through the Lateral-Rectus Approach.

There has been a controversy in the surgical approach for delayed acetabular fracture. The objective of the present study is to investigate the feasibility, surgical techniques, safety, and efficacy of periacetabular osteotomy using the single lateral-rectus approach (LRA) for the surgical treatment of delayed acetabular fracture. The retrospective study included 22 patients (16 males and six females, with an average age of 45 years) with delayed acetabular fractures from June 2012 to June 2019. For all cases, periacetabular osteotomy was performed through the single LRA. Fracture classification, mechanism of injury, associated injury, time to surgery, operation time, intraoperative blood loss, and complications were recorded and analyzed. The quality of the reduction was assessed based on Matta radiographic criteria. Potential impact factors affecting the quality of reduction were analyzed. Functional outcome was evaluated at the final follow-up according to a modified Mere D'Aubigne-Postel scoring system for each patient. All patients were followed up for at least 12months. The duration of surgery was 140 min on average (110-205 min) and the mean intraoperative blood loss was 1250 ml (500-2100 ml). According to Matta radiographic criteria, the accuracy of reduction was "anatomical" in seven patients, "imperfect" in 11 patients, and "poor" in four patients, with an excellent and good rate of 81.8%. The time to surgery in poor reduction group was significantly longer than anatomical or imperfect reduction group (p < 0.05). All the acetabular fractures united after 8-12 weeks. The average modified Merle D'Aubigne-Postel score evaluated at the final follow-up was 14.6 (6-18), and the clinical outcomes were rated as excellent in six patients, good in 10 patients, fair in four patients, and poor in two patients, with an excellent and good rate of 72.7%. There were two cases of osteonecrosis of the femoral head (9%). No other complication was found for all cases. The LRA is an effective and minimally invasive approach in the treatment of delayed acetabular fractures excluding posterior wall fracture and posterior dislocation.

Long-term follow-up of a posterior glenohumeral fracture-dislocation treated with open reduction and internal fixation: a case report

aGeorgetown University School of Medicine, Washington, DC bDepartment of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland Financial Disclosure: The authors report no conflicts of interest. Correspondence to Anand M. Murthi, MD, c/o Lyn Camire Jones, MA, ELS, Editor, Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, 3333 North Calvert Street, Suite 400, Baltimore, MD 21218 Tel: +410-554-6668; fax: +410-261-8105; e-mail: [email protected].

Good functional results with open reduction and internal fixation for locked posterior shoulder fracture-dislocation: a case series.

There is no standardized therapeutic strategy for locked posterior shoulder fracture-dislocation (PSFD), and no consensus exists on the analysis of preoperative factors. This retrospective study aimed to evaluate functional results and complications in a series of PSFD cases managed with open surgical treatment. Patients diagnosed with locked PSFD who underwent open surgical treatment with reduction and osteosynthesis between April 2016 and March 2020 were included. All participants were treated with open reduction and internal fixation. Functional assessment used the modified University of California, Los Angeles (UCLA) mod scale, American Shoulder and Elbow Surgeons (ASES) questionnaire, subjective shoulder value (SSV), and visual analog scale (VAS). Complications were evaluated clinically and radiologically by X-ray and computed tomography. Twelve shoulders were included (11 patients; mean age, 40.6 years; range, 19- 62 years). The mean follow-up duration was 23.3 months (range, 12-63 months). The UCLA mod, ASES, SSV, and VAS scores were 29.1±3.7, 81.6±13.5, 78±14.8, and 1.2±1.4 points, respectively. The overall complication rate was 16.6%, with one case of post-traumatic stiffness, 1 case of chronic pain, and no cases of avascular necrosis. Open surgical treatment of locked PSFD can achieve good functional results. A correct understanding of these injuries and good preoperative planning helped us to achieve a low rate of complications.

Man With Right Shoulder Pain

A 61-year-old man fell from his scooter resulting in right shoulder pain. The patient required first aid in a local hospital where plain film radiography showed no apparent abnormalities. He then presented to our emergency department due to persistent pain and an inability to move his right shoulder, with his right arm in a supportive sling. Radiography revealed rounding of the humeral head (Figure 1), which was confirmed by point-of-care ultrasound (Figure 2A ).Figure 2Point-of-care ultrasound, using a curvilinear probe in the transverse orientation behind the scapular spine. A, Before the procedure, the humeral head was protruding from the glenoid toward the posterior aspect of the shoulder, indicating a posterior dislocation. B, After the procedure, the humeral head was immediately adjacent to the glenoid, confirming a successful reduction. Ant, anterior side; Post, posterior side; Med, medial side; Lat, lateral side; D, deltoid muscle; G, glenoid; H, humeral head; I, infraspinatus muscle; S, scapula spine.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Posterior dislocation of the right shoulder. Point-of-care ultrasound showed that the humeral head protruded from the glenoid toward the posterior side. A closed reduction of the right shoulder was performed, and point-of-care ultrasound confirmed a successful reduction (Figure 2B). The patient was discharged and was followed up in an outpatient clinic. Posterior shoulder dislocations are rare. Missed diagnoses are frequent because the humeral head appears aligned within the glenoid fossa on plain film radiograph.1Hatzis N. Kaar T.K. Wirth M.A. et al.The often overlooked posterior dislocation of the shoulder.Tex Med. 2001; 97: 62-67PubMed Google Scholar,2Magnussen A.P. Watura C. Torr N. et al.Missed posterior shoulder fracture dislocations: a new protocol from a London major trauma centre.BMJ Open Quality. 2020; 9e000550Crossref Scopus (1) Google Scholar Additionally, patients with shoulder trauma usually have the shoulder immobilized with a sling at the time of imaging, causing the anteroposterior radiographs obtained to be imprecise with the expected rounding of the humeral head. This makes the characteristic “light bulb” sign on a radiograph unreliable.2Magnussen A.P. Watura C. Torr N. et al.Missed posterior shoulder fracture dislocations: a new protocol from a London major trauma centre.BMJ Open Quality. 2020; 9e000550Crossref Scopus (1) Google Scholar Ultrasonography is highly sensitive and specific for the identification of shoulder dislocation.3Gottlieb M. Holladay D. Peksa G.D. Point-of-care ultrasound for the diagnosis of shoulder dislocation: A systematic review and meta-analysis.Am J Emerg Med. 2019; 37: 757-761Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar Normally, the humeral head appears as a hyperechoic, semicircular line with an acoustic shadow immediately lateral to the glenoid. The humeral head will not be congruent to the glenoid in shoulder dislocations, appearing deeper with an anterior dislocation and more superficial with a posterior dislocation.

The survivorship and factors affecting the outcome of the use of spring plates in multifragmentary posterior wall acetabular fractures at a single academic institution.

Multifragmentary posterior wall fractures are not uncommon after posterior hip fracture-dislocation. They can be elementary but are commonly associated with transverse acetabular fractures. Specific technical challenges are encountered when managing these fracture patterns. The loss of the posterior landmarks due to the associated comminution may render achieving an anatomical reduction and stable fixation difficult. The application of spring plates can provide a good buttress with multiple anchor points and creates a new cortex for the bridging plate. -To assess the outcome and survivorship of the use of spring plates for the fixation of multi-fragmentary posterior wall fractures. -To analyse the factors affecting the outcome of the fixation of these challenging injuries. We retrospectively reviewed all the patients who underwent posterior wall acetabular fixation using a spring plate between December 2009 and March 2020 at our institution. Forty-seven patients had a minimum follow-up of 1year and were included in the study with a mean age of 36 ± 10years (range:17-60) and a mean follow-up period of 4.4 ± 3.5years. Seventeen patients had an associated transverse acetabular fracture, and an anterior columnar screw was used for additional fixation. Functional outcome was assessed using the Oxford hip score (OHS). Radiological assessment was undertaken for the images done immediately post-operatively and at the last follow-up. Patients with advanced post-traumatic arthritis and complications such as avascular necrosis (AVN), nerve injuries, non-union, heterotopic ossification and fixation failure were identified. The hazard rate of re-operation on the native hip was estimated using the life tables. Kaplan Meier analysis was used to assess survival with THR or excision arthroplasty as an endpoint. Six patients underwent a total hip replacement: secondary to AVN in four and infection in two patients. The hazard of THR was estimated at 6% (SE = 0.02) during the first three years, then decreased dramatically afterwards. The five-year survival of native hip was 83% (SE = 0.06). Native hip was expected to survive for 10.67years (95% CI 9.49-11.83) without joint replacement. The mean OHS in our cohort was 33.66 (3-48), and 29 patients (61.70%) had an OHS of more than 30. The use of spring plates to fix multifragmentary posterior wall fractures has excellent mid-term results, high survivorship and a low complication rate. Combining an anterior columnar screw and a posterior spring plate has shown to be a suitable fixation construct in selected patients with associated transverse acetabular fractures. A longer-term follow-up with a larger cohort using this fixation construct is needed.

Posterior hip fracture-dislocation associated with posterior wall fracture of the acetabulum and ipsilateral comminuted trochanteric fracture of the femur: A case report.

Introduction and importanceTraumatic posterior dislocation of the hip is often associated with fractures of the femoral head and posterior wall of the acetabulum. However, hip fracture-dislocation that includes the posterior wall of the acetabulum and the ipsilateral femoral trochanter is rare. There is no consensus on the bone that should be operated on first, the operative position, and the choice of implant for femoral fixation.Case presentationA 67-year-old man was brought to our emergency department after a 2-m fall. He was diagnosed with a hip fracture-dislocation associated with posterior wall acetabular fracture and ipsilateral femoral trochanteric fracture. Surgical reconstruction was performed with intramedullary nail (IMN) fixation of the femoral trochanteric lesion, followed by anatomically rigid acetabular fixation in the lateral decubitus position. At the 5-year follow-up after the injury, the patient showed good objective and subjective clinical outcomes.Clinical discussionFixing the femur first could allow an easier reduction and traction. The lateral decubitus position was useful, because fixation of the femur and the acetabulum could be performed without changing the position. When fixing the femoral trochanteric lesion, attention was paid to reduce the anteromedial cortex of the proximal fragment extramedullarly to the distal fragment to prevent complications such as cutout and implant breakage.ConclusionAnatomically rigid fixation of the posterior wall of the acetabulum secondary to IMN fixation of the femur, with anteromedial cortical support in the lateral decubitus position, could achieve good objective and subjective clinical outcomes.

Застарелый задний переломовывих плеча

Posterior fracture-dislocations often remain undiagnosed at initial medical attendance. In dislocation, the head of the humerus extends beyond the glenoid to form a zone of impaction, which “fixes” it. The injury is almost unidentifiable in standard frontal X-ray images. Meanwhile, continued fixation of the humerus in the state of posterior dislocation leads to a rapid progression of the traumatic impaction over up to 50% of the articular surface area. The associated damage to the articular lip of the scapula, rupture of the rotator cuff muscles, symptoms of shoulder instability after relocation, and severe pain syndrome require advanced treatments for this type of injury. Here we report a clinical case of anatomical neck fracture of the humerus with displaced consolidation, combined to posterior dislocation. To avoid subacromial impingement, instead of correcting the position of the head, we abandoned the reposition and performed an osteotomy with distal displacement of the greater tubercle of the humerus.

Functional outcome of posterior lip acetabular fracture and hip dislocation fixed with reconstruction plate.

Objective: To determine the functional outcome of posterior lip acetabular fracture and hip dislocation fixed with reconstruction plate. Study Design: Descriptive Case Series study. Setting: Department of Orthopaedic, Dr Ruth K. M. Pfau Civil Hospital Karachi. Period: August 2014 to December 2020. Material &amp; Methods: 36 patients were included in the study. Age between18 years to 60 years. All patients fixed with reconstruction plate. Harris hip score assessed at follow up till 12 months. Harris hip score above 90 was considered as excellent, between 70–89 as good and below 70 as poor. Results: The mean age of the patients was 43.67 ±11.56 years. Majority of the patients were males (n=29, 80.6%). Good functional outcome was found in (n=15, 41.7%) of the patients, excellent in 8 (22.2%) and poor in 13 (36.1%) patients. Satisfactory outcome was found in 23 (63.9%) patients. A significant association of satisfactory outcome was found with age (p-value &lt;0.001). Avascular necrosis 7, infection 5 and arthritis in 6 patients noted. One patient had associated sciatic nerve palsy, three had head of femur fracture and 1 with ipsilateral midshaft femur fracture. Conclusion: For posterior hip dislocation with lip fracture we suggest emergency reduction and timely fixation of posterior lip fracture can improve the clinical outcome of patient and even complications happen in future it preserve the bone stock for the future arthroplasty procedure.

Epidemiology and specific features of shoulder injuries in patients affected by epileptic seizures

PurposeEpileptic seizures can cause multiple shoulder injuries, the most common of which are dislocations, recurrent instability, fractures, and isolated lesions of the rotator cuff. Currently, only limited literature exists which describes the frequency and types of lesions in cohorts of epileptic patients and the corresponding treatment outcome. This study aims to document the occurrence of shoulder lesions in patients affected by seizures and to provide detailed information on trauma dynamics, specific lesion characteristics and treatment complications.MethodsAll patients referring to a tertiary epilepsy center were screened for shoulder injuries and the clinical records of those sustaining them during a seizure were reviewed. Demographic information, lesions’ characteristics and trauma dynamics were analysed, as wells as—when carried out—the type of surgical intervention and any postoperative complications.ResultsThe average age at the time of injury of 106 included patients was 39.7 ± 17.5 years and a male predominance was recorded (65%). Bilateral injuries occurred in 29 patients, simultaneously in 17 cases. A younger age, bilateral shoulder injuries and shoulder dislocations were significantly associated with the occurrence of a shoulder injury solely by muscular activation (p = 0.0054, p = 0.011, p < 0.0001). The complication rate in 57 surgically treated patients with follow-up data was 38.7%, with recurring instability being the most frequently reported complication (62.5%).ConclusionsUncontrolled muscle activation during a seizure is a distinctive but not exclusive dynamic of injury in epileptic patients, accounting for more than the half of all shoulder lesions, especially in the younger. This can lead both to anterior and posterior dislocations or fracture-dislocations and is frequently cause of bilateral lesions and of instability recurrence after surgery. The high complication rates after surgical treatment in this selected subgroup of patients require that appropriate preventative measures are taken to increase the probability of treatment success.Level of evidenceCohort study, level III.

Good Mid-Term Results After Surgical Treatment Preserving The Humeral Head In Posterior Fracture-Dislocations Of The Proximal Humerus

Good Mid-Term Results After Surgical Treatment Preserving The Humeral Head In Posterior Fracture-Dislocations Of The Proximal Humerus

Treatment strategies to prevent complications of posterior olecranon fracture dislocation based on poor grade case and review of literature

Treatment strategies to prevent complications of posterior olecranon fracture dislocation based on poor grade case and review of literature