A 10 wk old male shih tzu (1.9 kg) was presented for severe non-weight-bearing lameness of the right thoracic limb. Radiographs revealed luxation of the right humeroulnar joint (type II), with severe external rotation of the proximal ulna. The ulna was manually reduced to achieve articulation with the medial part of the humeral condyle under general anesthesia, which was maintained by two positive-profile threaded pins placed into the lateral part of the humeral condyle in a caudal to cranial direction ("stopper" antiluxation pins). The lameness improved at 5 days postoperatively. One pin appeared loose radiographically and both pins were removed at 30 days postoperatively. The dog showed no lameness with mildly limited range of motion with radiographic findings including the mild residual humeroulnar incongruity and degenerative joint disease at the final follow-up (6.8 yr postoperatively). We propose that this extra-articular method to prevent luxation is advantageous for its minimal adverse effect on elbow range of motion, as compared with the previously described methods including transarticular pinning and external fixators. This case report describes a novel treatment option for congenital humeroulnar luxation in very young dogs that maintains reduction and allows early return to function.

To report the use of a hybrid, transarticular external skeletal fixator and platelet-rich plasma injection without primary tenorrhaphy for management of partial calcanean tendon disruption in dogs. Multi-institutional retrospective study. A total of 11 client-owned dogs. Medical records from two referral centers from 2019 to 2022 were reviewed for inclusion in the study. Dogs diagnosed with partial, non-traumatic calcanean tendon disruption treated with hybrid, transarticular external skeletal fixation and platelet-rich plasma injection were included in the study. Cases that did not include complete postoperative follow-up over 8-12 weeks and owner-reported outcomes at >6 months were excluded from the study. Dogs with traumatic laceration or those in which a primary tenorrhaphy was performed were also excluded. A total of 11 (n = 11) dogs met the inclusion criteria. Median follow-up time was 18.5 months (6 months-34 months). Mean time of fixation was 9 weeks (6 weeks-12 weeks). Five dogs returned to full, pain-free function (5/11 = 45%). Five dogs had an acceptable return to function (5/11 = 45%). One dog had an unacceptable outcome (1/11 = 9%). Pin tract complications occurred in five dogs (5/11 = 45%) and resolved with medical intervention. The results of this study suggest that temporary tibiotarsal immobilization with a hybrid, transarticular external skeletal fixator and platelet-rich plasma injection without primary tenorrhaphy can lead to a successful outcome in dogs with partial calcanean tendon disruption. Temporary hybrid, transarticular external skeletal fixation and platelet-rich plasma injection without primary tenorrhaphy may play a role in the management of partial calcanean tendon disruption in dogs.

An 8-year-old, female, neutered mixed-breed cat presented with traumatic elbow luxation and radius fracture due to high-rise syndrome. According to the anamnesis, the trauma had occurred 10 days prior. Therefore, the patient was treated with an open reduction technique. The reduction of the elbow joint was performed with the cerclage transarticular external fixation (CTEF) method. Fixation of the radius fracture was performed using the paraosseous clamp cerclage method. The follow-up time for the patient was 1 year, and the functional outcome was considered fair due to humero-ulnar ankylosis of the elbow joint with 110° of extension. In this case report, post-operative long-term clinical and radiographic results were not as desired. This can be explained by the inability to perform surgery at the desired time, the severity of the trauma, and cartilage damage. However, further cases are required to determine whether this procedure is optimal for the treatment of traumatic elbow luxation in cats.

Abstract Objective Reporting the reinsertion of the triceps brachii onto the proximal ulna as a salvage procedure in a dog with nonreconstructible olecranon fracture. Case Description A Labrador Retriever was presented with a comminuted olecranon fracture. Initial fracture stabilization was unsuccessful, resulting in implant failure and a nonreconstructible comminuted fracture, thus preventing triceps tendon reattachment. Revision surgery was performed after the implants and bone fragments were removed. A synthetic implant was sutured onto the triceps tendon and fixed on the proximal ulna by an interference screw (IS) in a bone tunnel. A transarticular Jean-Alphonse Meynard external fixator was applied for 3 weeks. Results After 3 weeks, the dog had moderate lameness with a painless elbow. At 1.5 months, it had severe lameness with a painful elbow and mild osteoarthritis (OA). Nonsteroidal anti-inflammatory drugs were prescribed, and intensive physical therapy was initiated. Lameness improved at 2.5 and 3.5 months despite mild OA. At 9 months, the dog had mild lameness and a swelling of the elbow. Radiographs showed moderate OA and lucency around the IS. Bacteriologic examination was positive. The implants and infected tissues were removed, and antibiotics were prescribed for 1 month. At 18 months, the dog had mild lameness with no pain. At 33 months, it had intermittent mild lameness with no pain, yet severe OA. Conclusion Triceps tendon re-insertion onto the proximal ulna yielded satisfactory long-term outcome in this dog with nonreconstructible olecranon fracture.

Translated article] Subtalar dislocations: Analysis of a case series. Our urgent treatment algorithm

Objective To describe the clinical and surgical characteristics of external fixation technique to manage complex open proximal humerus fractures caused by high-energy firearm injuries at the Hospital Militar Central, Colombia. Methods A retrospective case series of patients with open complex proximal humerus fractures (Gustilo & Anderson III A-B or Neer III and IV) caused by long range or fragmentation weapons treated with external fixation. The variables are demographic data, range of motion, consolidation measurements, and functional outcomes according to the Quick Disabilities of the Arm, Shoulder and Hand (Quick DASH) functional scale. Results Seven male patients, with high-energy injuries causing open complex proximal humerus fractures (Gustilo & Anderson III A-B or Neer III or IV) underwent surgical treatment with external fixation and arthrodiastasis. Median age was 21.0 (19–24) years, mean treatment duration was 5.6 (4–7) months, and all patients completed 15 months of follow-up. Mean postoperative active movement measurements were flexion: 80° (40°–120°), abduction 85.7° (40°–130°), external rotation: 24.7° (10°–45°), and internal rotation: 23.6° (10°–45°). Mean postoperative pain according to visual analog scale was 2.7 (1–4) and mean Quick DASH was 36.2 (15.9–58). Two patients presented postoperative complications, one case each of infection and osteitis. Conclusion Complex open proximal humeral fractures caused by high-energy trauma treated with transarticular external fixation via arthrodiastasis show promising short-term and mid-term results with low complication rates, low levels of postoperative pain, and moderate functional results. This external fixation technique seems to be a valid option for the treatment of polytraumatic patients with humeral injuries. Longer follow ups and larger sample sizes studies must be presented to better characterize the clinical and satisfaction outcomes.

Luxaciones periastragalinas: análisis de una serie de casos. Nuestro algoritmo de tratamiento urgente

Congenital luxation of the ulnar and radius is a rare orthopaedic condition in the dog. This case report describes a novel surgical treatment for congenital elbow luxation in a medium-breed dog. A 6-week-old Kelpie presented for left forelimb lameness and deformity. Radiographs and computed tomography (CT) confirmed the diagnosis of unilateral ulnar and radius luxation. The surgical repair involved open reduction followed by fixation with an extraarticular pin and a transarticular external fixator. The outcome of surgery was improved leg function and weight-bearing, however, reluxation of the radial head was diagnosed 7 weeks following surgery. This technique may offer an alternative surgical option to improve clinical signs, as well as insight into improving the management of this condition.

Category: Ankle Arthritis; Arthroscopy; Trauma Introduction/Purpose: One of the options for the surgical treatment of tibial pilon fracture is the circular external fixator. Similar results are found in the literature, with good outcomes in relation to a low incidence of infection, osteomyelitis and soft tissue injuries compared to open reduction and internal fixation. Even so, evolution to a probable arthrodesis occurs in 3-27% of cases, showing that the prognosis for this type of fracture is dismal. Options for performing joint fusion include open arthrotomy with joint decortication and internal fixation (plates and/or screws), in addition to arthroscopic joint preparation, a method that has been gaining popularity since 1983, in its first description. Fusion through circular external fixation is an excellent option that has shown good results in the literature. Methods: Patient with left tibial pilon fracture. Uniplanar external fixation was performed in the emergency room, with subsequent conversion to transarticular circular external fixation. After 4 months of review, the patient has evidence of tibiotarsal arthrosis. It was decided to perform arthrodesis using the arthroscopic technique, performing joint compression with circular external fixation, already installed in the patient. Spinal anesthesia was performed on the patient and the Smarch tourniquet was used. First, access to the anteromedial portal, trocar and optic passage was obtained, and the intermediate dorsal cutaneous branch of the superficial peroneal nerve was identified laterally, and the anterolateral portal was constructed. Through these portals, a 4.5mm Shaver blade was used to perform curettage and joint debridement, in addition to curettes and osteotomes. In addition to arthroscopic control, fluoroscopic observation was also performed for adequate joint preparation.Finally, joint compression was performed with the device already installed. Results: The patient presented complete consolidation of the tibio-tarsal arthrodesis. At the moment (2 years and 10 months postoperatively) the patient does not use crutches/gait accessories, does not limit his daily activities due to foot problems, does not have difficulty going down and up stairs, has good ankle alignment, plantigrade foot, has no joint pain and can walk long distances. Conclusion: This work showed a technique rarely reported or cited in the orthopedic literature, not presenting any article as an original description. Supported by the description of the procedure by the robust final functional results of the patient in question, this report establishes the basis for the widespread method and new works to emerge to enrich the debate and study around arthroscopic ankle arthrodesis using the Ilizarov method.

Abstract A 6‐year‐old outdoor cat presenting with a progressive 5‐month duration right thoracic limb lameness was diagnosed with an articular fracture of the distal caudomedial part of the right humeral condyle. Surgical repair was performed via the modified Wendelburg caudomedial approach to the elbow using a positional screw to reduce the fragment and applying a temporary transarticular external skeletal fixator. Three weeks after surgery, the transarticular external fixator was removed and 6 weeks after surgery, a CT scan was performed revealing satisfactory bone healing. Eight months after the surgery, the cat had no lameness and a normal level of exercise.

This study is to explore the influence of palmar lateral joint capsule ligament complex on dorsal stretching stability of wrist lateral joint and to analyze its biomechanical principle, so as to provide reference for clinical medicine. To study the biomechanical characteristics of palmar lateral joint capsule posterior ligament complex, in this study we selected 8 freshly donated body upper limbs including 5 left ones and 3 right ones as research objects. By cutting off forearms and hand soft tissues and leaving wrist lateral joint capsule ligaments, the complex model was made, which can be used as normal sample. Extending from styloid process of radius to styloid process of ulna, we operated on distal ulna and cut off palmar lateral joint capsule ligament complex along an arc line and regarded it as a damaged sample. Through simulating actual clinical operation, the sample was repaired using an external fixation and analyzed according to wrist joint displacement load values. Results showed that regarding the same sample, the comparison of different displacement points was of statistical significance. In all, palmar wrist lateral joint capsule ligament complex is of vital importance, which is a key structure that determines the stability of wrist joint. Once the complex is injured, it will cause extremely serious consequences in which the most significant one is the wrist joint instability. In clinical practice, it cannot achieve very satisfactory effect by only repairing palmar lateral joint capsule ligament complex. By only relying on a transarticular external fixator, the complex can be successfully repaired and thus the complex injury displacement can be avoided and wrist joint stability be secured.

Abstract Case Presentation A 42-year-old man was transferred to our institution after a high-energy accident (an explosion). He presented second-degree burns on 20% of the total body surface area (TBSA), affecting the lower hemiabdomen and the lower right limb. He also presented a supraintercondylar open fracture of the right femur (Gustilo I). The burns were treated with debridement and coverage with mesh graft, while the fracture required an early transitory transarticular external fixation with delayed definitive osteosynthesis. Our patient presented good local and systemic evolution. We can offer a eleven-month follow-up. Discussion The literature supports that the combination of trauma and burn injuries is a relatively rare pattern, which may explain the lack of knowledge and studies on this subject. This double injury has demonstrated a synergistic effect on mortality. The management of soft tissues in the coexistence of an open fracture and a burn in the same limb is a challenge. The method and timing of the treatment of the fracture directly impacts the treatment of the burn (and vice versa), and most authors tend to treat the fracture first. All of the studies reviewed emphasized the importance of the multidisciplinary approach. Conclusions We have presented a complex case combining major trauma and severe burns. Although there is a lack of studies in the literature on this subject, the papers state that this is an unusual pattern with a synergistic effect on mortality. In our experience, the management of soft tissues and the multidisciplinary approach play a central role, as it is also stated in the literature. The management of these patients is still controversial, and more studies are needed.

Vascularized pedicled graft from distal radius for scaphoid nonunion with double stabilization: A long term follow up study

BackgroundThe topic that whether the injured deltoid ligament should be repaired when associated with ankle joint fractures is still discussed. The objective of this study was to compare the clinical effect of open reduction and internal fixation (ORIF) with deltoid ligament repair (DLR) or transarticular external fixation (TEF) in treating supination-external rotation type IV (SER IV) ankle fractures.MethodsBetween January 2012 and December 2015, 43 patients were diagnosed as SER IV ankle fractures, 20 underwent ORIF and transarticular external fixation (TEF) without DLR (group 1), 23 were treated with ORIF and DLR (group 2). The pre- and post-operative radiographic examination were performed, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, the visual analog scale (VAS), the Medical Outcomes Short Form 36-item questionnaire score (SF-36), and the ankle range of motion (ROM) were used for functional evaluation.ResultsIn both groups, the three scores improved significantly after surgery, but there was no significant difference between the two groups. At 6 weeks after surgery, patients in group 2 had better ankle ROM than group 1 (29.35 ± 2.033 vs. 40.35 ± 3.550, P < 0.001), but there was no difference at 12 months postoperatively. No cases of bone nonunion or post-traumatic arthritic changes were seen during the follow-up. Patients in group 1 required a shorter time to achieve fracture union than patients in group 2.ConclusionsORIF with TIF is an optional strategy to manage SER IV ankle fractures as it achieves comparable functional results to ORIF with DLR. It also allows patients to start relatively earlier weight-bearing and may promote fracture union.

Objective To investigate the causes and treatment strategy for postoperative complications following trans-articular external fixation in the elder patients with distal radius fracture of type C3. Methods The clinical data were retrospectively studied of the 226 patients with distal radius fracture of type C3 who had been treated by trans-articular external fixation from January 2011 to December 2016 at Department of Orthopaedics, Union Hospital. Of them, 42 (18.6%) suffered from postoperative complications. They were 12 men and 30 women, aged from 65 to 83 years (average, 68.4 years). Results Of the 42 patients, 22 (52.4%) had loss of reduction which was improved by timely adjustment of their external fixators, 14 (33.3%) had joint stiffness which was mitigated by physical therapy, 5 (11.9%) had traumatic arthritis which was relieved after medication and physical therapy, and one (2.4%) had pin tract infection which was controlled after antibiotic treatment and regular dressing change. Conclusion Although trans-articular external fixation is an effective treatment for elder patients with distal radius fracture of type C3, it is likely to result in a major complication, loss of reduction, which should be treated timely and effectively to avoid serious consequences. Key words: Radius; Fractures; External fixator; Complications of fracture

This article presents a novel surgical technique in the management of open complete talocrural luxations and evaluates the results, and clinical benefits with its routine clinical utilization. Retrospective study. Seventeen medium- or large-breed client-owned dogs of different breed, age and sex with complete talocrural luxations and radiographic follow-up of at least 24 weeks duration. Selective talocrural arthrodesis was performed by using a hybrid transarticular external skeletal fixator frame. Clinical and radiographical evaluation was performed regarding the lesion, concomitant injury, duration of the surgery, time to first use of the limb, fixator removal time, complications and clinical outcomes. Dogs started to use the injured limb between postoperative days 1 to 11. Pin or wire tract related complications were observed in all dogs. Time to fixator removal ranged from 57 to 90 days with a median of 73 days. All of the operated joints with an exception of one dog resulted in talocrural fusion. Mid-term clinical outcomes score was regarded as excellent in 13/17 dogs, good in 3/17 dogs and poor in 1/17 dogs subject to authors' evaluation. A transarticular hybrid external fixator may allow early use of postoperative limb with an excellent patient compliance and is well tolerated as well. The technique showed a promising opportunity of providing favourable limb use.

Early and mid-term results of transarticular external fixation in the treatment of supination-external rotation type IV equivalent ankle fractures

Objective: To explore the characteristics and methods of different fixation methods and prevention of open knee joint fracture. Methods: The data of 86 cases of open knee joint fracture admitted from January 2002 to December 2015 in Department of Orthopaedics, Affiliated Hospital of Chengdu University were analyzed retrospectively.There were 65 males and 21 females aged of 38.6 years. There were 38 cases treated with trans articular external fixation alone, 48 cases were in the trans articular external fixation plus auxiliary limited internal fixation group. All the patients were treated according to the same three stages except for different fixation methods. Observation of external fixation and fracture fixation, fracture healing, wound healing and treatment, treatment and related factors of infection control and knee function recovery. χ(2) test was used to analyze data. Results: Eleven patients had primary wound healing, accounting for 12.8%. Seventy-five patients had two wounds healed, accounting for 87.2%. Only 38 cases of trans articular external fixator group had 31 cases of articular surface reduction, accounting for 81.6%; Five cases of trans articular external fixator assisted limited internal fixation group had 5 cases of poor reduction, accounting for 10.4%; There was significant difference between the two groups (χ(2)=44.132, P<0.05). Take a single cross joint external fixation group, a total of 23 cases of patients with infection, accounted for 60.5% of external fixation group; trans articular external fixation assisted limited internal fixation group there were 30 cases of patients with infection, accounting for the assistance of external fixator and limited internal fixation group 62.5%; There was significant difference between the two groups(χ(2)=0.035, P>0.05). Five cases of fracture nonunion cases of serious infection, patients voluntarily underwent amputation. The Lysholm Knee Scale: In the external fixation group, 23 cases were less than 50 points, accounting for 60.5%, 15 cases were more than 50 points, accounting for 39.5%, external fixation and limited internal fixation group 20 cases were less than 50 points, accounting for 41.7%, 28 cases were more than 50 points, accounting for 58.3%; There was significant difference between the two groups(χ(2)=1.279, P>0.05). Conclusions: Prevention and control of infection is a central link in the treatment of open fracture of the knee. Trans articular external fixator plus limited internal fixation is an important measure to treat open fracture of the knee-joint.

PRWE application in distal radius fracture: comparison and correlation with established outcomes

Unstable fragility fractures of the ankle in the elderly: Transarticular Steinmann pin or external fixation