Uncommon Injury Research Articles

Uncommon severe blunt ocular injury associated with large retinal dialysis caused by a fishing sinker

Introduction. Severe ocular injuries caused by fishing equipment are relatively rare. The visual prognosis for fishing-related injuries depends on the involved ocular structures, the presence of complications, and surgical techniques applied. Case outline. A 40-year-old man reported a sudden severe sharp pain and a loss of vision in his left eye while he was pulling the fishing rod during recreational fishing. At admission, his best corrected visual acuity (BCVA) of the left eye was 1/60. Clinical examination revealed a laceration in the temporal quadrant of the bulbar conjunctiva 0.2?0.3 mm in size and a dark tumefaction under the conjunctiva in the same region. It was identified during primary surgical exploration as a fishing sinker 1 cm in size lodged under the lateral rectus muscle. The bulbar wall was intact and the fishing sinker was safely removed. Phacoemulsification with the implantation of an artificial foldable intraocular lens and 23G pars plana vitrectomy were performed. During vitrectomy, subretinal hemorrhage in the macular region and large retinal dialysis in the temporal segment were revealed. Vitrectomy was finished with silicone oil tamponade. One week later, the patient?s BCVA of the left eye was 2/60. Eight months after surgery, spontaneous resorption of subretinal hemorrhage in the macular region and the attached retina was observed. The patient?s BCVA was 3/60 due to the destruction of photoreceptors and retinal pigment epithelium and the formation of epiretinal membrane. Conclusion. To our knowledge, this is the first case report of a severe blunt ocular injury associated with large retinal dialysis caused by a fishing sinker.

Simultaneous Bilateral Rupture of the Quadriceps Tendon after Minor Trauma in a Patient Receiving Hemodialysis: A Rare Variant to an Uncommon Injury

A spontaneous and simultaneous complete bilateral ruptures of the knee extensor system is a rare entity, and only few cases have been reported in literature. It is a rare occurrence After minor trauma. Therefore, an investigation should be focused on identifying certain medical predisposing conditions including chronic diseases and long-term use of certain drugs. Surgical repair is a treatment of choice. This article describes the case of a 36-year-old patient with renal failure requiring hemodialysis for the past 7 years, who sustained spontaneous bilateral rupture of quadricepital tendon diagnosed by bilateral ultrasound scan of the thighs and successfully managed by surgical repair using sutures passed through drilled holes in the patella. Postoperatively, the patient was immobilized with splints for 6 weeks before starting physiotherapy.

An uncommon injury: Motorcycle chain injury of the hand, its socioeconomic outcome, and prevention

IntroductionThe aim of the study was to define the characteristics of motorcycle chain injuries leading to serious limb loss, evaluating its socioeconomic outcome. HypothesisThe severity of injury with motorcycle chain is associated with hospitalization day and morbidity. Material and methodsTotal of 3486 patients applied to the two Centers of the Hand Surgery Clinic and 42 of them with injuries originating from squeezed hands between the motorcycle chain and the rear sprocket were included. Injured extremities were evaluated with the MHISS. In the retrospective analyses, patients were divided into groups according to the severity of injury and compared and patients who underwent replantation, flap and primary repair treatment protocols were also compared. ResultsThe number of patients with dominant hand injuries was 33 patients (78.5%). Inquiry of education level revealed that 24 (57.1%) patients graduated from primary school. According to MHISS, 76.2% of patients had major and severe injuries (mean: 95.05). Mean hospitalization time was 2.83 (range: 1–8) days. Mean time to returning to work was 2.71 (range: 1–5) months. The hospitalization days and return to work were longer in patients have major injury according to MHISS (p=0.006). The necrosis was observed three of the 9 (33.3%) replanted fingers. Flap necrosis was observed in two of the 15 (13.3%) cases. DiscussionsMost of these injuries are severe and major according to MHISS. As the severity of the injury increases, the duration of hospital stay and the return to work are prolonged. Level of evidenceIV; Economic/Decision Analysis.

EVALUATION OF PEDIATRIC INTRACAPSULAR NECK OF FEMUR FRACTURE FIXATION WITH MOORE'S PINS

Paediatric femoral neck fractures are uncommon injuries and are usually caused by high-energy trauma. Low-energy trauma can result in pathological neck fractures and stress fractures of the neck, due to repetitive activity. Surgical options can vary based on age, Delbet classification and displacement of the fracture. Treatment for displaced fractures is by closed or open reduction and Moore’s fixation. Fixation should be supplemented by spica cast immobilization in younger children. The high rate of complications occurs due to the vascular anatomy of the hip and proximal femur. Avascular necrosis, coxa vara, premature physeal closure, and non-union are the most common and these often result in poor outcome.

Clinical outcome of tibial spine ACL avulsion fracture in adults treated with suture bridge fixation

Introduction: Anterior cruciate ligament avulsion from the tibia with a bony fragment of the tibial spine is an uncommon injury of the knee joint. These are predominantly seen in children and young adults. Arthroscopic reduction and fixation of the tibial avulsion fracture is a technically demanding procedure as restoring the ACL length and tension during fixation is important to ensure stability of the knee while maintaining range of motion and minimal knee laxity. The purpose of the study was to evaluate the outcome of Arthroscopic Suture bridge fixation of tibial spine anterior cruciate ligament avulsion fractures. Materials and Methods: We followed up seven patients prospectively after Arthroscopic suture bridge fixation. The patients were assessed with clinical examination, Tegner Lysholm and IKDC (International Knee Documentation Committee) knee scores. The study group consisted of 5 males and 2 females with a mean age of 24.28 years (Range 18 years to 32 years). Mean follow-up time was 28.7 months (range 24 to 36 months). The study included 4 type II and 3 type III Meyer and McKeever fractures. Results: At follow-up the mean Tegner lysholm score was 91.28. The best results were seen in younger patients. Younger patients had significantly better score for IKDC functional and final scores. Conclusion: Displaced tibial spine avulsion fractures can be successfully treated in younger and older patients using arthroscopic suture bridge fixation with most patients returning back to preinjury levels of activity. Keywords: Arthroscopy, Tibial fractures, Avulsion, Anterior cruciate ligament injuries, Fracture fixation internal.

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

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

All-Suture Anatomic Footprint Repair of the Distal Triceps Tendon

Distal triceps ruptures are an uncommon injury, and currently, there is a lack of consensus on the optimal surgical technique for repair. The traditional transosseous cruciate repair has been shown to be nonanatomic and to have a higher failure rate and be biomechanically inferior to suture anchor repairs. The use of anchors significantly increases procedure cost and theoretically increases the risk of complications related to drill and anchor placement. The technique described in this article allows anatomic restoration of the triceps tendon while avoiding the increased cost and risk that may be associated with suture anchor placement.

Isolated volar ulnar dislocation: case report and literature review

Isolated ulnar head dislocation is a rare and frequently misdiagnosed clinical entity. To our knowledge, few cases of volar ulnar dislocation have been reported in literature and a well-defined treatment does not exist. This case report describes the management of an acute isolated volar ulna dislocation in a 64-year-old patient. We also performed a systematic review of the available English literature in order to evaluate management of volar ulna dislocation. Among 86 eligible articles, 13 were included and fully evaluated. Isolated distal radioulnar joint (DRUJ) dislocation with only ligamentous involvement are uncommon injuries. If diagnosis is uncertain and X-ray are not informative, further imaging with CT or MRI can be performed because it is mandatory to recognise these lesions and to manage them properly. The first step is to reduce the DRUJ dislocation. The second is to evaluate the stability of the joint. If multidirectional instability is noted, direct repair of the ligament or Triangular Fibrocartilaginous Complex (TFCC) is indicated. Management of the acute lesion initially consists of an attempt of closed reduction, but if closed reduction is impossible in our opinion the only option is to restore the normal anatomy of the DRUJ with operative treatment. Herein, we summarise the available evidence on this lesion, based on this case and after a systematic review of the literature. We propose operative management for this lesion, with open reduction and reconstruction of ligaments to allow a rapid functional recovery and to avoid secondary complications.

Tibia Stress Fracture and Subsequent Nonunion Associated With High Morbidity Following Vascularized Fibula Graft Harvest

There is little in the literature about tibial stress fracture after partial fibulectomy. As fibula strut grafting and vascularized fibula flap grafting becomes more common in the field of reconstructive surgery, the incidence of this complication will likely rise. The authors present the case of a 54-year-old woman with tibial stress fracture and subsequent nonunion following vascularized fibula graft harvest. The aim of this case report is to present a unique tibial stress fracture and nonunion following vascularized fibula flap for mandibular reconstruction and a discussion of the orthopedic management of this uncommon injury. The authors' goal is to educate both surgeons and patients about the altered biomechanics and subsequent risks associated with fibula strut graft harvest, from an orthopedic surgery perspective. By increasing physician awareness and obtaining better informed consent preoperatively, better health care outcomes associated with fibular graft harvesting can be obtained. [Orthopedics. 2021;44(2):e306-e308.].

Pipkin type IV femoral head fractures: a case series and review of literature.

Femoral head fractures with associated acetabular fractures are uncommon injuries usually resulting from high-energy mechanisms such as motor vehicle collisions. Outcomes of Pipkin type IV fractures have been historically poor, with high rates of osteonecrosis, post-traumatic arthritis, and heterotopic ossification. The objective of this study was to define the outcomes of operatively treated Pipkin type IV fractures In addition, we reviewed the available literature of this uncommon injury pattern. A retrospective chart review at a single level 1 trauma center from 2007 to 2016 identified 10 patients with Pipkin IV femoral head fractures. Demographic information, fracture type, associated injuries, operative details, and complications were evaluated. Clinical and radiological outcomes were assessed at latest follow-up including conversion to total hip arthroplasty. Six of the seven patients were treated with open reduction and internal fixation of the femoral head fracture and acetabular fracture through a Kocher-Langenbeck approach aided by a trochanteric flip and one had fragment excision. Six patients (87.5%) developed post-traumatic arthritis. Four (57.1%) later underwent conversion to total hip arthroplasty (THA) a mean of 20.5months after index procedure. Our study shows a rate of osteonecrosis and osteoarthritis that is even higher than the previously reported studies. The former may relate to longer-term follow-up and the latter possibly due to associated comminuted posterior wall fracture.

Proprioception After Multiligament Knee Injury: Does Ligament Repair Lead to Better Proprioceptive Acuity Than Ligament Reconstruction?

IntroductionMultiligament knee injuries are uncommon but serious injuries. There is ongoing debate on the optimal treatment of these injuries. We designed a study to establish the effects of repair or reconstruction on proprioceptive outcomes following multiligament injury to the knee.Materials and MethodsA total of 34 patients were analysed by independent researchers who had no conflict of interest in the cases (23 in the repair group and 11 in the reconstruction group). Proprioception of the knee was measured using a previously validated tool to assess the reproduction of passive positioning. Functional outcome was measured using the Lysholm score. Sub-group analysis was performed. The mean time from injury to review was 83 months (range: 25-193 months).ResultsThere were no significant differences in proprioceptive acuity between the injured (5.9±4.2°; range: 1.0-18.3°) and uninjured contralateral (control) knees (5.2±3.8°; range: 1.0-15.0°; p=0.35). Similarly, there was no significant difference in proprioceptive acuity identified between the injured knees that underwent repair (6.0±4.3°; range: 1.0-18.3°) or reconstruction (5.0±3.6°; range: 1.3-14°; p=0.53).Overall knee outcomes were good; the mean Lysholm score at final follow-up was 75.5±16.8 (range: 36-100). No significant differences were identified in any of the sub-groups.ConclusionsWe were unable to identify any differences in knee proprioceptive acuity between injured knees and controls nor between the types of surgical treatment, demonstrating equivocal recovery for both methods of treatment.

Functional Outcome of Open Reduction and Internal Fixation of Displaced Extra-Articular Scapula Fractures

Scapular fractures are uncommon injuries of upper extremity resulting mostly from high-energy trauma. Extra-articular fractures form the majority of them. Un-displaced fractures can be managed conservatively with good results. But displaced fracture does not yield satisfactory results and needs surgical fixation. In this case series, we report our experience about such fractures. This was a retrospective study of 12 patients with displaced scapular body and neck fractures treated between 2015 and 2018. Scapular fractures were exposed by modified Judet approach and fixed with either 3.5mm T buttress or recon locking plate and screws. One case had associated clavicle fracture which was fixed along with scapula. Patients were put on structured rehabilitation and followed up regularly. Functional outcome and range of motion were analyzed. The patients included 10 males and two females. Mean age was 42years. Average follow-up was 33months. Average constant and Murley score was 80. Excellent results were seen in four patients, good results in seven patients and one patient has got fair result. The mean post-operative range of motion of the shoulder at the time of final follow-up was 140° of forward flexion, 136° of abduction, and 34° of external rotation. Displaced extra-articular scapular fractures managed by internal fixation using T buttress locking plates and reconstruction plates give good functional outcome.

Latarjet Procedure With Coracoclavicular Ligament Augmentation for Traumatic Coracoid Fracture and Recurrent Anterior Glenohumeral Instability in an Elite Contact Athlete

Coracoid fractures are relatively uncommon injuries and are typically treated conservatively or with open reduction and internal fixation of displaced fractures. In rare cases, coracoid fractures coincide with glenohumeral instability. Although glenohumeral instability is frequently treated with Bankart procedures, the Latarjet procedure (or transfer of the coracoid process) is used in patients with significant glenoid bone loss, recurrent instability, or prior failed Bankart procedures. However, in some cases, surgeons opt for the Latarjet procedure in patients who are at risk for recurrent instability, such as the elite contact athlete presented in this case. This Technical Note describes the transfer of a previously fractured coracoid fragment to the anterior glenoid rather than reduction of the fracture with concurrent coracoclavicular ligament augmentation to restore anterior shoulder stability.

Arthroscopic management of neglected complex knee injury

<p>Meyers and mckeevers type IV comminuted pattern of avulsion fracture of the anterior tibial eminence is not an uncommon injury, however its association with root avulsions of lateral and medial meniscus is very rare combination of injury and the management of the neglected case of this complex knee injury is challenging. A 43-year-old gentleman who came with a history of pain, recurrent instability, locking of his right knee for 2 weeks with restricted activity of daily living. He also had a road traffic accident 5 years ago. He was evaluated clinically, radiologically by X Rays and MRI Scan which revealed complete tear of anterior cruciate ligament (ACL) with loose fragments, root tear anterior horn lateral meniscus and posterior horn tear with posterior root avulsion of the medial meniscus. He was managed with arthroscopic removal of large loose body with other loose bony fragments, ACL Reconstruction with hamstring autograft, anterior root repair of lateral meniscus with pull out sutures, with all inside repair of posterior horn tear of medial meniscus using fast-fix 360 device (Smith and Nephew, Andover, MA). At 4 years follow-up the patient was analysed clinically, and the functional outcome was measured with international knee documentation committee (IKDC) and knee injury and osteoarthritis outcome score (KOOS) Scoring system which showed good outcome. Patient has returned to his pre-injury activity level with no limitation of his activity of daily living. There is no set protocol of managing these kinds of neglected complex knee injury. Sometimes you need to think out of the box. A thorough knowledge of anatomy and pathomechanics of knee combined with appropriate technique of repair to save the meniscus and reconstruction of ACL and rehabilitation can yield good result.</p>

Facial Trauma Patterns Among Young Athletes.

Retrospective case series review. Participation in athletics is common in high school and college students and presents an increased risk of injury in this age-group. Previous studies have included National Collegiate Athletic Association athletes but not high school athletes. Here we report the trends of maxillofacial injuries in high school students. Patients presenting to a level 1 trauma center with maxillofacial injuries were identified by chart query with associated International Classification of Diseases, 10th Revision codes for facial fractures between October 2015 and October 2017. Data collected included age, sport, fracture type, need for surgery, associated concussion, and time to return to play were measured. New York State Public High School Athletic Association regional high school sports participation data from 2016 to 2018 were used to calculate incidence. A total of 33 patients aged 13 to 19 years were identified. Baseball, basketball, and lacrosse were most frequently associated with maxillofacial trauma. Annual incidence rates for mandible fractures in high school athletes were 0.037%, 0.012%, and 0.01% for lacrosse, baseball, and basketball, respectively. Annual fracture incidence rates for midface fractures in high school athletes were 0.17%, 0.018%, and 0.01% for baseball, lacrosse, and basketball, respectively. Maxillofacial fractures are uncommon injuries among athletes but present with serious implications including surgical correction. Baseball was strongly associated with midface fractures despite being considered a noncontact sport. Improved facial protection across all sports will be imperative at reducing the incidences of these injuries. Level 4.

Penetrating Midface Trauma: A Case Report, Review of the Literature, and a Diagnostic and Management Protocol

Penetrating facial trauma is an uncommon injury, but patients who present with these dramatic situations require special consideration. We describe the case of a young man who had been shot with an arrow that deeply penetrated his midface as well as report the results of a literature review of penetrating midface injuries. The information gathered was used to create a diagnostic protocol for patients who sustain such injuries. A PubMed search up to October 2019 using several key phrases was performed, and 623 unique articles were evaluated. Excluding firearm injuries to the midface, there were 57 unique cases that involved penetrating midface injuries. Clinical and imaging data were compiled and evaluated with descriptive statistical analysis. The average patient age was 27years, with a male predilection. The most common reported etiology was accidental trauma (54%), and a knife was the most common weapon of injury (30%). The most common (32%) specific location of trauma was within the orbital region, including the canthus or the eyelid. In all cases where the patient had not died immediately, surgery was used to remove the penetrating object. We found that computed tomography was the most commonly obtained imaging study (39% of cases). Radiographs were the sole imaging in 28% of the cases, with angiography (16%) and magnetic resonance imaging (10%) used less frequently in management. In 28% of the cases, deep structures, such as the carotid artery, sphenoid sinus, or skull base, were involved in the injury. In 25% of the cases, there was injury to the central nervous system. Death occurred in 8.8% of the cases. Postoperative complications occurred in at least 21% of the cases. Statistical analysis also revealed a significant correlation between antibiotic use and full recovery. Penetration of the object posterior to the maxillary sinus was correlated with incomplete recovery or death. Based on all case reports collected, a Dartmouth Penetrating Midface Protocol was developed to aid the practitioner who may happen to be responsible for these dramatic life-threatening injuries. The Dartmouth Penetrating Midface Protocol is based on the type of imaging available at the treating facility, the neurologic and hemodynamic stability of the patient, and the depth of penetration beyond the posterior wall of the maxillary sinus.

Diagnosis, preoperative evaluation, classification and total hip arthroplasty in patients with long-term unreduced hip joint dislocation, secondary osteoarthritis and pseudoarthrosis

BackgroundNeglected long-term unreduced hip joint dislocation with secondary osteoarthritis and pseudoarthrosis poses a great challenge to hip surgeons. However, as this is an uncommon injury, few studies have systematically investigated these patients.MethodsWe retrospectively reviewed 16 patients from 2010 to 2017. The diagnostic values of three different types of common radiological examinations were evaluated. We evaluated the bone conditions of the original acetabulum and classified the patients into three types (four subtypes). The surgical procedures and prognosis of the patients were also investigated.ResultsWith the combined application of X-ray, CT scans and 3D reconstruction, 93.8% of these patients (sensitivity = 93.8%, Youden’s index = 0.93, intraclass correlation coefficient = 0.95) could be diagnosed correctly. There were 6/16 (37.5%) type A patients, 4/16 (25.0%) type B1 patients, 5/16 (31.3%) type B2 patients and 1/16 (6.3%) type C patient. For patients with type A injury, the surgical procedures for total hip arthroplasty were similar to “standard” total hip arthroplasty. For patients with type B injury, due to atrophy or partial bone deficiency of the original acetabulum, the surgical procedure for total hip arthroplasty was probably similar to those for patients with developmental dysplasia of the hip. For patients with type C injury, the situation was similar to that of revision surgery. The average Harris hip score postoperatively was 89.94 ± 5.78 points (range: 79–98 points).ConclusionsThe new classification system could help surgeons estimate potential difficulties during total hip arthroplasty. The prognosis of most patients after total hip arthroplasty is expected to be excellent or good.

Isolate and irreducible radial head dislocation in children: a rare case of capsular interposition

BackgroundRadial head dislocation with no associated lesions, is a relatively uncommon injury in children.In this case report, it is reported a case of anteromedial locked radial head dislocation in children, and we discuss its clinical presentation and pathogenetic mechanism of injury.Case presentationAn 8-year-old girl fell off on her right forearm with her right elbow extended in hyperpronation. An isolated radio-capitellar dislocation was identified with no other fractures or neurovascular injuries associated. Elbow presented an extension-flexion arc limited (0°- 90°), and the prono-supination during general anesthesia shows “a sling effect” from maximal pronation (+ 55°) and supination (+ 90°) to neutral position of forearm. The radial head dislocation was impossible to reduce and an open reduction was performed using lateral Kocher approach. The radial head was found “button-holed” through the anterior capsule. The lateral soft tissues were severely disrupted and the annular ligament was not identifiable. Only by cutting the lateral bundle of the capsule was possible to reduce the joint.At 50 moths follow-up, patient presented a complete Range of motion (ROM), complete functionality and no discomfort or instability even during sport activities.Discussion and conclusionIt is important to understand the pathogenic mechanisms of locked radial head dislocation in children. Some mechanism described are the distal biceps tendon or the brachialis tendon interposition. However even the anterior capsule can hinder reduction. A characteristic “sling-effect” of the forearm could be pathognomonic for capsular button-holing. Surgical release of the capsular bundle sometimes is the only way to reduce the dislocation and obtain a good outcome.

Mini-Open Distal Biceps Tendon Repair Using All-Suture Anchors

Distal biceps tendon ruptures are uncommon injuries that can cause impairment in range of motion and function. While distal bicep tendon repair to the radial tuberosity has been demonstrated to restore function and strength, there is a lack of consensus on the optimal technique. The purpose of this Technical Note and video is to provide our preferred method of repair using an open, onlay-tissue fixation with all-suture anchors (FiberTak; Arthrex) and anatomic positioning of the biceps tendon on the radial tuberosity.

Unusual obstetric trauma in newborn

Background: Birth injuries during delivery are rare but can be the most common cause of morbidity and mortality. All parts of the body can be damaged. The aim of this study is to determine the impact of these uncommon injuries on the newborn. This is a retrospective chart review of 11 newborn babies who had concurrent birth trauma. Pertinent data on the cause of injury treatment and the outcome were recorded. Methods: It is a retrospective chart review of newborns who sustained a birth trauma during delivery. These patients presented to the Department of Pediatric Surgery, SETIF, Algeria from 2010 to 2020. Results: A total of 11 cases with birth trauma occurred during delivery were managed during the study tenure. Of these 11, 9 were males and 2 females. Two cases sustained scalp laceration including one extensive laceration exposing the brain tissue with uncontrollable hemorrhage. One newborn sustained facial trauma secondary to the forceps delivery. One newborn who needed resuscitation and ventilation at birth developed bilateral pneumothorax secondary to the barotrauma. One patient sustained a femur fracture whereas another had a humerus fracture along with brachial plexus injury during delivery. Three cases had umbilical cord injury including two cases of clamped hernia of the umbilical cord resulting in neonatal intestinal obstruction. Two cases had scrotal trauma including one with testicular evisceration. Two cases were expired in this cohort. Conclusion: We have presented a diversity of birth trauma in newborns and their management. Proper antenatal follow-up and better planning for the delivery can avoid such injuries in newborns which often require surgical interventions for the management and at times can lead to mortality as well.