Achilles tendon rupture associated with ankle fracture

The case of a 40-year-old man who sustained a medial malleolar fracture with extension of the fracture into the tibial plafond is discussed. Before surgery, the physical examination revealed an Achilles tendon rupture. Surgical treatment to repair the bone and tendon injury was performed. Achilles tendon rupture is not an uncommon injury, but it is rarely associated with a fracture. When a fracture is present, the Achilles tendon injury can be overlooked, which may result in a delay of treatment or residual morbidity.     

Fracture of the coracoid process of the scapula

Four cases of fracture of the coracoid process of the scapula are reported. Different mechanisms of injury resulted in different types of fracture. In the first case the injury resulted from a direct fall on the involved shoulder and the fracture was through the base of the coracoid. In the second case the fall was on the elbow and the fracture was of the avulsion type, at the tip of the coracoid and indirect in type. In the third case the fractured coracoid process was associated with fracture of the acromion and in the fourth case it was associated with a fracture of the clavicle, both combinations not previously reported. The importance of recently developed radiographic techniques is stressed. Conservative treatment appears to be suitable in most of the acute cases.     

Maisonneuve fracture associated with a bimalleolar ankle fracture-dislocation: a case report

The Maisonneuve fracture consists of a proximal fibular fracture with associated syndesmotic ligament disruption and injury to the medial ankle structures. The accepted mechanism of injury is an external rotation force applied to the ankle with the foot in either supination or pronation. Because most Maisonneuve fractures involve complete syndesmotic disruption, operative treatment is usually indicated. A case report is presented of an unusual fracture pattern-i.e., that of a distal fibular fracture with lateral ankle dislocation associated with a Maisonneuve fracture. To our knowledge, only two other similar cases are reported in the English literature.     

Medial and Lateral Rotatory Dislocations of the Ankle After Trivial Trauma—Pathomechanics and Management of Two Cases

Pure frontal plane rotatory dislocation of the ankle joint without an associated fracture is an extremely rare injury. We report one such case of an eversion rotatory dislocation and one case of an inversion rotatory dislocation. To our knowledge, this is the first report of an eversion injury resulting in dislocation of the ankle without fracture. Both patients had low energy trauma, predisposing ligamentous injuries, and recurrent sprains. In the patient with lateral rotatory dislocation, medial malleolar hypoplasia was also a contributing factor. Both patients healed the presenting index injury with nonoperative treatment, whereas the lateral rotatory dislocation had a lateral ankle stabilization to prevent subsequent injury.     

Peroneus longus tendon rupture as a cause of chronic lateral ankle pain

Rupture of the peroneus longus tendon with an associated fracture of the os peroneum is an uncommon injury, which may present as chronic lateral ankle instability. There have been only seven cases documented in the literature since 1966. A case of chronic peroneus longus tendon rupture with os peroneum fracture is presented. The authors review their clinical, radiographic, and operative treatment of this patient and review the literature of this unusual injury.     

Is immobilization adequate treatment of unstable burst fractures of the atlas? A case report with long-term follow-up evaluation

The biomechanics and roentgenographic anatomy of the unstable burst fracture of the atlas are well known. A few reports in the literature depict a bony avulsion of the transverse ligament associated with this fracture. However, all patients were treated surgically, so the natural course of this injury is undocumented--in other words, it is not known if the bony avulsion will heal. This is a case report of a 38-year-old woman with burst fracture of the atlas associated with a bony avulsion of the transverse ligament treated nonsurgically. At follow-up examination three years later, the bony fragment had not healed, and atlantoaxial instability persisted. Nonsurgical treatment of this injury may have a role, but surgical stabilization will usually be required after the posterior arch heals.     

Hangman's fracture

The injury known as hangman's fracture is described. The patients seen in Belfast with this injury over the past 20 years are reviewed. It is noted that there is disagreement in the literature over the best form of treatment and we strongly advocate the case for conservative management. We also put forward a simple explanation for the absence of neurological sequelae associated with the accidental form of this injury.     

Fracture–dislocation of the shoulder and brachial plexus palsy: a terrible association

Primary post-traumatic anterior dislocation of the shoulder with associated fracture of the greater tuberosity and brachial plexus injury is rare and, to our knowledge, has never previously been reported in the literature. We present a case of this unhappy triad in which a brachial plexus injury was diagnosed and treated 3 weeks later. The characteristics of this rare condition are discussed on the basis of our case and the published literature in order to improve early diagnosis and treatment of this lesion.     

Axillary Artery and Brachial Plexus Injuries due to Anterior Shoulder Dislocation

Abstract Axillary artery injury after shoulder dislocation, without an associated bone fracture is very rare. Vascular injuries associated with brachial plexus lesions range in incidence from 27% to 44%. Management of axillary artery injury is mainly surgical and depends on the extent and the site of injury. The treatment of associated nerve injuries is more controversial. There is a scarcity of literature surrounding the association of injury to the brachial plexus, axillary artery and to the shoulder. The authors report a case of axillary artery associated with a delayed brachial plexus palsy and review the literature with the aim to identify the clinical pattern of this condition and to evaluate the outcome of neuropraxia after blunt axillary artery injury associated with anterior shoulder dislocation.     

Hoffa's fracture with ipsilateral fibular fracture in a 16-year-old girl:An approach to a rare injury

Hoffa''s fracture is an uncommon fracture of the femoral condyle with coronal orientation of the fracture line. The mechanism of injury in pediatric Hoffa''s fracture is road traffic accident, sports injury, and trivial injury. Clinical examination and proper imaging is important for diagnosis of pediatric Hoffa''s fracture because of high chances of missing these injuries which can lead to nonunion and malunion at the fracture site. Open reduction and anatomical reduction of intraarticular fragment is the gold standard treatment of these fractures. We present a rare case of Hoffa''s fracture in a 16-year-old girl with associated ipsilateral fibular fracture.     

Elbow fracture-dislocation combined with Galeazzi fracture in adult: A case report and literature review

INTRODUCTIONGaleazzi fracture associated with ipsilateral posterior elbow dislocation and radial head fracture is a rare pattern of injury. Few reports exist that describes this injury pattern and its treatment. We describe a case report of simultaneous occurrence of Galeazzi fracture and ipsilateral dislocation of elbow.PRESENTATION OF CASEA 58 year-old female presented with Galeazzi fracture and posterior elbow dislocation associated with radial head fracture of left upper extremity. This was managed with closed reduction of the elbow, open reduction and internal fixation of the radial shaft fracture and K-wire stabilisation of the unstable distal radioulnar joint. Prophylactic fasciotomy was performed. At 10 months follow-up, the outcome was favourable with the American shoulder and elbow surgeon score of 92 and the disabilities of the arm, shoulder and hand score of 18.DISCUSSIONThe presumed mechanism of the injury was a forceful axial loading of a hyperpronated forearm and extended elbow. Our literature review shows that this pattern of injury occurs as a result of high energy trauma in young individuals, and successful outcome can be achieved by addressing each component of this complex injury individually.CONCLUSIONSimultaneous occurrence of elbow dislocation and Galeazzi fracture seems to be the result of extreme axial force and unique position of upper extremity at the time of impact. Individualised approach to each component of this injury can result in favourable outcome.     

Combined talar body and tibial plafond fracture: A case report

We report a case of a crush fracture of the body of the talus associated with an anterior tibial plafond fracture. This injury is a rare variant of talar body fracture which merits special attention. The bony injury in this type of fracture is associated with multiple loose fragments involving both weightbearing surfaces of the ankle joint. After appropriate imaging to allow preoperative planning, we utilized a two-incision approach which was necessary to achieve adequate exposure and fixation. We used basic fracture management principles to deal with a previously undocumented fracture pattern.     

Traumatic separation of the proximal femoral epiphysis and fracture of the mid-shaft of the ipsilateral femur in a child: A case report and review of the literature

A case is described of traumatic separation of the proximal femoral epiphysis associated with a fracture of the mid-shaft of the same femur in a two-year-old girl. The rarity of this injury is emphasized and its treatment outlined. No similar reports could be found, and the relevant literature is reviewed.     

Iatrogenic axillary artery injury from humeral neck fracture repair. A rare and unusual event in which and aggressive strategy was mandatory to save a child limb

Humeral neck fracture is rarely associated with injury of the nearby axillary artery and in the English literature only 29 such cases have been reported. An injury of the distal axillary artery secondary to reduction and fixation of a humeral neck fracture is a very rare and unusual complication, to the best of our knowledge has never been reported in literature. In this paper we report the case of entrapment of the distal axillary artery in the humerus rhyme fracture in a 9-year-old child who suffered a nighttime car-accident with her father. At admission, the child presented a left humeral neck fracture with no other lesions and no neurologic problems in her limb; peripheral pulses present in her left hand at palpation. After closed reduction and pinning of the fracture with 2 K-wires, the left upper limb became ischemic and pulseless and the child was transferred at our Institution for diagnosis and treatment. In this paper we discuss the treatment to be adopted in this very unusual situation.     

Isolated posterior cruciate ligament injuries associated with closed tibial shaft fractures: a report of two cases

Introduction  Knee ligament injuries associated with tibia shaft fractures are usually neglected and treatment is delayed. To our knowledge, no case presentation discusses the clinical result of closed tibial shaft fracture with concomitant ipsilateral isolated PCL injury. In this literature, we report the clinical result of two cases that sustained closed tibial shaft fracture with concomitant PCL injury and discuss the treatment options. Materials and methods  We report the clinical result of two cases that sustained closed tibial shaft fracture with concomitant posterior cruciate ligament (PCL) injury. Case 1 received open reduction with plate fixation for the tibial shaft fracture, and he also received arthroscopic reconstruction of PCL with bone-patellar tendon-bone graft due to neglecting PCL injury 5 months later after fracture fixation. Case 2 sustained left tibial-fibular shaft fracture with isolated PCL injury confirmed by magnetic resonance image on the first day of injury. She received tibia fixation with intramedullary nail and conservative treatment with bracing and rehabilitation for PCL injury. Results  In case 1, the male patient only focused on fracture healing without any knee rehabilitation. His knee flexed deeply for protected weight bearing in the injured leg which may have exacerbated the posterior instability and reduced the possibility of PCL healing. The end result of knee function was poor even though PCL reconstruction was done later. In case 2, the female patient with diagnosed posterior cruciate ligament injury on the day of injury, her knee was immobilized in brace with full extension, which improved PCL healing. In addition, she received rehabilitation of quadriceps strengthening, and hamstring muscle contraction was avoided in her daily activity. After rehabilitation, the female patient did not complain of severe subjective instability even with an obvious posterior translation on posterior drawer test. Conclusions  We need to perform a careful physical examination of ipsilateral knee in cases of leg fractures, and MRI of knee before surgery if any doubt exists. However, a further research is needed to conclude on the best operation and rehabilitation program in patients with combined tibial shaft fracture and PCL injury. No support from any institution was gained for this study.     

Anterior fracture dislocation of the hip: an unusual presentation and a review of principles of management

Anterior dislocation of the hip occurs in 10–15% of cases (DeLee et al. in J Bone Joint Surg Am 62(6):960–964, 1). It is usually due to high velocity trauma and associated with multiple injuries. We present a case of this unusual injury associated with an acetabular fracture and a Brumback type IV B fracture of the femoral head caused by a low energy mechanism. We discuss the rationale for our management including issues involved in making the diagnosis, the reasons for our delay in diagnosing the injury and we propose strategies to avoid this in the future. The current literature evaluating the aetiology as well as the treatment of anterior fracture dislocation of the hip is also critically evaluated.     

Fractured anterior calcaneal process

The case report of an intra-articular calcaneal fracture is presented. The case is noteworthy because the entire anterior process was fractured and dislocated into the subtalar joint. Treatment consisted of open reduction and internal fixation with good results. The literature was reviewed and an aggressive treatment posture adopted in order to prevent the long-term disability often associated with this type of injury.     

Traumatic rupture of the tibialis posterior tendon after ankle fracture: a case report

Degenerative tears of the posterior tibial tendon associated with chronic disease are well documented in the literature. Traumatic ruptures of this tendon, however, are much less common and consequently have received little attention. An association has been shown between pronation-external rotation ankle fractures and tears of the tendons that cross the medial aspect of the ankle, most commonly the posterior tibial tendon. In the present case report, we share our unique experience of an open-ankle fracture associated with the traumatic rupture of the posterior tibial tendon. This injury illustrates that soft-tissue injury must always be suspected concomitantly in the treatment of certain fractures on the basis of both mechanism of injury and fracture pattern.     

Modified Extension Block Technique for Bony Mallet Injury of the Hallux

Bony mallet injury of the hallux is uncommon. In the few reports of this injury, authors have described surgical treatments such as closed reduction with percutaneous pinning and open surgical fixation with Kirschner wires or a suture anchor. However, the appropriate surgical management for this injury remains controversial. In this article, we describe a case of bony mallet injury of the hallux repaired with the modified extension block techniqueusing 3 Kirschner wires. This method is an effective and simple treatment to allow anatomic reduction of the displaced articular fracture fragment without incision, residual hardware, or the complications associated with open surgical treatment.     

Unsuspected atlas fracture and instability associated with oropharyngeal injury: case report.

A case of oropharyngeal injury associated with an unsuspected direct atlas anterior arch fracture is presented. Instability at the occipito-atlanto-axial joints developed because of the coexistence of a rather common congenital defect of the posterior atlas arch. Awareness of the frequency of congenital atlas anomalies and the possibility of direct cervical spine injury with pharyngeal trauma will aid early recognition of this problem and allow early effective treatment.