Arthroscopic treatment of a juvenile tillaux fracture

Tillaux fractures are relatively uncommon fractures of the anterolateral tibial epiphysis that are observed in adolescents during the 18-month period when the distal tibial physis has begun to fuse centrally. The case of a 16-year-old boy with a juvenile Tillaux fracture treated successfully by reduction and percutaneous fixation under arthroscopic control is presented. The procedure is technically feasible, allows accurate reconstruction of the weight bearing surface of the joint and secure internal fixation of the fracture. The authors describe the principles of the procedure and discuss its advantages compared to open surgery.     

踝关节周围隐匿性骨折的MRI诊断

目的：探讨踝关节周围隐匿性骨折MRI的诊断价值。方法：对18例有明确外伤史、临床症状明显但平片检查阴性患行MRI检查，其中男11例，女7例，场强1．5T，常SE序列T1W成像（TR／TR＝700／20）、快速SE序列T2W成像（TR／TE＝4700／100）和脂肪抑制（FS）序列。结果：18例患共有22处骨髓信号异常，15处为T1低信号、T2高信号，7处为T1低信号，T2混杂信号，脂肪抑制序列均为明显高或混杂偏高信号。结论：MRI是早期诊断隐匿性骨折的理想方法，T2WI脂肪抑制序列最为准确和敏感。     

踝关节内侧韧带损伤及其病理机制初探

目的 探讨踝关节内韧带损伤后内侧不稳定的病理机制.方法 患者15例,男8例,女7例;年龄22～58岁,平均40岁.其中踝关节急性扭伤患者2例,踝关节慢性损伤3例,先天性平足3例,胫后肌腱失能5例,旋前外旋骨折1例,陈旧性的内踝撕脱骨折1例.所有患者均行三角韧带修补术,同时行跟骨延长术8例,内侧楔骨闭合截骨5例,跟骨截骨内移术1例.全部患者术后随访7～56个月,运用美国足踝外科协会(America Orthopedic Foot and Ankle Society,AOFAS)踝-后足功能评分进行评估,统计学分析采用t检验.结果 1例踝关节急性骨折患者,由于术前无法评分,不放在统计分析内.其余14例患者术前评分为(42.4±10.6)分,术后评分(89.8±6.2)分(P＜0.05).结论 三角韧带是一个重要的解剖结构,在以下几种情况下须注意其修复:(1)三角韧带损伤范围较广,涉及前部的胫弹簧韧带和胫舟韧带.(2)先天性的平足以及获得性的胫后肌腱失能患者.(3)以往有经常的踝关节扭伤,有外侧韧带的损伤,此次发生了伴有内侧韧带损伤的骨折.     

三踝骨折分型与手术体位选择的关系及疗效分析

目的 探讨根据三踝骨折分型选择手术体位的临床疗效.方法 选取2007年1月-2010年1月29例三踝骨折患者作为病例组,行切开复位内固定术,其中男21例,女8例;年龄20～67岁,平均41岁.根据Lauge - Hansen分型:旋前外旋型9例,旋前外展型1例,旋后外旋型17例,旋后内收型2例.患者均根据骨折分型并结合CT片选择相应的体位,其中单纯俯卧位10例,侧俯卧位改仰卧位15例,单纯仰卧位4例.对照组29例,其中旋前外旋型9例,旋前外展型1例,旋后外旋型17例,旋后内收型2例.全部患者采用先仰卧位再改为俯卧位的手术体位.比较两组手术时间、术中出血量、切口愈合时间以及骨折愈合时间等.结果 病例组29例患者均获随访,随访时间5～ 36个月,平均21个月.骨折复位效果满足:(1)恢复了踝穴的正常解剖关系;(2)踝关节负重面与小腿纵轴线垂直;(3)踝关节面平滑.平均手术时间:病例组102.5 min,对照组156.8 min.平均出血量:病例组145.6 ml,对照组270.3 ml.平均切口愈合时间:病例组14.6 d,对照组19.3 d(P ＜0.05).骨折平均愈合时间:病例组14.2周,对照组15.4周(P＞0.05).结论 对于三踝骨折,根据不同的骨折类型选择相应的手术体位,可以节省手术时间,减少失血量,缩短切口愈合时间.     

Autologous chondrocyte transplantation for the treatment of massive cartilage lesion of the distal tibia: a case report with 8-year follow-up

We report on the 8-year follow-up outcome after autologous chondrocyte transplantation in a case of massive cartilage lesion of the distal tibia in a young patient after intraarticular fracture. To our knowledge, this is the first case report in which autologous chondrocyte transplantation was performed in the distal tibial chondral lesion. Long-term clinical success was achieved by this method of treatment in a patient too young to be treated with arthrodesis.     

Wii knee

We present the case of a 16-year-old boy who injured his knee whilst playing on the video games console Nintendo Wii. The patient presented with an acutely swollen and painful knee to the emergency department of our institution. Initial radiographs revealed an effusion and an osteochondral fracture. Further imaging with magnetic resonance imaging demonstrated evidence of lateral patella dislocation with medial patello-femoral ligamentous damage and a large femoral osteochondral fracture. The patient was successfully treated with surgical fixation of the osteochondral fragment and medial patello-femoral ligament repair. This case highlights the force that can be generated whilst using these new games consoles.     

逆行掌侧螺钉内固定治疗战士腕舟骨骨折

目的探讨逆行掌侧螺钉内固定治疗战士腕舟骨骨折的手术疗效。方法对14例战士腕舟骨骨折采用掌侧切开复位逆行螺钉内固定治疗,用Cooney’s临床评分系统对患腕的疼痛情况,腕关节活动度及握力进行评分。结果14例中有13例愈合,1例不愈合,平均愈合时间为12周,平均腕关节活动度为健侧的90%,握力为健侧的95%,12例患者没有疼痛,1例轻度疼痛,另外l例不愈合有中度疼痛,除1例不愈合患者外,其余都能胜任原有的工作,按Cooney’s评分10例优,3例良,1例差。结论逆行掌侧螺钉内固定治疗腕舟骨骨折手术操作简单,对腕舟骨残存的血运破坏小,固定牢靠,可缩短骨折愈合时间及提高骨折愈合率,是治疗腕舟骨骨折的一种有效的手术方法。     

The role of the reversed oblique radiograph in trauma of the foot and ankle

The objective of this study was to demonstrate the statistical significance of a reversed oblique radiograph of the foot in patients with ankle or foot trauma. In 100 consecutive patients a reversed oblique radiograph of the foot was taken in addition to the conventional plain films. Ten of 29 fractures were not visualised on the conventional films of foot and ankle and could only be diagnosed on the reversed oblique film. In 7 of these 10 cases an avulsion fracture at the anterolateral aspect of the calcaneus was present. This additional reversed oblique film of the foot seems to be of considerable importance, especially when an anterolateral avulsion fracture of the calcaneus is clinically suspected. Received: 1 December 1998; Revision received: 9 June 1999; Accepted: 14 July 1999     

Fracture of the lateral process of the talus: appearance at MR imaging and clinical significance

The case of a 59-year-old man with chronic lateral ankle pain following an inversion injury is presented. MR imaging performed to evaluate for soft tissue injury revealed an unsuspected fracture of the lateral process of the talus. The patient underwent surgical exploration of the fracture with debridement of adjacent loose bodies and is currently undergoing aggressive physical rehabilitation. Received: 23 November 1998 Revision requested: 18 December 1998 Revision received: 4 January 1999 Accepted: 4 January 1999     

Cone beam computed tomography for accurate diagnosis of suspected fracture of the mandible

The purpose of this case report is to illustrate and discuss the importance of cone beam computed tomography (CBCT) for accurate diagnose of mandibula fracture. A case of maxillofacial trauma was used for this report. A 17-year-old male patient was referred to Oral Diagnosis and Radiology Department with a history of maxillofacial trauma. The history of patient revealed a traumatic injury on his face because of ball stroke. The patient as initially examined in emergency department and it was diagnosed a mandible fracture in emergency department by a 2D lateral skull projection. His clinical examination was unremarkable. We had not encountered any fracture in maxillofacial region with either panoramic view or CBCT. This case report accentuates that two dimensional plain radiography techniques may be misleading for accurate diagnosis of mandible fracture.     

Rehabilitation of avulsion fracture of the tibial tuberosity following Osgood-Schlatter disease

A sixteen-year-old boy suffered from sharp pain in the knee during a jump while playing basketball. He had a positive history of Osgood Schlatter disease. Radiographic evaluation demonstrated an avulsion fracture of the tibial tuberosity Type III according to the classification of Watson-Jones. Rehabilitation after avulsion fracture of the tibial tuberosity is an important consideration for this relatively uncommon adolescent injury. In such avulsion fractures, landing on the ground with the knee fully extended after a jump is the most likely cause. This case report reviews the rehabilitation program, and selected functional outcome measures after rehabilitation are reported. The patient returned to sporting activity after 12 months.     

Sacral insufficiency fracture detected by FDG-PET/CT: Report of 2 cases

We report 2 cases of sacral insufficient fracture detected by FDG-PET/CT. In case 1, a 79-year-old female patient with malignant lymphoma, who had recent lumbago, received FDG-PET/CT examination. Vertical linear FDG uptake medial to bilateral sacro-iliac joint was observed on FDG-PET and a fracture line corresponding to FDG uptake was observed in bone window of CT images. In case 2, an 81-year-old male patient with colon cancer, who also complained of lumbago, received FDG-PET/CT examination. Vertical linear FDG uptake medial to bilateral sacro-iliac joint and horizontal uptake which connects vertical line (H-shaped) was demonstrated and CT also demonstrated a fracture line corresponding to FDG uptake. H-shaped high intensity area corresponding to FDG uptake was observed on T2-weighted image of MRI. On bone scintigraphy, H-shaped uptake was also observed. Like bone scintigraphy, typical H-shaped FDG uptake may be diagnostic in sacral insufficiency fracture. Adding CT information to FDG-PET, that is, assessing SIF with FDG-PET/CT may be useful when atypical findings are observed.     

Postpartum osteoporosis associated with proximal tibial stress fracture

A 33-year-old woman presented with acute nonspecific knee pain, 6 months postpartum. MR imaging, computed tomography and radiography were performed and a proximal tibia plateau insufficiency fracture was detected. Bone densitometry demonstrated mild postpartum osteoporosis. To our knowledge these findings have not been described in this location and in this clinical setting. The etiology of the atraumatic fracture of the tibia is presumed to be due to a low bone mineral density. The bone loss was probably due to pregnancy, lactation and postpartum hormonal changes. There were no other inciting causes and the patient was normocalcemic. We discuss the presence of a postpartum stress fracture in a hitherto undescribed site in a patient who had lactated following an uncomplicated pregnancy and had no other identifiable cause for a stress fracture.     

Horizontal fracture of the anterior arch of the atlas associated with a congenital cleft of the anterior arch

We report a rare combination of a horizontal fracture of the anterior arch of the atlas associated with a congenital cleft of the anterior arch. Sagittally reformatted computed tomography (CT) images demonstrated a fracture of the anterior arch of the atlas and a type II odontoid process fracture. There was also a smoothly marginated midline cleft of the anterior arch just above the fracture consistent with a congenital variant. 3D CT images were helpful in the evaluation of the fractures and the developmental variant. Magnetic resonance imaging showed a spinal cord injury. The patient underwent posterior C1–C2 fusion.     

Aortic injury with chance fracture in a child

To present the findings in a 10-year-old male with a Chance fracture and associated aortic vascular injury and review of the literature on the subject. We reviewed the clinical and imaging findings in a patient who was in a serious motor vehicle accident, sustaining a Chance fracture of the lumbar spine and associated aortic and common iliac vessel injury. We also accomplished a literature review. Evidence of an associated aortic injury was available on the initial computed tomography (CT) study, but the findings were more exquisitely demonstrated on reconstructed studies of the lumbar spine. Our literature review indicated that aortic injury associated with Chance fracture is relatively rare and often overlooked. Abdominal aortic injury although rare, can occur with Chance fractures. With the now present sophisticated CT imaging in most Emergency Rooms it is possible to obtain exquisite reconstructed images of all organ systems including the vascular tree. The images may provide enough details so that further delineation of any given problem may not be necessary.     

Triple blowout fracture of the orbit

We describe a case of traumatic orbital fracture involving the superior, medial, and inferior walls with preserved orbital rim. This “triple blowout” fracture has not been previously reported. There was no damage to the globe or the optic nerve and the patient had an excellent recovery with minimal residual diplopia.     

Lateral ankle fracture with missed proximal tibiofibular joint instability (Maisonneuve injury)

We present a case of a soccer player who sustained a lateral ankle fracture and the associated proximal anterolateral tibiofibular joint instability (Maisonneuve injury) was overlooked. After a non-contact injury the (incomplete) diagnosis of a lateral malleolar fracture (type Weber B, AO 44-B1) was made and the patient was surgically treated with open reduction and internal fixation including a distal syndesmosis screw. After removal of the syndesmosis screw (six weeks after surgery) the patient suffered from activity-related pain around the fibular head. After thorough clinical and radiologic examination, temporary screw transfixation of the fibular head and capsular repair under meticulous fluoroscopic control of fibular rotation helped to restore patient’s sport activity level. This case report emphasizes the importance of precise clinical examination for detection of a proximal tibiofibular joint instability. Restoration of a well functioning and stable proximal tibiofibular joint may be difficult to achieve in previously operated and missed instabilities. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Exercise-related longitudinal tibial stress fracture in a young person

A 22-year-old man presented to the Nuclear Medicine Clinic for evaluation of distal right tibial pain. The patient reported recently beginning a rigorous exercise program involving lower extremity impact temporally related to the onset and worsening of the pain. The physical examination was remarkable for significant tenderness to palpation of the distal one-third of his right tibia. The presumptive diagnosis was a stress fracture. Recent roentgenograms of the right tibia were not available for review but were reportedly normal. Scintigraphy, in combination with computed tomography, revealed an unusual type of stress fracture (particularly in a young person and in relation to exercise)--a longitudinal stress fracture.     

Computed tomography and three-dimensional reconstruction in the evaluation of occipital condyle fracture

Two cases of a rare Anderson type III occipital condyle fracture are presented. In any patient sustaining craniovertebral injury an occipital condyle fracture may be missed because plain films can be unremarkable. It is important to include computed tomography or coronal hypocycloidal tomography for all suspect cases of craniovertebral junction injury. Although three-dimensional reconstruction did not alter therapy for this injury, spatial localization of the fracture fragment was enhanced by this method. Serious neurological deficits are possible if this unusual injury is not treated.     

锁骨骨折内固定术三种麻醉方法的临床经济学评价

目的 采用成本效果分析方法对锁骨骨折内固定手术患者三种麻醉方法作出临床经济学评价。方法随机将144例患者分为3组,Ⅰ组臂丛加颈浅丛神经联合阻滞,Ⅱ组臂丛神经阻滞,Ⅲ组颈浅丛神经阻滞。分别计算出三种麻醉方法的成本和效果,作出成本效果比较。结果单病例成本而言,单纯颈浅丛神经阻滞成本最低,锁骨骨折位于锁骨外2／3时单纯臂丛神经阻滞平均成本最低,锁骨骨折位于锁骨内1／3时单纯颈浅丛神经阻滞平均最低。结论从临床经济学角度来看,锁骨骨折位于锁骨外2／3时首选单纯臂丛神经阻滞,锁骨骨折位于锁骨内1／3时首选单纯颈浅丛神经阻滞。