Fracture due to shock from domestic electricity supply

This report describes a fracture-dislocation of the shoulder joint due to electric shock. This is the first case reported in an English language journal of fracture due to shock from the domestic electricity supply. Other cases have been reported but not caused by such a low voltage current.     

Dorsal radiocarpal dislocation

Dorsal radiocarpal dislocation is rare. Large forces are necessary to produce such injuries and the majority of these patients have severe associated injuries and are unable to remember exactly how they occurred. A case is reported in which there was an isolated dorsal radiocarpal fracture-dislocation associated with contusion of the median nerve. The manner of injury is well demonstrated.     

Transscaphoid transcapitate transtriquetral perilunate fracture-dislocation: a case report

We present a rare stage III greater arc fracture-dislocation of the carpus including transscaphoid, transcapitate, and transtriquetral dorsal perilunate fracture-dislocation.     

Isolated dorsal fracture-dislocation of the scaphoid: a case report

This paper reports an isolated dorsal fracture-dislocation of the scaphoid at its waist with the proximal fragment dislocated dorsally. Such a fracture-dislocation is extremely rare. We believe the pathomechanics of this injury to have been a flexion and radial deviation with an axial force on the wrist.     

Irreducible trans-scaphoid perilunate dislocation

Two cases of irreducible trans-scaphoid perilunate dislocation are described. In each case there was soft tissue interposition between the proximal and distal elements of the fracture-dislocation and this prevented capitolunate and scaphoid reduction. The dorsal capsule was impaled on the distal scaphoid fragment in one case, and a flap of dorsal capsule was entrapped between the capitate and the lunate in the other. In light of these findings, we recommend a dorsal approach for open reduction of trans-scaphoid perilunate dislocation when the capitolunate joint cannot be reduced by closed manipulation.     

Hamatometacarpal fracture-dislocation: distinctive three dimensional computed tomographic appearance

We report here two fully documented cases of hamatometacarpal fracture-dislocation following trauma and treated in our hospital. In our cases, the patients suffered hamate fracture in association with metacarpal dislocation. In the first case, a dorsal oblique fracture of the hamate was associated with a dorsal dislocation of the base of the fourth metacarpal. In the second case, a dorsal oblique fracture of the hamate was not associated with a dorsal dislocation of the base of the fifth metacarpal. This diagnosis should be suspected on initial review of plain radiographs, which must include an oblique view because of diagnostic difficulty for this injury. We recommend three dimensional computed tomography (3D-CT) in any patient presenting with pain after blunt trauma to the hand to prevent in diagnosis. Open reduction and internal fixation of the fracture is indicated and relevant for displaced fracture.     

Divergent fracture-dislocation of the hamatometacarpal joint: case report

Hamatometacarpal fracture-dislocation is a rare injury that consists of a fourth metacarpal fracture and a fifth carpometacarpal joint injury. We present the case of a 21-year-old man with a divergent hamatometacarpal fracture-dislocation that consisted of a combination of dorsal intra-articular fracture-dislocation of the fourth carpometacarpal joint, palmar dislocation of the fifth carpometacarpal joint, and fracture of the hook of the hamate. The mechanism of palmar dislocation of the fifth metacarpal base and fracture of the hook of the hamate involved extension of the fifth metacarpal and ulnopalmar load transmission.     

Dorsal Dislocation of the Intermediate Cuneiform with Fracture of the Lisfranc Joint: A Case Report

Tarsal cuneiform dislocation in association with Lisfranc fracture-dislocation is a rare pedal injury. In this report, we describe the case of a patient who sustained a dorsal dislocation of the intermediate cuneiform in association with tarsometatarsal fracture-dislocation following traumatic axial loading and torsion of his foot. A satisfactory outcome was achieved by treating the injury by means of closed reduction and percutaneous Kirschner wire fixation. ACFAS Level of Clinical Evidence: 4.     

Simultaneous closed dislocations of the metacarpophalangeal joints of the index, long, and ring fingers: a case report

A patient with simultaneous closed dislocation of the metacarpophalangeal joints of the index, long, and ring fingers and an ipsilateral fracture of the radius with an associated fracture-dislocation of the distal radioulnar joint is presented. This is the first such case to be described. The mechanism of injury was a fall on an outstretched hand. The dislocations of the metacarpophalangeal joints were successfully reduced by open relocation through dorsal approaches. The fractured radius was treated with open reduction and plate fixation. The patient was placed in a dorsal extension block splint after surgery, and active motion was encouraged. Eleven months later, the patient could make a full fist and extend all fingers. Grip strength was 110 pounds in the right hand, and 100 pounds in the injured left hand.     

Complex volar distal radioulnar joint dislocation occurring in a Galeazzi fracture

The Galeazzi fracture-dislocation of the forearm consists of a transverse or short oblique fracture of the radius at the junction of the middle and distal thirds with an associated subluxation or dislocation of the distal radioulnar joint. Anatomic reduction with rigid internal fixation of the radius typically produces anatomic reduction of the distal radioulnar joint and is the favored treatment. At least three cases of a mechanically blocked distal radioulnar joint requiring open reduction through a separate exposure have been reported. In all three cases there was dorsal displacement of the ulna. We report a case of an irreducible volar dislocation of the distal radioulnar joint following open anatomic reduction of the radius.     

Brachial plexus lesions complicating anterior fracture-dislocation of the shoulder joint.

Four cases of brachial plexus lesions caused by anterior fracture-dislocation of the shoulder are reported. The incidence, mechanism of injury and prognosis are reviewed.     

Unconventional alternative for hook plate fixation of the cervicothoracic junction

The most common cause for instability at the cervicothoracic junction (C7-T1) is traumatic fracture-dislocation. Surgical treatment of these unstable injuries has gained wide acceptance as the treatment of choice. The hook plate is the device of choice for achieving dorsal fusion of these injuries. It guarantees independent stability that is sufficient even in cases without anterior stabilization. Because of the high cost of commercially available hook plate systems, we resorted to the use of modified semi-tubular plates for posterior fixation of the cervicothoracic junction. Semi-tubular plates are widely available, cost effective, and can be easily modified to function as a hook plate.     

髋关节中心性骨折脱位的外科治疗

目的探讨髋关节中心性骨折脱位的诊断、分类及外科治疗的特点。方法采用回顾性研究方法对髋关节中心性骨折脱位的外科治疗病例进行总结分析。结果 8例髋关节中心性骨折脱位均为臼底部骨折并股骨头中心型脱位突入盆腔,其中仅累及臼底部骨折3例,臼底部骨折合并髋臼前柱骨折2例,臼底部骨折合并髋臼前柱骨折及前壁骨折3例。8例均采用术前下肢股骨牵引使脱位的股骨头复位及改良扩大的髂股入路进行髋臼底骨折的切开复位钢板螺丝钉内固定术,其中2例臼底破损严重的病例采用取带缝匠肌髂骨骨瓣植骨重建术。髋臼骨折复位按Matta标准,术后解剖复位4例,满意复位4例,无不满意复位。结论髋关节中心性骨折脱位为髋臼较少见的严重损伤。对中心性脱位的股骨头宜采用三向分力的股骨牵引进行复位,因髋臼底位置深在手术复位较困难,故采取髂股手术入路,直视下可显露髋臼底骨折处。采用重建钢板进行骨折固定可确保髋臼内壁的光滑,髋臼底破损严重病例采用带肌蒂髂骨骨瓣植骨可起到重建臼底及加速骨折愈合的目的 。     

Simultaneous bilateral posterior fracture-dislocation of the shoulder

A case of simultaneous bilateral posterior fracture-dislocation of the shoulders in a man following a convulsive seizure is described. Removal of both humeral heads gave a good functional result.Posterior dislocation of the shoulder is relatively uncommon, bilateral posterior dislocations are rare, and simultaneous bilateral posterior fracture-dislocations are excessively rare. Only 13 cases have been culled from the literature. The recent occurrence of such a case has prompted this report.     

Ulnar to radial dorsal fracture-dislocations of the wrist: a report of 2 cases

This report describes 2 patients with apparent ulnar to radial dorsal fracture-dislocation: 1 had a transtriquetrum, translunate fracture dislocation and the other had a reverse stage 2 lesser arc perilunate dislocation with fracture of the ulnar styloid at its base.     

Traumatic dislocation of the hip with ipsilateral femoral shaft fracture: a method of treatment

Two cases of posterior fracture-dislocation of the hip associated with an ipsilateral femoral shaft fracture are presented with a technique of reduction and stabilization which allows for closed treatment of both injuries. This approach is advantageous in the severely injured patient.     

An unusual dorsal fracture-dislocation of the proximal interphalangeal joint

A case of dorsal fracture-dislocation of the proximal interphalangeal joint in which the volar plate had been pulled from its distal attachment without bony or cartilaginous attachments and the lip of the volar plate had also been detached separately and was obstructing full flexion of the joint is presented. A tentative mechanism of causation of this unusual variant of a common injury is suggested.     

CT三维重建技术在骨盆骨折脱位中的应用价值

目的:探讨CT三维重建在骨盆骨折脱位诊治中的应用价值。方法:37例骨盆骨折脱位患者,术前均行X线、CT扫描和CT三维重建成像,通过骨盆像的任意旋转,获得骨盆各个方位的图像,并根据需要摄片。根据骨盆骨折脱位和骨盆环的破坏程度,选择最佳治疗方案和手术入路。其中26例行切开复位重建钢板螺钉内固定术,11例采取保守疗法。结果:37例CT三维重建成像均能较清晰显示骨盆骨折脱位在三维层面即矢状面、额状面及水平面上的移位方向、移位程度及骨盆环破坏情况。术后35例获得随访,随访时间2~4.5年,平均33个月,参照骨折疗效标准:优23例,良8例,可4例。结论:CT三维重建把CT扫描和图像重建技术有机地结合得出三维空间图像,能直观、全面、精确地显示骨盆的立体形态和各部位解剖结构的空间关系,对选择合适的手术入路和内固定起重要作用。     

Arthroplasty of the ulnar carpometacarpal joints

Fracture-dislocation of the ulnar carpometacarpal (CMC) joints may result in malunion or arthropathy when it is missed or inadequately treated. Partial resection arthroplasty of the ulnar CMC joints was done in 16 patients to treat malunion subsequent to dorsal fracture-dislocation. This procedure is recommended as a reliable means of treatment that preserves the important motion on the ulnar side of the hand.     

An irreducible phalangeal epiphyseal fracture-dislocation. A case report

A 20-month-old infant sustained an irreducible epiphyseal fracture-dislocation of a proximal interphalangeal joint. The dorsal dislocation of the joint was associated with a 90 degree rotational displacement (Salter-Harris Type I fracture) of the epiphysis of the middle phalanx. This injury, which seems not to have been described previously, required open reduction through both volar and dorsal incisions because the intact collateral ligaments and extensor central slip did not permit adequate distraction of the joint.