Rare Isolated Trapezoid Fracture: A Case Report

Isolated fractures of the trapezoid are rare. Of all of the fractures of the carpus, the most common is the scaphoid, which represents 68.2% of all carpal fractures (Papp, Orthop Clin N Am 38:251–60, 2007). In contrast, trapezoid fractures represent 0.4% of all carpal injuries. Because it is an infrequently fractured carpal bone, there is a wide variety of treatment plans, including rest, immobilization, and surgery (Green and Pederson, Green’s Operative Hand Surgery, Elsevier, Philadelphia, 759 pp, 2005). In this report, we describe a patient who presented with an isolated fracture of the trapezoid that was successfully treated with cast immobilization and had a full functional recovery.     

Maisonneuve Fracture without Deltoid Ligament Disruption: A Rare Pattern of Injury

The Maisonneuve fracture is considered by many to be one of the most unstable ankle injuries. We report a rare injury involving fracture of the proximal fibula in association with a posterior malleolar fracture and disruption of the anterior-inferior tibiofibular ligament, without disruption of the deltoid ligament or fracture of the medial malleolus. This report of a diagnostically challenging case highlights the importance of timely clinical and radiographic reassessment of a patient who fails to improve with initial therapy, and describes the clinical and diagnostic imaging findings of an unusual ankle injury.     

Peroneal Tendons Rupture in a Closed Talar Body Fracture: A Rare Injury

The combination of tendon and ligament ruptures with fracture of the talus is very rare. We demonstrate our experience in the acceptable management of a 34-year-old male referred with a closed comminuted fracture of the talar body after falling 7 meters. During the surgery, complete rupture of the peroneus brevis tendon, partial rupture of the peroneus longus tendon, and an avulsed superficial deltoid ligament from medial malleolus were found. Twelve months after open reduction and internal fixation of the talar body fracture and repair of the peroneal tendons and superficial deltoid ligament, the patient was satisfied, without any talar dome collapse, sclerosis, or arthritic changes. It is recommended to take care of possible tendon or ligament ruptures during fixation of talar fractures in cases of high-energy trauma.     

Treatment of a Scientifically Neglected Ankle Injury: The Isolated Medial Malleolar Fracture. A Systematic Review

Isolated medial malleolar fractures are frequently encountered injuries. Literature regarding their treatment, though, is scarce and contradicting. The aim of this systematic review is to compare surgical and conservative treatment of isolated medial malleolar fractures considering complication rates and functional outcomes. PubMed, Embase, Cochrane, and CINAHL were searched for this review. Articles from 1980 or later, written in English, French, German, or Dutch, reporting any outcome of 10 or more isolated medial malleolar fractures in skeletally mature patients were included. Study quality was assessed using the Methodological Index for Non Randomized Studies (MINORS) instrument. Eighteen studies were included involving 2566 isolated medial malleolar fractures, which showed a mean (± SD) MINORS score of 8 ± 2. Mean nonunion rate was 1.7% after surgical treatment and 3.5% after conservative treatment. Overall, comparable functional outcomes were found after both treatment methods. Only 2 of the included studies reported the exact amount of fracture displacement. One study—comparing surgical and conservative treatment—showed similar functional outcomes for 1- and 2-mm displaced isolated medial malleolar fractures, and the other, a nonunion rate of 3.5% and a good mean functional outcome in 57 conservatively treated isolated medial malleolar fractures with a mean displacement of 3.8 mm. The available evidence is scarce and of low quality but suggests that conservative treatment of isolated medial malleolar fractures displaced ≤2 mm is safe. No study exists that compares surgical and conservative treatment in isolated medial malleolar fractures displaced >2 mm. Therefore, further research is needed. Until then, the eventual choice of treatment for isolated medial malleolar fractures displaced >2 mm, might be mainly dependent on the patients' characteristics and demands.     

Isolated Carpal Dislocation of the Pisiform with Distal Radius Fracture in Two Adults: A Rare Entity

Background  Pisiform dislocations are an extremely rare injury. There are reports in the literature of isolated dislocations, but to our knowledge there are no reports of distal radius fractures with associated pisiform dislocations. Methods and Results  We present two cases of isolated pisiform dislocation and distal radius fracture in the adult population. Both patients were managed conservatively with closed reduction in both the distal radius and pisiform, and subsequently achieved good pain relief and progressive return of wrist function. Conclusion  For adult patients with distal radius fractures and an associated pisiform dislocation, successful closed reduction and immobilization can result in symptomatic improvement and return of function.     

Trapezoid Stress Fracture in an International Shot-Putter: A Case Report

Trapezoid fractures are relatively rare upper limb fractures. The case report of a trapezoid stress fracture in the dominant hand of a 22 year old international standard shot-putter is presented.

Key points

• This is the first documented case report of a trapezoid stress fracture.
• Plain x-rays can be negative in stress fractures and therefore a high index of suspicion warrants further investigation with a CT scan and/or MRI of the relevant area.
• Non-displaced trapezoid fractures can be treated with immobilisation whereas displaced fractures will require surgical intervention.

Key words: Trapezoid, stress fracture     

A Rare Fracture,an Even Rarer Treatment: The Arthroscopic Reduction and Internal Fixation of an Isolated Femoral Head Fracture

This case report describes the first documented arthroscopic reduction and internal fixation of a rare isolated femoral head fracture without associated dislocation. A large suprafoveal osteochondral fracture was arthroscopically reduced by use of crossover techniques gained from experience performing arthroscopic femoroacetabular impingement surgery. An innovative “chopstick” maneuver was used to rotate the mobilized osteochondral fragment into anatomic position, followed by arthroscopic Herbert screw fixation. Relevant surgical techniques and clinical outcome are presented. Although this case shows arthroscopic osteosynthesis for a rare fracture, the techniques described herein may permit broader arthroscopic applications. As hip arthroscopy evolves, the role of arthroscopic surgery in the traumatized hip may expand beyond diagnostic arthroscopy and foreign/loose body removal. An anatomic reduction with stable internal fixation permitting early joint motion trumps the ability to perform outpatient arthroscopic procedures. However, if the equivalent procedure can indeed be accomplished in a safe and minimally invasive manner, one can envision a future expansion of the role of hip arthroscopic surgery in fracture management.     

Complete Medial Dislocation of the Tarsal Navicular without Fracture: Report of a Rare Injury

Complete dislocation of the tarsal navicular, without fracture of the navicular, is an uncommon injury. A review of the published data revealed only 15 previous reported cases. The rarity of this injury can be attributed to the rigid bony and ligamentous support surrounding the navicular, which usually undergoes fracture and dislocation rather than pure dislocation of the navicular. The mechanism and appropriate treatment of this injury remains unclear. In the present report, we describe the case of a 29-year-old male who sustained complete dislocation of the tarsal navicular, without fracture of the navicular, along with fractures of the cuboid and calcaneus, when he was involved in a motor vehicle collision. The proposed mechanism of injury in this case was that of a pronation-abduction force applied to the midfoot, resulting in a transient midtarsal dislocation and disruption of the ligamentous support of the navicular, with medial dislocation of the navicular when the midtarsal dislocation was reduced. The anterolateral calcaneus and cuboid fractures were likely from an avulsion injury through the bifurcate ligament. The patient was treated successfully with closed reduction and Kirschner wire fixation of the navicular combined with application of a spanning external fixator. The pins and external fixator were removed at 7 weeks postoperatively, and the navicular was stable at that time. The patient was lost to follow-up shortly thereafter.     

Blunt Cardiac Injury in Patients with Isolated Sternal Fractures: the Importance of Fracture Grading

Background: Sternal fractures have long been considered to harbor cardiac injury, although recent studies suggest that the clinical relevance of these injuries is limited. The risk of underlying cardiac injury may be linked to the severity of the fracture. We investigated the relation between the grade of fracture displacement and signs of blunt cardiac injury (BCI) in patients with isolated sternal fractures. Material and Methods: We retrospectively analyzed the available data of 337 patients with sternal fractures, who presented at the Emergency Department of the University Hospital Ghent, Belgium, in a 10-year period. 115 patients had isolated fractures. Fractures were classified according to the grade of displacement. We identified two categories, nondisplaced and displaced fractures. BCI was diagnosed on the basis of electrocardiographic or echocardiographic findings, available in 100% and 96% of patients, respectively. Inhospital arrhythmias were recorded in both patient groups. Results: 32% of patients had BCI. There were 37 patients with displaced fractures (32.1%). These patients showed significantly more signs of BCI (54% vs. 21%; p < 0.01), and had significantly more arrhythmias during hospitalization (23.5% vs. 5.6%; p = 0.017). Conclusion: BCI is common after sternal trauma, and the severity of the fracture is an indicator of possible myo- or pericardial damage. Patients with displaced sternal fractures should be thoroughly investigated for possible BCI.     

A Rare Case of Penetrating Rectal Injury

Penetrating injuries of the colon and rectum have been reported earlier and are often associated with injuries of adjacent viscera such as bladder, uterus or vagina, prostate and seminal vesicles as well as iliac vessels. But this case is rare not only regarding the mechanism of injury but also with respect to the depth of penetration, with the foreign body having almost reached the thorax after entry through the anal orifice.     

Proximal Tibial Sleeve Fracture: Case Report of a Rare Injury and Review of the Literature

A sleeve fracture occurs when a ‘‘sleeve’’ of cartilage or periosteum is avulsed with or without an osseous fragment, an injury most commonly reported in the patella. Proximal tibial sleeve fractures are extremely rare and we present a case in an adolescent male who had concomitant osteochondral as well as chondral fractures of his patella. Sleeve fractures present in the skeletally immature, and may look relatively benign on radiographs, but misdiagnosis may lead to adverse consequences. Clinicians should have a high index of suspicion if a child or adolescent presents with a knee injury with clinical concerns regarding the extensor mechanism. Given that the ‘‘sleeve’’ of the injury contains tissue with osteogenic potential, we recommend that displaced proximal tibial sleeve fractures should be managed operatively to avoid dysfunction of the extensor mechanism. These patients should also have perioperative assessment for occult osteochondral and chondral injuries that are potentially repairable and thus may have implications for prognosis.     

离体人睾丸缺血再灌注损伤模型

目的：建立离体人睾丸的缺备再灌注（I／R）损伤模型，为研究抗I／R损伤药物的作用及机理提供一实质器官灌注模型。方法：采用１３例捐赠尸睾，用250ml0℃-4℃高渗枸橼酸盐嘌呤液灌洗后冷存，再以500ml37℃该液进行再灌注，不同时间点取材作组织学及酶组织化学检查。结果：4℃冷缺血12h开始出现血管仙皮细胞肿胀、变圆、空泡样变，24h内皮细胞变性脱落，睾丸曲细精管基膜与生精上皮剥离，生精细胞变性脱落，间质水肿等，病变随冷缺血时间延长而加重。酶组化结果显示，单纯冷保存18h后，睾丸组织乳酸脱氢酶（LDH）活性升高，琥珀酸脱氢酶（SDH）活性24h后升高，经37℃复温再灌注后损伤明显加重。结论：离体人睾丸可替代人体其它实质器官作为研究I／R损伤的离体灌注模型。