Bilateral fracture-dislocation of the sacroiliac joint: a case report

Bilateral fracture-dislocation of the sacroiliac joint with intrapelvic displacement of the sacrum is a rare and extremely severe injury. We treated a patient with bilateral fracture-dislocation of the sacroiliac joint using a nonoperative method and obtained an excellent functional result.     

Delayed post-traumatic cauda equina compression syndrome

Acute lumbosacral fracture-dislocation is an unusual injury. A delayed cauda equina injury accompanying the fracture-dislocation is seldom encountered. We report a cauda equina lesion complicating an acute lumbosacral fracture-dislocation 3 weeks postinjury. The patient had been trapped in a knee-elbow position under an overturned vehicle. Symptoms were relieved following posterior decompression and fusion from L5 to S1.     

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 。     

Occult Monteggia fracture in an adult: a case report

Injuries with the Monteggia fracture-dislocation pattern necessitate operative fixation of the ulna fracture in an adult. It is important to identify this by taking radiographs of the elbow and wrist joints in all cases of ulna fracture. We present a case of an occult Monteggia fracture-dislocation in an adult, which was not apparent on the initial radiographs. A thorough clinical examination along with an examination under anaesthesia in view of the high index of suspicion helped us to achieve the diagnosis.     

Unstable dorsal fractrue-dislocation of the fifth carpometacarpal jont

Four cases of unstable fracture-dislocation of the fifth carpometacarpal joint are reproted, including 3 isolated dorsal fracture-dislocation and 1 dorsal fracture-dislocation associated with a fracture of the fourth metacarpal bone. All cases required open reduction and Kirschner wire fixation which resulted in good function. Attention is drawn to the frequent delay in diagnosis. The applied anatomy is discussed.     

Interposition of Tibialis Posterior and Flexor Digitorum Longus Tendons Resulted in Irreducible Ankle Fracture-Dislocation

Irreducible ankle fracture-dislocations are very rare entities. The present case report demonstrates an unusual finding of tibialis posterior and flexor digitorum longus tendons interposed in the tibiofibular joint impairing successful closed reduction of ankle fracture-dislocation. A 45-year-old patient presented with a bimalleolar pronation-external rotation ankle fracture-dislocation after a motorcycle accident. Attempts to perform closed reduction before surgery were unsuccessful. Subsequent urgent open reduction and internal fixation surgical management revealed interposition of the tibialis posterior and flexor digitorum longus tendons in the tibiofibular joint. In irreducible fracture-dislocation of the ankle with severe lateral displacement of the talus, one should be aware of the possibility of soft tissue interposition of the tibialis posterior and flexor digitorum longus tendons in the tibiofibular joint.     

Superior fracture-dislocation of the hip

A case of superior fracture-dislocation of the hip following a low-energy injury is reported. The direction of the dislocation is uncommon. Radiological investigation was delayed for 5 months and then showed the appearances of a radiologically perfect false acetabulum. The fracture-dislocation was a type IV with an associated fracture of the femoral neck, an injury which is expected to produce a high rate of avascular necrosis of the femoral head. However, bone scans suggested that the femoral head was viable.     

Value of multidetector spiral CT in diagnosis of acute thoracolumbar spinal fracture and fracture-dislocation

Objective: To investigate the diagnostic value of multidetector spiral CT (MSCT) in acute thoracolumbar spinal fracture and fracture-dislocation. Methods: CT imaging files of 152 consecutive traumatic patients with thoracolumbar fractures were retrospectively reviewed. MSCT scannings were performed with a collimation of 3-5 mm and a pitch of 5.5. The postprocessing included sagittal and coronal multiplannar reconstruction, and 3-D reconstruction. Results: There were 88 cases of compression fracture, 54 cases of burst fracture and 10 cases of fracture-dislocation. Transverse images of MSCT could visualize all fractures directly and determine whether spinal canal was intact. Postprocessing image was helpful in depicting the displacement of fragment and orientation of dislocation. Conclusions. MSCT plays an important role in diagnosis and management of acute thoracolumhar spinal fracture and fracture-dislocation.     

微型外固定支架结合有限内固定治疗跗横关节骨折脱位

目的 分析微型外固定支架结合有限内固定治疗跗横关节骨折脱位的临床疗效.方法 自2006年5月至2008年1月应用微型外固定支架结合有限内同定治疗跗横关节骨折脱位15例,骨折脱佗按Main分型:Ⅰ型8例,Ⅱ型2例,Ⅳ型1例,Ⅴ型4例.对骨折脱位行切开复位内同定,使用微型外固定支架恢复维持足内外侧柱的长度.术后指导功能锻炼,术后3个月拆除内、外固定,采用美国足踝外科协会(AOFAS)中足评分系统评估临床疗效. 结果 本组12例患者获得11～24个月(平均15个月)随访,3例失访.术后3个月AOFAS评分为(68.6±3.9)分,术后6个月为(72.9±2.6)分,术后1年为(77.5±4.6)分,所有患者均能自丰行走,无需进一步治疗. 结论 微型外固定支架结合有限内固定治疗跗横关节骨折脱位可获得满意的临床疗效,治疗时除了使骨折脱位解剖复位外,更应注意恢复足内外侧柱的长度.     

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.     

Management of posterior fracture-dislocations of the shoulder

Posterior fracture-dislocation of the shoulder is rare. Comprehensive treatment guidelines for posterior fracture-dislocation of the shoulder with fracture of the humeral head have not been previously published. Although open reduction and internal fixation of the proximal humerus for posterior fracture-dislocation has been reported in several series, the successful reconstruction of the articular surface by rigid internal fixation of a large osteochondral fragment has not been reported. This paper describes two cases of posterior fracture-dislocation of the shoulder with a substantial defect of the anteromedial humeral head resulting from the cleavage of a large osteochondral fragment. Preoperative computed axial tomographic (CAT) scanning of the injured shoulders helped in operative planning by precisely defining the extent of the articular injury. Accurate reconstruction of the articular surface restored joint stability and gave excellent clinical results. Large humeral head osteochondral fracture fragments require accurate reduction and internal fixation.     

后路短节段椎弓根螺钉系统治疗胸腰椎骨折脱位伴脊髓损伤

目的探讨脊柱后路减压加短节段椎弓根螺钉系统内固定治疗胸腰椎骨折脱位伴脊髓损伤的疗效。方法对45例上述患者行AF、RF或DSS系统内固定治疗。结果术后平均随访11（5-25）个月,脊柱后凸角由术前平均24.5°恢复到5°;伤椎椎体前缘高度由术前平均51.5%恢复到93.2%。31例患者脊髓神经功能Frankel分级较术前改善1-2级。结论后路减压加短节段椎弓根螺钉系统内固定具有手术操作简单、损伤小、椎管减压充分等优点,有利于脊髓功能的恢复。     

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.     

Post-traumatic osteonecrosis of the lateral tibial plafond

We report a series of patients who presented with post-traumatic osteonecrosis of the lateral tibial plafond. Nine patients were identified with evidence of osteonecrosis limited to the lateral tibial plafond. All of them were seriously impaired with a mean valgus collapse of the ankle joint of 15.3°. Seven patients had a Weber C open medial fracture-dislocation, and two had a closed Weber C fracture-dislocation. This series confirms that post-traumatic osteonerosis of the lateral tibial plafond is associated with Weber C fracture-dislocation. It evolves into a valgus deformity of the ankle due to collapse of the lateral tibial plafond. The prognosis is poor and required further reconstructive surgery in all cases.     

前路手术治疗陈旧性下颈椎骨折脱位

目的：探讨陈旧性下颈椎骨折脱位的手术入路选择以及前路手术治疗的治疗效果。方法：2003年1月至2010年5月,17例下颈椎骨折脱位患者因不同原因于伤后4周以上行持续颅骨牵引和前路减压植骨钢板内固定术。其中男11例,女6例;年龄24～56岁,平均41岁;受伤至手术时间4周～3个月。Frankel分级：A级7例,B级4例,C级2例,D级2例,E级2例。评价治疗前后的神经功能,观察术后植骨融合情况、椎间高度和颈椎椎体序列。结果：17例患者切口均Ⅰ期愈合。1例出现声音嘶哑,1个月后症状消失。平均随访23个月（4～47个月）,术后X线示椎间隙高度和颈椎序列恢复满意,内固定物和植骨稳定无松动,融合满意。术后Frankel分级明显改善,A级5例,B级5例,C级1例,D级3例,E级3例。结论：单纯前路手术可以使屈曲牵引型（DF）Ⅰ、Ⅱ型和部分Ⅲ型复位,对陈旧性下颈椎骨折脱位的患者采用前路减压植骨钢板内固定术是一种有效、简便、安全的方法。     

Total hip arthroplasty and acetabular bone grafting for unreduced fracture-dislocation of the hip

Functional restoration after chronic persistent fracture-dislocation of the hip was achieved by total hip arthroplasty (THA) in two patients with history of severe multiple injuries. Acetabular deficiency was corrected by use of the femoral head as an autologous bone graft. A 24-year-old man and a 42-year-old woman were treated for persistent fracture-dislocation of the hip two years and one year, respectively, after the accidents. In both, total hip arthroplasty in combination with acetabular bone grafts, with the femoral head, produced satisfactory clinical results at follow-up periods of 59 and 55 months.     

Posterior Fracture-Dislocation of the Hip in Sports

Abstract Posterior fracture-dislocation of the hip is a rare injury in sports and is most frequently seen after road traffic accidents. A posterior fracture-dislocation of the hip that occurred in an adult sportsman during rugby is reported. This case illustrates the great forces that can be sustained by the hip joint of rugby players. Operative stabilization led to a stable hip joint allowing early mobilization. Following rehabilitation, the patient returned to light sporting activities after 9 months.     

改良Ilizarov外固定器治疗复杂踝关节骨折脱位

目的 :应用改良Ilizarov外固定器治疗复杂的踝关节骨折脱位。方法 :对 2 4例复杂踝关节骨折脱位采用手法复位 ,闭合穿针改良Ilizarov外固定器固定进行治疗。结果 :本组2 4例中优 12例 ,良 10例 ,差 2例 ,总优良率 91.67%。骨折的平均愈合时间为 7.5周。结论 :应用改良Ilizarov外固定器治疗复杂踝关节骨折脱位疗效满意 ;应用橄榄针穿针弹性固定下胫腓联合分离 ,符合生物学固定的原则 ,是治疗下胫腓联合分离的一种有效方法。     

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。     

Posterior shoulder fracture-dislocation: A systematic review of the literature and current aspects of management

Purpose Posterior fracture-dislocation of shoulder is an infrequent traumatic event;however,most orthopaedic surgeons may face the challenge of treating it.The aim of this study is to review and summarise systematically the current principles of the management of this complex injury,and create a treatment algorithm.Methods Both PubMed and Scopus Databases were systematically searched for the terms“posterior shoulder fracture-dislocation”or“posterior glenohumeral fracture-dislocation”or“posterior glenoid fracture-dislocation”for articles written in English and published in the last decade.Results A total of 900 articles were identified,of which 13 were retained for analysis.A total of 153 patients(161 shoulders)were identified.These patients were treated either with open reduction and internal fixation,modified McLaughlin procedure,allograft/autograft humeral head reconstruction or shoulder arthroplasty.The mean age was 40.15 years.The mean postoperative Constant score in cases treated by open reduction and internal fixation was 86.45,whereas by bone graft was 84.18.Further,the mean postoperative Constant score was between 79.6 and 67.1 in those that were managed by modified McLaughlin and arthroplasty procedure,respectively.Conclusion The management of posterior shoulder fracture-dislocation may be challenging,and the best surgical option depends on many variables such as the chronicity of the injury,the presence of a fracture at the level of the surgical neck or tuberosities and the extend of the Hill-Sachs lesion if any.A treatment algorithm is proposed,based on the current literature in an effort to create a consensus for these injuries.For the acute shoulder fracture-dislocations,an open reduction should be performed.For the chronic fracture/dislocations in the elderly low-demand patients,conservative treatment should be performed.For the rest of the patients,depending on the severity of the Hill-Sachs lesion different surgical options are available such as the McLaughlin technique,the use of an allograft,osteotomy or arthroplasty.