Bicondylar Hoffa's fracture with patellar dislocation – a rare case

Bicondylar Hoffa''s fractures of the femur is very uncommon. Conjoint bicondylar Hoffa fracture with ipsilateral patellar dislocation, Bicondylar Hoffa''s with patellar fracture and extensor mechanism rupture has been described in literature. We report a case of unconjoint bicondylar Hoffa''s fracture with lateral patellar dislocation in 17-year-old male patient treated with open reduction and cancellous screw fixation that subsequently healed well with good functional outcome.     

The pediatric triplane ankle fracture

The pediatric triplane ankle fracture represents a unique spectrum of injury that does not fit neatly into the Salter-Harris classification of physeal injury. This fracture is particular to the pediatric population and often is termed a transitional injury. It is the result of the characteristic asymmetric closure of the distal tibial physis over a period of approximately 18 months. The triplane ankle fracture is a multiplanar injury with three classically described fracture fragments. It has several variations and represents 5% to 10% of pediatric intra-articular ankle injuries. The fracture typically presents in children aged 12 to 15 years; incidence is slightly higher in boys than in girls. Nondisplaced triplane fractures and extra-articular fractures can be managed with immobilization in a long leg cast. Displaced fractures are treated with open reduction and internal fixation performed through an anterolateral approach or an anteromedial approach. Intra-articular reduction to within 2 mm is required for optimal treatment of these unique pediatric ankle fractures.     

Glomus Tumor of Hoffa's Fat Pad and Its Management by Arthroscopic Excision

We present a rare case of glomus tumor of Hoffa''s fat pad in a 42-year-old woman. Magnetic resonance imaging findings along with the characteristic clinical picture led us to suspect a glomus tumor as the possible etiology. An ischemia test was found to be positive and this further substantiated our diagnosis. An arthroscopic excision was performed and the histology confirmed the diagnosis of glomus tumor of Hoffa''s fat pad. The patient responded well to the excision with immediate complete resolution of pain and she remains asymptomatic at the last follow-up after 15 months. To our knowledge, this is the second reported case of glomus tumor of Hoffa''s fat pad and the first ever to be managed by simple arthroscopic excision. The tumor poses a great challenge to an orthopedic surgeon. However, knowledge of its characteristic clinical presentation and the recognition of such a rare entity can help achieve an early diagnosis and timely management.     

An atypical clay shoveler's fracture: a case report

A case of an atypical clay shoveler''s fracture with involvement of the spinolaminar line is described. Causative mechanisms of injury, radiographic appearances, differential diagnosis, treatment and prognosis are reviewed. Classic clay shoveler''s fractures are considered stable fractures. However, when the spinolaminar line is disrupted, spinal cord involvement must be ruled out.     

Ipsilateral proximal and distal forearm fracture/fracture dislocation in children

Fifteen children with segmental forearm fractures were classified into two groups based on their proximal injury pattern. Proximal injury in group A was either Monteggia fractures or its variant and in group B it was diaphyseal fractures. The distal lesions in both these groups were either a metaphyseal fracture or an epiphyseal separation, or a combination of these two. Eleven children of group A were managed conservatively, whereas three of four children in group B required open reduction. After 2.67 years of follow-up in 13 children, clinical outcome based on modified Boyd and Boal's criteria was good in eight and fair in two children of group A, and good in two children and fair in one child of group B. The clinical outcome of pediatric segmental forearm fractures is good (P=0.05) and it may frequently need surgical intervention when the proximal fracture is diaphyseal.     

Understanding the susceptibility to lateral condyle fracture by analyzing unaffected Baumann's angle in children with distal humeral fracture

BackgroundPrevious studies have shown that posttraumatic cubitus varus deformity in children is somehow related to subsequent humeral lateral condyle fracture. Moreover, we had previously encountered an exactly similar case. In this study, we aim to understand whether there is a morphological difference between pediatric supracondylar and lateral condyle fracture of the humerus by comparing Baumann's angle of the unaffected elbow.MethodsWe conducted a retrospective evaluation of 40 cases of supracondylar fractures (36 boys, 4 girls) and 20 cases of lateral condyle fractures (16 boys, 4 girls) at a single facility between January 2014 and December 2018. The unaffected Baumann's angles and lateral capitellohumeral angles of both groups were measured by two orthopedic surgeons and analyzed using Welch's t-test. The effect size was also calculated using Cohen's d, and intraclass correlation coefficients were applied for intra-rater and inter-rater reliability.ResultsThe average age of patients in the supracondylar fracture group was 6.78 years and that in the lateral condyle fracture group was 5.70 years. No significant differences were observed between gender and fracture type, between laterality and fracture type, and in the lateral capitellohumeral angles between the groups. Baumann's angle was significantly less in the lateral condyle fracture group (17.27° ± 4.68°) than in the supracondylar fracture group (20.28° ± 3.10°) as analyzed by Welch's t-test (p = 0.015). The effect size was 0.76. Each of the intra-rater reliabilities were 0.97 and 0.96, whereas the inter-rater reliability was 0.75.ConclusionsA significant morphological difference was found between the supracondylar fracture group and the lateral condyle fracture group. The loss of Baumann's angle which tends to occur after the healing of supracondylar fracture may increase the susceptibility to lateral condyle fracture. Orthopedic surgeons should repair and fix supracondylar fractures appropriately to avoid an ipsilateral second fracture, such as lateral condyle fracture.     

Tumor like swellings arising from Hoffa's fat pad: A report of three patients

We report three rare cases of tumor-like conditions arising from Hoffa''s fat pad (HFP). Patients were having persistent knee pain, the cause of which was not diagnosed by the general physician, and then were referred to us for knee pain. Magnetic resonance imaging revealed the lesions to be arising from HFP (ganglion cysts and hemangioma), as was suggested by clinical findings. Anatomy, pathology, and radiological features of the Hoffa''s disease are described here to increase awareness in orthopedic community of this rare but interesting disease which is often misdiagnosed as meniscal pathology. These cases illustrate that increased cognizance can facilitate timely intervention which will prevent morbidity of the patient.     

Treating the boxer's fracture in Wales: a postal survey

INTRODUCTION

There is no standardised treatment for fifth metacarpal neck fractures. Treatment of this common fracture can vary from immediate mobilisation to immobilisation in a plaster cast for 3 weeks. There is no literature identifying current practice amongst surgeons.

SUBJECTS AND METHODS

This survey''s aim was to reveal current practice in Wales by means of a postal questionnaire sent to all Welsh orthopaedic consultants.

RESULTS

The questionnaire had a 60% response rate. Results demonstrated varied opinion regarding the degree of displacement warranting reduction. Overall, 10% of surgeons reduce the fracture at 30° of displacement, 29% at 40°, 18% at 50° and 20% at 60° of displacement. The treatment was also very varied. Most surgeons preferred to treat these fractures with neighbour strapping (43%,) while others preferred plaster immobilisation (39%) or immediate mobilisation (10%.) Only 22% of surgeons discharge these patients back to the community after their first visit to out-patients while 13% offer two follow-up appointments.

CONCLUSIONS

The treatment being offered for this common fracture in Wales is inconsistent. There is a need to develop evidence- based best practice guidelines which should standardise the treatment of this common injury. Perhaps, a large multicentre outcome study may enable this to be drawn up in the future.     

Pediatric open elbow dislocation without fracture: A case report

INTRODUCTION

Elbow dislocations in children are rare injuries. These injuries are often in the form of complex injuries that is accompanied by the median nerve damage and medial epicondyle fracture in the pediatric age group. Open elbow dislocation without fracture in the pediatric age group has been reported very rarely in the literature.

PRESENTATION OF CASE

The purpose of this study is to present an 8-year-old patient who has open elbow dislocation without fracture accompanying with brachial artery injury. In the clinical examination of the patient, there was an open wound in the transverse antecubital region. After repair of brachial artery injury, open reduction was performed under general anesthesia. In the postoperative clinical examination at 6 months, left elbow flexion was 140°, extension was full and there were no deficit in the supination and pronation of the forearm.

DISCUSSION

Elbow dislocation without fracture in pediatric patients is a very rare injury. Usually the trauma mechanism of elbow dislocation is falling on outstretched hand with elbow in approximately 30° of flexion. However our patient had fallen on outstretched hand with elbow in full extension. Although this type of trauma mechanism is typical for supracondylar humerus fractures in pediatric age group, in our patient an open posterior elbow dislocation without fracture had occurred.

CONCLUSION

Pediatric elbow dislocations are rare injuries and the management of these injuries can be technically demanding due to concurrent neurovascular injuries. An open dislocation without fracture is very rare and it should be treated with immediate intervention, an effective teamwork and good rehabilitation.     

Smith's fracture generally occurs after falling on the palm of the hand

Orthopedic trauma surgeons often encounter Smith's fracture in patients who report that they have fallen on the palms of their hands. The aim of this study was to clarify the pathogenesis of Smith's fracture in basic clinical aspects. First, a survey was conducted for investigating the mechanism of injury and arm position at the time of injury among patients with Smith's fractures who consulted at our outpatient clinic. Second, we created three‐dimensional finite element models (FEMs) to predict the influence of arm position on the type of injury resulting from a fall. These predictions were then used in ten freshly frozen cadavers to provide experimental proof of Smith's fractures resulting from the impact on the palmar side. Twenty‐six patients (5 males and 21 females) with Smith's fractures were enrolled in this study. Injury resulting from a fall on the palm of the hand, the dorsum, or ulno‐dorsum of the hand, and fisting handle was observed in 16 cases (61%), 3 cases (12%), and 1 case (4%), respectively. Six patients were uncertain of their arm position at the time of injury. FEM analysis showed that Smith's fractures occurred when the angle between the long axis of the forearm and the ground was 30°–45° in the sagittal plane and 75°–90° in the coronal plane. Smith's fractures occurred in 7 of 10 wrists in the experimental study, whereas no Colles’ fractures were observed. This study demonstrated that Smith's fracture results from falling on the palm of the hand. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2435–2441, 2017.

     

微创经皮桥接钢板技术治疗真骨盆缘完整的髋臼前柱骨折的疗效分析

目的 :探讨微创经皮桥接钢板技术治疗真骨盆缘完整的髋臼前柱骨折的可行性和疗效分析。方法 :对2013年5月至2015年12月收治的8例真骨盆缘完整的髋臼前柱骨折患者进行回顾性分析,根据Judet-Letournel分型,均为单纯的髋臼前柱不稳定骨折。其中男5例,女3例;年龄22~63岁,平均42.8岁;挤压伤4例,压砸伤3例,高处坠落伤1例。受伤至手术时间5~19 d,平均9.5 d。术前CT显示髋臼高位前柱骨折,骨盆真骨盆缘完整,骨折端分离均1 cm。所有患者采用闭合复位微创经皮桥接钢板固定技术治疗。观察并记录患者的骨折复位质量、手术时间、术中出血量、骨折愈合时间、末次随访时的髋关节功能及术后并发症发生情况等。结果:8例患者均获得随访,时间10~19个月,平均14.5个月。依据Matta影像学评分标准评定骨折复位质量,解剖复位4例,复位良好3例,复位较差1例。手术时间30~80 min,平均51.3 min;术中出血量50~120 ml,平均86.2 ml;骨折愈合时间10~19周,平均13.3周。末次随访时髋关节功能采用Merle D’Aubigne评分系统评定:优5例,良2例,可1例。8例患者术后均无血管神经损伤、伤口感染、术中大出血、下肢深静脉血栓形成等并发症发生。结论:微创经皮桥接钢板技术治疗真骨盆缘完整的髋臼前柱骨折具有创伤小、出血少、恢复快、疗效好等优点,是一种治疗髋臼前柱骨折的良好手术方式。     

A scaphoid fracture associated with a displaced distal radial fracture in a child

A hyperextension injury to the wrist caused a transverse scaphoid fracture associated with a displaced distal radial fracture in an 11-year-old boy. Anatomic reduction and immobilization in a long-arm cast for a period of 12 weeks resulted in subsequent healing of these fractures. The coexistence of a scaphoid fracture with a distal radius fracture in a child is important to recognize because reduction maneuvers are modified to effectively treat this combination of injuries. Patients with distal radial physeal injuries should be closely evaluated for clinical and roentgenographic signs of scaphoid fractures.     

Repeatability and reproducibility of a telemanipulated fracture reduction system

We evaluate the inter- and intraobserver variability of a telemanipulated femur fracture reduction system using a joystick device. Five examiners performed virtual reduction of 3D femur fracture models on two separate occasions. We assessed the inter- and intraobserver variability for the final alignment and reduction. The average difference between testing rounds was only 0.3 mm for overall displacement and 0.5° for overall rotation. There was an average time reduction between rounds of 11.7 s. The mean differences in overall displacement between examiners ranged between 0.2 and 0.9 mm; between 0.2° and 3.2° for overall rotation; and between 9 and 82 s for time to reduction. The time required to complete the reduction did not have a significant effect on the overall displacement or rotation of the final model. Telemanipulated fracture reduction is a reliable and reproducible technique, which does not require extensive training.     

Clinical outcome after orbital floor fracture reduction with special regard to patient's satisfaction

Purpose: Primary reconstruction via transconjunctival approach is a standardized treatment option for orbital floor fractures. The aim of this study was to compare the findings of specific ophthalmologic assessment with the patient''s complaints after fracture reduction. Methods: A retrospective medical chart analysis was performed on patients who had undergone transconjunctival orbital floor fracture reduction for fracture therapy with resorbable foil (ethisorb sheet or polydioxanone foil). A follow-up assessment including ophthalmological evaluation regarding visual acuity (eye chart projector), binocular visual field screening (Bagolini striated glasses test) and diplopia (cover test, Hess screen test) was conducted. Additionally, a questionnaire was performed to assess patients'' satisfaction. Results: A total of 53 patients with a mean follow-up of 23 months (ranging from 11 to 72) after surgical therapy were included. Diplopia was present preoperatively in 23 (43.4%) and reduced in follow-up examination (n=12, 22.6%). Limitations in ocular motility reduced from 37.7% to 7.5%. The questionnaire about the patient''s satisfaction revealed excellent outcomes in relation to the functional and esthetical parameters. Conclusion: Transconjunctival approach is a safe approach for orbital fracture therapy. Postoperative diplopia is nearly never perceptible for the individual and differs to pathologic findings in the ophthalmic assessment.     

Conjoint bicondylar Hoffa fracture in an adult

Conjoint bicondylar Hoffa fracture is an extremely rare injury. Only one case has been reported previously in the pediatric age group. We describe this injury in a 17-year-old male who presented following a fall with direct impact on his semiflexed right knee. Plain radiographs were inadequate to define the exact pattern of injury. Computed tomographic (CT) scans demonstrated the coronal fracture involving both the femoral condyles which were joined by a bridge of intact bone. The patient was treated with open reduction and internal fixation using swashbuckler (modified anterior) approach. Union occurred within 3 months and at final followup (at 18 months) the patient had a good clinical outcome. The possible mechanism of injury is discussed.     

Paediatric biepicondylar elbow fracture dislocation - a case report

Paediatric elbow biepicondylar fracture dislocations are very rare injuries and have been only published in two independent case reviews. We report a case of 13 years old boy, who sustained this unusual injury after a fall on outstretched hand resulting in an unstable elbow fracture dislocation. Closed reduction was performed followed by delayed ORIF (Open Reduction and Internal Fixation) with K wires. Final follow-up at 14 weeks revealed a stable elbow and satisfactory function with full supination-pronation, range of motion from 0°-120° of flexion and normal muscle strength. This type of injury needs operative treatment and fixation to restore stability and return to normal or near normal elbow function. The method of fixation (screws or K wires) may depend on size and number of fracture fragments.     

Nonunion of a pediatric lateral condyle fracture without ulnar nerve palsy: sixty-year follow-up.

Displaced lateral condyle fractures in the pediatric population are usually treated with open reduction and internal fixation. Significant complications associated with the nonoperative management include nonunion, malunion, deformity, and tardy ulnar nerve palsy. However, few cases of nonunion of the lateral condyle and tardy ulnar nerve palsy with long-term follow-up have been reported. We present a radiographically documented case of a pediatric lateral condyle fracture and subsequent nonunion with significant cubitus valgus deformity without ulnar nerve palsy sixty years following injury.     

后路部分椎体切除治疗合并神经损伤的难复性下腰椎爆裂性骨折

目的探讨后路部分椎体切除治疗合并神经损伤的难复性下腰椎爆裂性骨折的疗效。方法回顾性分析2014年3月—2018年10月收治的28例合并神经损伤的难复性下腰椎爆裂性骨折患者临床资料,载荷分享评分(LSC)6 ～ 9(7.2±1.1)分;高处坠落伤7例,交通伤15例,重物砸伤6例;L_3骨折18例、L_4骨折7例、L_5骨折3例,其中6例合并邻近椎体压缩性骨折;马尾神经损伤10例,神经根损伤4例,两者均有损伤14例;受伤至手术时间2 ～ 7(3.4±1.4)d。记录手术时间、术中出血量,对疼痛视觉模拟量表(VAS)评分、伤椎椎体前缘高度比、Cobb角及神经功能美国脊髓损伤协会(ASIA)分级改善情况进行评价。结果所有手术均顺利完成,手术时间(163.9±22.4)min,术中出血量(652.1±95.5)mL。所有患者随访12 ～ 30个月,平均16.7个月。术后VAS评分、伤椎椎体前缘高度比和Cobb角均较术前显著改善,差异有统计学意义(P 0.05)。神经功能ASIA分级,术前A级1例术后仍为A级;术前B级4例,术后恢复至C级3例、D级1例;术前C级15例,术后恢复至D级11例、E级4例;术前D级8例,术后仍为D级4例,恢复至E级4例。结论后路部分椎体切除治疗合并神经损伤的难复性下腰椎爆裂性骨折疗效满意。     

Open pelvic fracture with vaginal laceration and diaphragmatic rupture in a child

A case report of a 4-year-old child who sustained an unstable open pelvic fracture with a diaphragmatic rupture is presented. A strong correlation exists between rupture of the diaphragm and pelvic fractures. We note the difference between pediatric and adult pelvic fractures, and discuss late complications unique to the child with a pelvic fracture. Pelvic external fixation is faster and less morbid than other surgical treatments for unstable pelvic fractures, and therefore provides an excellent alternative to pelvic open reduction in the acute treatment of pediatric patients with multi-system injuries. If fracture reduction is incomplete following initial closed manipulation, a staged secondary open reduction can then be performed.     

改良Uhl闭合穿针技术治疗Colles骨折回顾性研究

目的:回顾性分析中国接骨学(Chinese osteosynthesis,CO)理念指导下改良Uhl技术治疗Colles骨折的优势。方法:回顾性研究2016年1月至2021年6月采用改良Uhl闭合穿针技术治疗Colles骨折358例,符合条件的纳入120例,按照手术方法不同分为两组:闭合穿针组和切开复位组。闭合穿针组68例,采用CO接骨理念指导下改良Uhl闭合复位经皮穿针技术;切开复位组52例,采用切开复位钢板内固定技术。术后6个月比较两组腕关节改良的Sarmiento影像学评分、Gartland-Werley腕关节评分及手术时间、住院时间、治疗费用。结果:两组患者均获得6个月以上随访。两组在Sarmiento影像学评分、Gartland-Werley腕关节评分方面比较,差异无统计学意义(P>0.05)。闭合穿针组手术时间(35.88±14.11) min、住院时间(9.78±2.48) d、治疗费用(16 074.91±1 964.48)元,与切开复位组手术时间(65.48±14.26) min、住院时间(15.88±2.00) d、治疗费用(20 451.27±1 760.2...