Use of the Ilizarov apparatus to improve alignment in proximal humeral fractures treated initially by a unilateral external fixator

One of the recommended methods for the management of displaced unstable proximal humeral fractures is the unilateral external fixator. In polytrauma cases this method may be especially useful for the stabilisation of these fractures. However, problems may arise if the fracture is fixed in a malaligned or distracted position. Conversion of the treatment concept to other modalities is difficult because of the problem of pin tract infection. The Ilizarov apparatus provides an useful method in such situations, as it allows distraction, translation and compression without the need for further anaesthesia and additional fixation

Open reduction and internal fixation in a case with transscaphoid perilunate dislocation 8 months after the injury: a patient with a 5-year follow-up

The management of perilunate dislocations diagnosed later than three months continue to elicit debate with literature being scarce. We report a 22-year-old male with transscaphoid perilunate dislocation who reported to our hospital 8 months after sustaining the injury. Open reduction was done along with bone grafting. Five years after the surgery the patient is symptom-free with an excellent range of motion

First metatarsal bone reconstruction using Masquelet’s technique after bone loss in open III B injury

Background: Masquelet technique involves two stages for reconstruction of bony defects. During stage one decontamination and debridement is performed. The bone defect is filled by a spacer made of bone cement. After a gap of around 6 weeks, a bio-membrane is established around the cement spacer. During stage two, the cement spacer is removed and cancellous autologous bone graft is used to fill the space that was previously occupied by the cement spacer. However, there is a huge scarcity of literature on reconstruction of bone defects in foot metatarsals, especially open injuries that require soft tissue coverage also. Methods: This prospective study involved 25 patients with a minimum follow-up of 12 months. Masquelet’s technique was used to reconstruct large bony defects in metatarsals of foot in a staged manner. The primary outcome variable was union and consolidation of the bone. The secondary outcome variables included complications and functional outcome using Maryland foot score.  Results: One of the patients needed a below knee amputation for extensive bone and soft tissue infection. Pin site infection was the commonest indication observed and deep infection was observed on table at the time of second stage in two patients. Both the patients needed a re-do of stage one and a new cement spacer was placed which was removed at six weeks. Hallux varus deformity was observed in two patients at the final follow-up. Excluding the patient that needed amputation, all the patients had consolidation and union at the final follow-up and the mean Maryland foot score was 79.45±8.8. Good to excellent functional outcome was observed among 91.66% patients.     Conclusions: Masquelet’s induced membrane technique is a potentially fruitful method to deal with bone defects created by open fractures of metatarsals of feet. However, due to limited sample size and lack of control group, we recommend large scale randomized control trials be conducted on the subject.

Middle phalanx base fractures managed with Suzuki frame: a series of 23 patients

Background: Intra-articular fractures of the base of middle phalanx are difficult to manage. With many known methods of treatment available, the authors present their experience of managing these injuries by Suzuki’s pin and rubber traction method. Methods: A prospective study of five years duration which included 23 patients. All the patients were managed with Suzuki’s pin and rubber traction system. The primary outcome variable was ROM at the PIP joint. The secondary outcome variable was the complication profile.  Results: The mean ROM at the PIP joint at the final follow-up was 80±12.2 (range: 50-100) degrees. The mean flexion at PIP joint at the final follow-up was 82.72±10.5 degrees and the mean extension at PIP joint was -2.7±4.5 degrees. No case of non-union was observed in the present study. Pin tract infection occurred in 17.39% of cases and was the commonest complication observed. Two patients needed realignment of K-wires for pin displacement. One patient developed osteomyelitis of middle phalanx at three weeks and needed early removal of hardware. The same patient also developed complex regional pain syndrome (CRPS) at two months. One patient developed painful arthritis of PIP joint. Conclusions: Suzuki’s pin and rubber traction method is an effective modality of treatment for intra-articular fractures of the base of proximal phalanx of fingers of hand. Although, not free of complications the final results in most patients are good. However, the authors recommend large randomized control trials to be held for these injuries to compare carious modalities of treatment

Outcome of volar Barton fractures of distal radius managed with open reduction and internal fixation with volar locking plate

Background: Volar Barton fractures of distal radius almost always require a surgical fixation. Near anatomical reduction and a stout fixation is imperative for good outcome. The present study aimed at studying the outcome of open reduction and internal fixation with volar locking plate for volar Barton fractures. Methods: The present study included 25 patients with volar Barton fractures of distal radius presenting to the orthopaedic department who were managed with volar locking plate. The minimum follow-up period was 12 months. Wrist movements were recorded and outcome was studied using modified mayo wrist score at final follow-up.   Results: The mean modified mayo wrist score at final follow-up was 88.47±15.3. Excellent to good outcome was observed in 80% of the patients. None of the patients had a poor outcome. Clinically significant movements were observed at wrist at final follow-up. Superficial wound infection was the most common complication and deep infection was seen in two patients and both of them needed early implant removal at three months. Hypertrophic scar at surgical incision site was observed in two patients but did not bother the patients. Two patients needed a stellate ganglion block and physiotherapy for complex regional pain syndrome (CRPS) and both responded well. Conclusions: Open reduction and internal fixation (ORIF) with volar locking plate provides stout fixation in volar Barton fractures and allows early physiotherapy and rehabilitation of wrist. The results are predictably good in most patients with minimal complications rates.

Stable relocation of the radial head without annular ligament reconstruction using the Ilizarov technique to treat neglected Monteggia fracture: two case reports

<p>Abstract</p> <p>Introduction</p> <p>A Monteggia facture dislocation is not an uncommon injury, and the diagnosis can often be missed. Long-term follow-up of untreated Monteggia fracture dislocations reveals development of premature arthritis, pain, instability, and loss of pronation and supination. Methods involving annular ligament reconstruction require post-operative immobilization and use of transcapitellar pinning for maintenance of reduction, and thus a delay in rehabilitation. The literature reports satisfactory results with methods that involve ulnar osteotomy and open reduction of the radial head without annular ligament reconstruction. We used the Ilizarov method in two cases with neglected Monteggia fracture dislocations to stably reduce the radial head without open reduction and annular ligament reconstruction.</p> <p>Case presentation</p> <p>We report two cases of neglected Monteggia fracture dislocation, in two Kashmiri boys aged four and six years. Using ulnar osteotomy with distraction osteogenesis, we were able to relocate the radial head gradually and maintain the reduction without a requirement for open reduction and annular ligament reconstruction.</p> <p>Conclusion</p> <p>Distraction lengthening and hyperangulation in different planes by use of the Ilizarov technique effectively reduces the radial head without open reduction and annular ligament reconstruction.</p