A rare case of isolated trapezium fracture in motorcycle polytrauma patient in emergency department

Abstract Medical staff hardly recognize fractures of trapezium due to the small size and the complex anatomy of the wrist and the hand. Seventy percent of all carpal fractures are scaphoid's fractures. Only 0.4% of all carpal injuries are trapezial fractures. In this paper, we presented a case of a high speed trauma where there were only trapezial fractures. Origin, diagnosis, differential diagnosis, treatment and complications are evaluated and described

emergent hybrid external fixation for tibial pilon fractures in adults

Abstract Objective To investigate that if the hybrid external fixation is the definitive treatment and management of tibial extra articular and intra-articular pilon fractures of the adult in emergency. Methods We treated 237 cases of pilon fractures using hybrid external fixation with or without minimal osteosynthesis from February 1999 to December 2014. All fractures were classified according to the Association for the Study of Internal Fixation. The three groups were represented by 108 patients (45.5%) for the Type A; 75 patients (31.8%) for Type B and 54 patients (22.7%) for Type C. Road accidents [118 patients (50.0%)] were the most common cause of tibial pilon fractures. Results According to a mean follow-up of 7.3 years we had bone healing after 4.8 months from surgery in the 61.18% of the patients. The results were subjectively excellent, while the 54.00% were objectively excellent according to Ovadia and Beals score, and the results showed 29 complications. Conlusions From our data hybrid external fixation with or without minimal fixation is a good surgical method to treat pilon fractures

Treating and management in acute Laugier's fracture: a case report

Abstract Laugier's fractures are rare because they are located deep in the elbow joint and are thus protected from any direct trauma. Laugier's fractures have been insufficiently described in the literature. Surgical treatment does not have an alternative, and timely diagnosis and surgical and physical therapy. We presented a case report of a 23 years' old man, sustained a Laugier's fracture in June 2012 after falling from motocycle (low energy trauma) and hit with his flexed elbow against the street

The Challenges of the Femoral Bone Loss in the Management of the Floating Knee IIB According Fraser: A Case Report

Introduction: This case report describes the management and the possible therapeutic solutions for the treatment of femoral bone loss associated with an open fracture IIIB Gustilo Andersonin a polytrauma that includes floating knee (GF) Fraser IIB from damage control orthopedics to final treatment. Case Report: The patient was treated with an external fixator femorotibial bridge after extensive cleaning and debridement of open fractures. After 17-day post-trauma, we substitute the fixator with a less invasive stabilization system plate and screws with contralateral allograft bone strut.3months after the first surgery, the patient underwent surgery for the intramedullary nailing of the tibia. The follow-up was clinical using the knee injury and osteoarthritis outcome score (KOOS), short form 12 health survey (SF-12) for the quality of life, and radiological at 1–3–6–12–18–24–36 months. The patient walked with partial load up until the 6months after injury and then began a progression to a total load. At 24-months post surgery, the patient had both the KOOS and SF-12 at 100 points. Conclusion: Not all Fraser IIB are equal, the timing of treatment should be discussed case by case. The surgical sequence should be respected: First, the fixation of the femur, and then, the stabilization of the tibia, taking into account the condition of the skin, eventual exposure or the eventual level of sub-amputation of the limb. The clinical and radiographic results show how efficient damage can lay the foundations for an excellent definitive treatment

The emergency and delay management in total talus extrusion: Case report and review of literature after 24 months of follow up

Abstract Total talus extrusion is a rare and severe injury. It is burdened by many complications as avascular necrosis and osteomyelitis even if a proper debridement of extruded talus is performed. Few case reports or case series were published, and because of the rarity of this event, there are no guidelines for treatment. We report the first case on an octogenarian man providing a long-term follow-up performing contrast enhanced magnetic resonances. The authors report the case of an octogenarian man who fell from an olive tree reporting a total talus extrusion associated with the fracture of the medial malleolus. After an accurate debridement and washing of the wound, the talus was anatomically repositioned and the fracture was treated with an external fixator. The wound healed with difficulty after 12 months and the patient developed a chronic osteomyelitis of the talar dome and avascular necrosis of talar head. We followed the patient for 24 months performing contrast enhanced magnetic resonances and evaluating the development of the avascular necrosis. Even if we encountered these complications, the treatment allowed the patient to walk without pain, using a talus type shoe and one crutch. Although the literature suggests that an anatomic replacement of talus allows avoiding main complications, we deem that the patient's age is an important biological feature to consider in the prognostic stratification. Moreover, primary talectomy and tibio-calcaneal fusion should be reserved as a salvage procedure. Talus replacement allows an overall good outcome for the patients, retaining height, and allowing a good quality of life

A case of the management of Heterotopic ossification as the result of acetabular fracture in a patient with traumatic brain injury

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Dynamic corset versus three-point brace in the treatment of osteoporotic compression fractures of the thoracic and lumbar spine: a prospective, comparative study

Background: The three-point orthosis is the most commonly used brace in the conservative treatment of osteoporotic vertebral fractures. The Spinomed® dynamic orthosis represents an alternative. Aims: We compared efficacy and safety of these two types of brace in treating osteoporotic vertebral fractures. Methods: One hundred forty patients, aged 65–93 years, sustaining osteoporotic vertebral fracture were consecutively recruited and divided into two groups, and treated with either three-point orthosis or dynamic corset. Patients were evaluated with Visual Analogue Scale, Oswestry Low Back Pain Disability Questionnaire, and measurement of forced expiratory volume in the first second. Regional kyphosis angle, Delmas Index, and height of the fractured vertebral body were also measured on full-spine X-rays. Follow-up intervals were 1, 3, and 6 months after trauma. The complications encountered during the 6-month follow-up were recorded. Results: At the 3- and 6-month follow-ups, there was a significant difference (p 0.05) in all the radiological parameters between groups. Complications were reported for 28 patients in the three-point orthosis group, and for eight patients in the dynamic corset group (p < 0.05). Discussion: Biofeedback activation of back muscles is probably a key factor in improving functional outcome with dynamic orthosis. Conclusions: Compared to three-point orthosis, patients treated with dynamic orthosis had a greater reduction in pain and a greater improvement in quality of life and respiratory function, with equal effectiveness in stabilizing the fracture, and fewer complications

Is the Thoracolumbar Injury Severity Score (TLISS) still a good base for the education of residents in Orthopaedics and Traumatology?

ABSTRACT Introduction. Thoracolumbar spinal injuries indicated for surgical intervention specify the necessity of intervention within 24 hours. The traumatologists working in a structure without a Spinal Unit must be able to evaluate such injury and set indications for surgical treatment, that is, nonoperative treatment. The purpose of this study is to evaluate if Thoracolumbar Injury Severity Score (TLISS) is still a good base for the classification of thoracolumbar spinal injuries and to give a correct indication for nonoperative, that is, surgical treatment. Patients and Methods. Six Orthopaedics and Traumatology residents from Siena (Italy), five Orthopaedics and Traumatology residents from the Clinical Centre of Banja Luka (Bosnia and Herzegovina) and five Orthopaedics and Traumatology residents from the Alta Val d’Elsa Hospital, Siena (Italy) were presented 24 clinical cases from professional literature where the following data were indicated: patient’s age, neurological conditions, description of the injury, mechanism of the injury and radiological findings (RTG, MR). The abovementioned 24 patients were chosen from the literature based on the injuries mostly seen by an orthopaedist with a lack of experience in the problems of spinal column trauma (low energy trauma, with partial or without neurological impairments, with the TLISS score of 4). The residents from the three groups had to classify all patients according to the TLISS score and to define the most appropriate method of treatment-conservative or surgical, and after that, all classifications, as well as the therapeutic decisions, were compared. The statistical methods used in this study include: statistical significance, reliability (P<0.05), the validity of the decision, the percentage of accuracy and Cohen’s kappa coefficient. The best results in evaluation of the mechanism of the injury were demonstrated by the group of doctors from the Orthopaedic Hospital with an accuracy of 78.8% (P<0.05) and with an average correlation (K = 0.598). The best description of the injury was presented by the doctors from Siena with 87% accuracy (P<0.05) and with correlation (K=0.749). The doctors from Siena responded best at evaluating the neurological status with 97.6% accuracy (P<0.05) and with correlation (K=0.936). The assessment of the injury of the PCL residents from Siena was 64.7% accurate (P<0.05) with correlation (K=0.426). The total TLISS score was best calculated by the residents of Siena with 82% accuracy (P<0.05) and correlation (K=0.718). The most appropriate therapeutic decision was made by the residents from Siena with 80.3% accuracy (P<0.05) and with correlation (K =0.707). Conclusion. Currently, the Denis classification and the AO classification are the most widely used classification algorithms for the fractures of thoracolumbar spine but some defects have also been identified in both of them. The value of TLISS evaluation is by the three groups of residents in presented 24 patients from the professional literature. Significant differences in accuracy were found in defining a real damage of the spinal cord at the level of the cauda equina. The evaluation of the integrity of the posterior longitudinal ligament by the radiography is of low accuracy

The orthopedic damage control in pelvic ring fractures: when and why-a multicenter experience of 10 years' treatment

Abstract Objectives To report our experience of regional referral center for the pelvis. Methods We treated 526 pelvic fractures from January 2004 to December 2014 in three regional reference centers for pelvic trauma. Men were 480 and women were 46 and ages ranged from 16 to 93 years old. Car (65%) and farm (20%) crashes were the most frequent causes of pelvis fractures. Injury severity scores ranged from 9.0 to 75.0, with a mean of 37.5. A defined algorithm for fracture management has been in place and employed to assure adequate resuscitation and fracture care. Results There were 24 deaths in total (4.56%). Sixty three (11.98%) patients underwent angio-embolization for control of bleeding (12 deaths). The average amount of blood transfused was 8.3 IU. Hospital lengths of stay ranged between 1-35 days. Among the 502 alive patients, 55.98% were able to be discharged at home while the remaining 44.02% being transferred to various rehabilitation facilities or extended care facilities. Conclusions The goal of initial management is to restore vital indicators, urinary excretion function and protect the patient from infectious complications. An emergency decisional algorithm helps manage hemodynamic instability. Initial bone and ligament procedures should reduce displacement and make it possible for the patient to wait until his condition is stable enough for definitive surgical fixation

Complex Acetabular Prosthetic Revisions. Comparison of modern materials in treatment strategies

The increasing number of total hip arthroplasty (THA) operations has inevitably led to an increase in the number of revisions for aseptic, septic or traumatic mobilization. The surgical treatment of these lesions is a demanding challenge for the surgeon: the primary objective is a stable osterexesis of the fracture that allows an early mobilization of the patient, therefore a careful evaluation of the materials to be implanted is also necessary. The aim of our study is to demonstrate the usefulness and limitations of new revision surgery technologies in cotiprosteal fractures. We enrolled 54 patients who underwent hip acetabular revision. The criteria chosen for the evaluation of outcomes: the visual analogue scale of pain in the traumatized hip (VAS); the subjective score of the Harris HIP Score; quality of life measured with The Short Form (12) Health Survey (SF-12); the average time of cup integration and complications. The evaluation endpoint was set at 24 months. The results, assessed with the aforementioned parameters, were on average good. Complications are the same as those described in the literature. The advantages of the new generation of acetabular components are: excellent integration and ductility of materials during revision of hip arthroplasty