Modified Mason type III and IV radial head fractures: results of different surgical treatments

Fractures of the radial head account for 4% of all fractures and 33 % of all elbow fractures. Their treatment is somewhat challenging and diversified, especially in more complex fractures (type III and IV of modified Mason's classification). The aim of this study was to identify the best surgical treatment for patients having sustained these latter lesions and outline possible predictive factors of worse outcomes

Clinical approach in PIPj flexion contracture conservative treatment: our experience

Proximal interphalangeal joint (PIPj) flexion contractures are a common clinical problem seen by hand therapists and orthopaedic surgeons after various types of injury to the finger. Conservative treatment is preferable over surgery but a variety of pre-fabricated and custom-made orthoses have been proposed in the literature. The aim of the present paper is to share our 15 year experience in treating PIPj flexion contractures using 2 different custom-fabricated orthoses and the exercise regimen used to preserve maximal PIPj passive and active extension obtained through the orthotic intervention. Synthetic serial casting and static-progressive splinting are in our opinion the best choices to treat even the most resilient PIPj flexion contractures as they both offer maximal Total-End-Range-Time (TERT) and minimize functional impediment of the hand while they are in use. Either approach offers advantages and set-backs that need to be discussed with the patient once his or her functional demands and ADL/leisure limitations have been identified

A rare case of bilateral complex wrist injury in a professional motocross rider

We describe the treatment of a 29 year-old professional motocross rider, who sustained a perilunate dislocation in his right wrist and a distal radius fracture and dorsal dislocation of his left wrist during a race. Both wrists were treated acutely during a single operating session. Surgery consisted in open reduction, k-wire fixation and mini-anchor repair of the scapho-lunate and luno-triquetrium ligaments on the right wrist, while closed reduction and percutaneous k-wire fixation was used in the left wrist. Follow-up at 6 months has shown satisfying radiological and functional outcomes in both wrists. The rider ultimately returned to motocross 5 months following surgery

Complex transradial carpal dislocation in a professional pianist: Case Report

Carpal fracture-dislocation associated to distal radius fractures is an uncommon injury of the wrist. Clinical assessment, instrumental diagnosis and treatment are all challenges for the surgeon. In addition, the prognosis in high-functioning patients is nearly always poor.The authors describe an early diagnosis of scapholunate dissociation and joint capsule tear associated with radial styloid and triquetral fractures in a 39-year-old professional piano player. A dorsal approach was used to reduce and fixate the fracture with k-wires, and to repair softtissue injuries with a Titanium micro-anchor. Early controlled mobilization was prescribed post-operatively. No other similar investigations were found because of the various associated fractures in the current case study, which normally excludes subjects from retrospective outcome studies on wrist ligament repair. Early diagnosis and surgical management associated with early controlled mobilization resulted in excellent clinical outcomes, according to radiograph imaging, the Italian version of the DASH score (Disabilities of the Arm, Shoulder and Hand), goniometry and dynamometry

Fifth metacarpal neck fractures: fixation with antegrade locked flexible intramedullary nailing

Fifth metacarpal neck fractures (commonly named "boxer's fractures") are the most common metacarpal injuries and usually affect young active people. These lesions are mainly treated conservatively. Their surgical management, if indicated, is still a matter of debate. Different procedures have been described. The aim of this study was to evaluate the outcomes of 18 boxer's fractures which were synthesized with antegrade locked flexible intramedullary nailing

Thermal balneotherapy in Antsirabe-Madagascar: water analysis and its applications in an African context

The Orthopaedic Rehabilitation Centre of Madagascar can be found in the city of Antsirabe. The health care facility is equipped with 2 thermal sources of bicarbonate water used for post-operative rehabilitation and for the ailment of chronic degenerative illnesses. The aim of this study, which derives from the cooperation between the School of Specialization in Thermal Therapy of the University of Parma and Antsirabe Orthopaedic Hospital, is to analyze the real properties of thermal waters utilized in this centre and to do an overview of its possible applications in this particular African context

Triphalangeal thumb: case report and literature review

Triphalangeal thumb (TPT) is a relatively rare congenital anomaly of the hand with evidence for autosomal dominant transmission. Surgical treatment is not always required, but according to Wood's classification it is related to the shape of the extra phalange. In this article, we present a case of  a 32 year old woman with isolated bilateral TPT

Pectoralis major tendon rupture in a weight lifter: a rare case

Pectoralis major tendon (PMT) rupture is a rare event, and it was originally described by Patisser in 1822. The PMT is a thick lamina, which has two origins, one from the clavicle and the other from the ribcage sternum. PMT lesions are classified according to 3 levels of severity: Type 1 is contusions and strains, Type 2 is a partial tear and Type 3 is a complete tear. Diagnosis is made through a clinical examination which comprises a positive response to pain upon pressure over the axilla recess, the presence of bruising and limited motion, and is completed with an MRI. Type 3 injuries are treated exclusively through surgery, while Type 1 and 2 lesions are treated conservatively. In this article, we describe a rare case of PMT rupture in a 39-year-old weight lifter, the surgical treatment that was carried out through an open access at the Pectoralis and Deltoid junction and anchor suture, the post-surgical rehabilitation program and a 1-year follow-up assessment at which point return to sport was achieved