Bone versus implant: an atypical presentation of a typical complication of forearm fractures

Both bone forearm fractures are one of the most common upper limb fractures operated by orthopedicians. Although the primary surgery is usually relatively straight forward and simple, but we present a case where the primary surgery failed and the patient presented with a deformed hand after 5 months, even though there were signs of union on radiographs. When operated upon, although the ulna had undergone primary bone healing and a peri-implant fracture had occurred, whereas radius had refractured from the fracture site and the plate was bent giving the deformed appearance. We discuss this unique complication, the planning, difficulties and scope of errors in such a situation, where the race to union is won by ulna but lost by radius

Bilateral post-traumatic forearm and hand compartment syndrome: a case report and review of literature

Acute compartment syndrome is a condition in which interstitial tissue pressure within a closed osteo-fascial compartment is elevated to a nonphysiologic level causing decrease in tissue perfusion, which if left elevated for sufficient time, can lead to tissue necrosis and devastating loss of function. It poses a diagnostic and therapeutic challenge for treating surgeons. We present a case of acute post-traumatic bilateral forearm and hand compartment syndrome in a 12 year old boy associated with fracture of distal ulna and metacarpals. Patient regained excellent function with emergent fasciotomy of volar forearm and hand followed by wound management with vacuum-assisted wound closure system (VAC), delayed primary closure and split-thickness skin graft (SSG). Early diagnosis and emergent fasciotomy are crucial to avoid debilitating complications

Posterior dislocation of the hip with ipsilateral displaced

【Abstract】Traumatic posterior dislocation of hip associated with ipsilateral displaced femoral neck fracture is a rare injury. Moreover, the management of such patients evokes strong views regarding primary replacement or preserving the femoral head. We presented a case of young adult with such an injury. He was operated upon with reduction of the dislocation and fixation of femoral neck fracture with the help of cancellous screws. Two years later, the fracture had united and the patient was asymptomatic. We further proposed the mechanism of injury for such a fracture and discussed the management in the changing trauma scenario of the developing world. Key words: Trauma; Hip dislocation; Femoral neck fracture

Loose bodies in right elbow joint: Post traumatic? or post infective?

Tuberculous osteomyelitis after open fracture is uncommon. Early diagnosis of tubercular arthritis is difficult because of insidious onset, indolent process and mild or non specific local or systemic symptoms. This case report describes the fibrinous loose bodies in elbow joint of a patient who sustained a compound fracture presented with chronic non healing discharging sinus. Intra-operatively some suspected seed like bodies were removed and sent for histopathological examination which showed circumscribed homogenous fibrinous bodies with focal area of hyalinization and few embedded tiny osteolytic fragments. Acid Fast Bacilli staining was positive. The patient had a good recovery after treatment with anti-tuberculosis drugs

Role of percutaneous cerclage wire in the management of subtrochanteric fractures treated with intramedullary nails

Purpose: Cerclage wire application has emerged as a potential therapeutic adjunct to intramedullary nailing for subtrochanteric fractures. But its popularity is plagued by the concern of possible negative effect on fracture zone biology. This study was intended to analyze the clinico-radiological outcome and complications associated with cerclage wire application. Methods: Retrospective analysis was performed on all the subtrochanteric fractures operated with intramedullary nailing between January 2012 and January 2016. After exclusion, 48 patients were available with an average follow-up of 20.8 months. Long oblique, spiral, spiral wedge or comminuted fracture configurations with butterfly fragments were particularly considered for cerclage wire application, which was employed by percutaneous cerclage passer in 21 patients. Assessment was done in terms of operation time, blood loss, quality of reduction, neck-shaft angle, follow-up redisplacement, union time, complications, and final functional evaluation by Merle d’Aubigne'-Postel score. Results: Average operation time and blood loss were significantly higher in cerclage group (p < 0.05). However, cerclage use substantially improved quality of reduction in terms of maximum cortical displacement (p = 0.003) and fracture angulation (p = 0.045); anatomical reduction was achieved in 95.23% of cases as compared to 74.07% without cerclage. Union time was shorter, although not statistically different (p = 0.208), in cerclage group. Four patients in non-cerclage group developed non-union, 2 of them had nail breakage. No infection or any other implant related complications were reported with cerclage use. Conclusion: Minimally-invasive cerclage wire application has proved to be beneficial for anatomical reconstruction in difficult subtrochanteric fractures, whenever applicable, without any harmful effect on fracture biology