Use of oral ketamine for analgesia during reduction/manipulation of fracture/dislocation in the Emergency Room: An initial experience in a low-resource setting

Background: The use of ketamine for relief of procedure-related pain is limited in our environment. Ketamine, a phencyclidine derivative commonly used for induction and maintenance of anaesthesia, is administered routinely via the intravenous and intramuscular routes. One of the concerns while using ketamine for analgesia via these two routes is that the drug may produce anaesthesia, rather than analgesia alone. Aims and Objectives: We sought to find out if ketamine given via the oral route could be used to provide analgesia during minor orthopaedic procedures in the emergency room. We also wanted to find out if there were side-effects peculiar to the oral route. Methods: A prospective observational pilot study in consecutive patientswith fractures/dislocation in our Emergency Room was recruited into the study. All patients gave informed consent. Reduction of fractures was done 15 minutes following the administration of ketamine 5 mg/kg orally. The patients were observed during and after the procedure and the findings entered into a proforma. The data obtained were analyzed using simple statistical methods and the results presented in a table. The findings are discussed. Results: There were 9 males and 2 females with an age range of 4 yrs to 48 yrs. Pain levels were assessed using verbal rating scales. Seven patients (64%) had severe pain before administration of ketamine while 2 patients (18%) each had mild and moderate pain respectively. Four patients had Colle’s fracture only and 1 patient had a Colle’s fracture with a supracondylar femoral fracture. Two patients had tibial fractures, one patient had a complete knee dislocation, while 2 others had ulnar/radial fractures. One other patient had humeral and tibial fractures. For up to 15 minutes after the procedures all but one patient were pain-free. Five (5) patients (45.5%) were noticed to have drowsiness, 3 patients (27%) were sedated while 2 patients (18%) had no side-effects at all. Five (5) patients (45.5%) reported excellent analgesia while 6 patients (64%) said the intra and post procedure analgesia was very good. Conclusions: Oral ketamine may be useful in providing analgesia for minor procedures in the emergency room. Ketamine when sweetened with a soda drink appears to be palatable with a rapid onset of action and few side effects. Thus ketamine given orally may be a cheaper and more accessible option for effective pain-relief in the emergency room. There is a need to conduct more studies on a larger number of patients.

Mechanisms of mid-thoracic spine fracture/dislocation due to falls during horse racing:A report of two cases

We reported two cases of jockeys who sustained fracture/dislocation of the mid-thoracic spine due to traumatic falls during horse racing.We examined the injury mechanism based upon the patients’diagnostic images and video footage of races,in which the accidents occurred.Admission imaging of patient 1(a 42 years old male)revealed T5 burst fracture with bony retropulsion of 7 mm causing complete paralysis below T5/6.There existed 22°focal kyphosis at T5/6,anterolisthesis of T5 relative to T6,T5/6 disc herniation,cord edema and epidural hemorrhage from T4 through T6,and cord injury from C3 through C6.Admission imaging of patient 2(a 23 years old male)revealed T4/5 fracture/dislocation causing incomplete paralysis below spinal level.There existed compression fractures at T5,T6,and T7;4 mm anterior subluxation of T4 on T5;diffuse cord swelling from T3 through T5;comminuted fracture of the C1 right lateral mass;right frontal traumatic subarachnoid hemorrhage;and extensive diffuse axonal injury.The injuries were caused by high energy flexion-compression of the mid-thoracic spine with a flexed posture upon impact.Our results suggest that substantially greater cord compression occurred transiently during trauma as compared to that documented from admission imaging.Video footage of the accidents indicated that the spine buckled and failed due to abrupt pocketing and deceleration of the head,neck and shoulders upon impact with the ground combined with continued forward and downward momentum of the torso and lower extremities.While a similar mechanism is well known to cause fracture/dislocation of the cervical spine,it is less common and less understood for mid-thoracic spine injuries.Our study provides insight into the etiology of fracture/dislocation patterns of the mid-thoracic spine due to falls during horse racing.

Pulp health and calcific healing of a complicated crown–root fracture with additional root fracture in a maxillary incisor: A case report

BACKGROUND Complicated crown–root fracture (CRF) involves severe injury to the crown, root,and pulp, and may be accompanied by multiple root fractures. The loss of a toothhas lifelong consequences for children and teenagers, but the maintenance of pulphealth and the calcific healing of multiple root fractures are rarely reported in theliterature.CASE SUMMARY This case reports healing of a permanent tooth with complicated crown–root andadditional root fractures, in which pulp health was maintained. A 10-year-old girlfell and fractured the root of her maxillary left central incisor at the cervical level.After the coronal fragment was repositioned, the tooth was splinted until thetooth was no longer mobile, 2 years later. Eight years after treatment, the toothhas remained asymptomatic with vital pulp and localized gingival overgrowth.Cone-beam computed tomography revealed not only calcified healing of the CRFbut also spontaneous healing in an additional undiagnosed root fracture. Thefracture line on the enamel could not be healed by hard tissue and formed agroove in the cervical crown. It was speculated that the groove was related to thelocalized gingival overgrowth.CONCLUSION This case provides a clinical perspective of the treatment of a tooth with acomplicated CRF and an additional root fracture.

Establishment and validation of standardized animal models of spinal cord injury by normal external force-caused fracture dislocation

The duplication of animal models plays a key role in spinal cord injury research; however, there has been limited study into normal, external force-derived fracture dislocation. This study adopted experimental devices, designed in-house, to construct standardized ventral and dorsal spinal cord injury animal models of 6 g and 17 g falling from a height of 2, 4, and 10 cm, and 15, 30 or 50 g transversal compression on the spinal cord. The results showed that gradual increases in the degree of histopathological injury led to decreased Tarlov and Basso, Beattie and Bresnahan scores for the behavioral test, and increased Ashworth scores for the hind limb. Furthermore, there was a gradual decline in the slope test in the rats with dorsal spinal cord injury that correlated to increases in the falling substance weight or falling height. Similar alterations were observed in the ventral spinal cord injured rats, proportional to the increase in compression weight. Our experimental findings indicate that the standardized experimental rat models of dorsal and ventral spinal cord injury are stable, reliable and reproducible.

Biepicondylar fracture dislocation of the elbow joint concomitant with ulnar nerve injury

In this article, we present a case of humeral biepicondylar fracture dislocation concomitant with ulnar nerve injury in a seventeen year-old male patient. Physical examination of our patient in the emergency room revealed a painful, edematous and deformed-looking left elbow joint. Hypoesthesia of the little finger was also diagnosed on the left hand. Radiological assessment ended up with a posterior fracture dislocation of the elbow joint accompanied by intra-articular loose bodies. Open reduction-Internal fixation of the fracture dislocation and ulnar nerve exploration were performed under general anesthesia at the same session as surgical treatment of our patient. Physical therapy and rehabilitation protocol was implemented at the end of two weeks post-operatively. Union of the fracture lines, as well as the olecranon osteotomy site, was achieved at the end of four months post-operatively. Ulnar nerve function was fully restored without any sensory or motor loss. Range of motion at the elbow joint was 20-120 degrees at the latest follow-up.

THE OPERATIVE TREATMENT OF SPINAL FRACTURE-DISLOCATION WITHOUT NEUROLOGIC DEFICITS

To evaluate the results of operative treatment of spinal fracture dislocation without neurologic deficits. Methods.Eighteen patients with spinal fracture dislocation were neurologically intact at the time of injury, and all were treated operatively. The fracture sites were:8 cases in cervical spine, 3 cases in thoracic spine, and 7 cases in lumbar spine. Eight patients with cervical injuries had variant degrees of forward slide and kyphotic deformity. Of the 10 thoracic and lumbar fractures, one had lateral dislocation, 4 cases with kyphotic deformities, 5 cases with spinal canal compromise averaged 50% (ranging from 40% to 70%). Results.The average period of follow up was 4.4 years with a range of 11 months to 13 years. All the patients returned to full time work. No patient developed neurologic deterioration. Kyphotic deformity was corrected in the 4 cases, and no progressive kyphosis was noted. There was no operation related complication. The averaged post operative hospitalization time was 13 days. Conclusions. Despite the rare incidence of spinal fracture dislocation without neurologic deficits, we suggested that kind of fracture be considered unstable fracture because of its potential risk of delayed neurologic deterioration and kyphotic deformity, and be treated operatively to restore the sagittal alignment and the stability of the spine.

Subtalar dislocation without associated fractures: Case report and review of literature

Isolated subtalar dislocations are unusual injuries due to the inherent instability of the talus. Subtalar dislocations are frequently associated with fractures of the malleoli, the talus, the calcaneus or the fifth metatarsal. Four types of subtalar dislocation have been described according to the direction of the foot in relation to the talus: medial, lateral posterior and anterior. It has been shown that some of these dislocations may spontaneously reduce. A rare case of a 36-year-old male patient who sustained a closed medial subtalar dislocation without any associated fractures of the ankle is reported. The patient suffered a pure closed medial subtalar dislocation that is hardly reported in the literature. Six months after injury the patient did not report any pain, had a satisfactory range of motion, and no signs of residual instability or early posttraumatic osteoarthritis. The traumatic mechanism, the treatment options, and the importance of a stable and prompt closed reduction and early mobilization are discussed.

ATOMISTIC/CONTINUUM SIMULATION OF INTERFACIAL FRACTURE PART Ⅱ:ATOMISTIC/DISLOCATION/CONTINUUM SIMULATION

Coupled atomistic/dislocation/continuum simulation of interfacial fracture is performed in this paper.The model consists of a nanoscopic core made by atomistic assembly and a surrounding elastic continuum with discrete dislocations. Atomistic dislocations nucleate from the crack tip and move to the continuum layer where they glide according to the dislocation dynamics curve.An atoms/continuum overlapping belt is devised to facilitate the transition between the two scales.The continuum constraint on the atomic assembly is imposed through the mechanics at- mosphere along the overlapping belt.Transmissions of mechanics parameters such as displacements,stresses,masses and momenta across the belt are realized.The present model allows us to explore interfacial fracture processes under different mode mixity.The effect of atomistic zigzag interface on the fracture process is revealed:it hinders dislocation emission from the crack tip,especially under high mode mixity.

Characterization of Hydraulic Fracture with Inflated Dislocation Moving Within a Semi-infinite Medium

Hydraulic fracturing is accompanied by a change in pore fluid pressure. As a result,this may be conveniently represented as inflated dislocation moving within a semi-infinite medium. Theory is developed to describe the pore pressures that build up around an inflated volumetric dislocation migrating within a saturated porous-elastic semi-infinite medium as analog to hydraulic fracturing emplacement. The solution is capable of evaluating the system behavior of both constant fluid pressure and zero flux surface conditions through application of a superposition. Characterization of horizontal moving dislocation processes is conducted as an application of these techniques. Where the mechanical and hydraulic parameters are defined,a priori,type curve matching of responses may be used to evaluate emplacement location uniquely. Pore pressure response elicited at a dilation,subject to pressure control is of interest in representing hydraulic fracturing where leak-off is an important component. The effect of hydraulic fracturing on fracture fluid pressure is evaluated in a poroelastic hydraulic fracture model utilizing dislocation theory. A minimum set of dimensionless parameters are defined that describe the system. Pore fluid pressures recorded during hydraulic fracturing of a well in the San Joaquin Valley of Central California is examined using the proposed model. The estimated geometry of the hydraulic fracture is matched with reasonable fidelity with the measured data.

Safety and efficacy of surgical hip dislocation in managing femoral head fractures: A systematic review and meta-analysis

BACKGROUND Femoral head fractures(FHFs)are considered relatively uncommon injuries;however,open reduction and internal fixation is preferred for most displaced fractures.Several surgical approaches had been utilized with controversial results;surgical hip dislocation(SHD)is among these approaches,with the reputation of being demanding and leading to higher complication rates.AIM To determine the efficacy and safety of SHD in managing FHFs by reviewing the results reported in the literature.METHODS Major databases including PubMed,Embase,Web of Science,and Cochrane Central Register of Controlled Trials were searched to identify studies reporting on outcomes of SHD utilized as an approach in treating FHFs.We extracted basic studies data,surgery-related data,functional outcomes,radiological outcomes,and postoperative complications.We calculated the mean differences for continuous data with 95%confidence intervals for each outcome and the odds ratio with 95%confidence intervals for binary outcomes.P<0.05 was considered significant.RESULTS Our search retrieved nine studies meeting our inclusion criteria,with a total of 129 FHFs.The results of our analysis revealed that the average operation time was 123.74 min,while the average blood loss was 491.89 mL.After an average followup of 38.4 mo,a satisfactory clinical outcome was achieved in 85%of patients,ranged from 30%to 86%,with avascular necrosis,heterotopic ossification,and osteoarthritis being the most common complications occurring at an incidence of 12%,25%,and 16%,respectively.Trochanteric flip osteotomy nonunion and trochanteric bursitis as a unique complication of SHD occurred at an incidence of 3.4%and 3.8%,respectively.CONCLUSION The integration of SHD approach for dealing with FHFs offered acceptable functional and radiological outcomes with a wide range of safety in regards to the hip joint vascularity and the development of avascular necrosis,the formation of heterotopic ossification,and the development of posttraumatic osteoarthritis;however,it still carries its unique risk of trochanteric flip osteotomy nonunion and persistent lateral thigh pain.

Small bowel entrapment and ureteropelvic junction disruption associated with L3 Chance fracture-dislocation

Paediatric Chance fracture are rare lesions but often associated with abdominal injuries. We herein present the case of a seven years old patient who sustained an entrapment of small bowel and an ureteropelvic disruption associated with a Chance fracture and spine dislocation following a traffic accident. Initial X-rays and computed tomographic(CT) scan showed a Chance fracture with dislocation of L3 vertebra, with an incarceration of a small bowel loop in the spinal canal and a complete section of the left lumbar ureter. Paraplegia was noticed on the initial neurological examination. A posterior L2-L4 osteosynthesis was performed firstly. In a second time she underwent a sus umbilical laparotomy to release the incarcerated jejunum loop in the spinal canal. An end-toend anastomosis was performed on a JJ probe to suture the left injured ureter. One month after the traumatism, she started to complain of severe headaches related to a leakage of cerebrospinalis fluid. Three months after the traumatism there was a clear regression of the leakage. One year after the trauma, an anterior intervertebral fusion was done. At final follow-up, no neurologic recovery was noticed. In case of Chance fracture, all physicians should think about abdominal injuries even if the patient is asymptomatic. Initial abdominal CT scan and magnetic resonance imaging provide in such case crucial info for management of the spine and the associated lesions.

TINAVI robot-assisted one-stage anteroposterior surgery in lateral position for severe thoracolumbar fracture dislocation:A case report

BACKGROUND The combined anterior/posterior approach appears to be capable of reconstructing spinal stability,correcting thoracolumbar deformity,and promoting neural recovery in severe thoracolumbar fracture dislocation.However,this type of operation requires changing the body position during the procedure,resulting in a lengthy operation time.As a universal surgical robot,TINAVI robot has achieved good surgical results in clinical surgery.But to our knowledge,no reports describing TINAVI robot-assisted single lateral position anteroposterior surgery for thoracolumbar fracture dislocation.CASE SUMMARY We describe a case of a 16-year-old female patient with severe thoracolumbar fracture and dislocation underwent surgery assisted by the TINAVI robot.A onestage combined anterior and posterior operation was performed on a severe thoracolumbar fracture dislocation using the TINAVI robot,and the operation was completed in right lateral position.CONCLUSION The TINAVI robot-assisted one-stage anterior and posterior surgery in right lateral position for severe thoracolumbar fracture and dislocation is both safe and effective.

Trochanteric Fracture of a Congenital/Developmental Dislocation of the Hip in an Elderly Woman: A Case Report

An 87-year-old woman with a residual dislocated hip suffered a trochanteric fracture on the ipsilateral side. The fracture was treated by open reduction and internal fixation surgery with good results. To treat a proximal femoral fracture of the residual dislocated hip in an elderly patient, the patient’s overall status, pre-fracture ability, hip joint configuration, and fracture pattern should be considered.

Management of Subtalar Fractures-Dislocations at Ségou Hospital in Mali: A 7 Cases Series

Introduction: Subtalar or peritalian dislocation is rare;it represents 15% of peritalian injuries. The aim of this study was to describe the radioclinical and therapeutic characteristics and to assess the functional result. Patients and Methods: This study is about a continuous descriptive and prospective study over a period of 5 years. It has been conducted from March 2013 to February 2018 at the Ségou Hospital, a second referral hospital in Mali. The functional results were evaluated by the score of the American Orthopedic Foot and Ankle Society (AOFAS). Results: Seven cases of subtalar dislocation fractures were diagnosed in six male patients with an average age of 38 years (36 to 47 years old). In five cases the etiology of the trauma was a motorcycle accident and a fall from height. The lesion was bilateral in one case. The average time to care was 3 hours (1 to 9 hours). There was one case of open dislocation fracture with talus enucleation. The dislocation was medial in 6 cases and lateral in one case. It was pure in three cases. The treatment was orthopedic in 2 cases and surgical in 5 cases. The post-operative complications were complicated by an infection of the operative site in one case. The average length of hospital stay was 4 days. The functional result was excellent in 2 cases;good in 2 cases, fair in 2 cases and poor for 1 case. Conclusion: Subtalar dislocation is a rare and serious lesion of the posterior tarsus. The long-term prognosis depends on the earliness of treatment and the severity of the associated injuries.

Posterior Positioning of a Clavicle Hook Plate Is a Risk Factor for Acromial Fractures after Acromioclavicular Joint Dislocation

Purpose: Acromioclavicular (AC) joint dislocation is commonly treated using a clavicle hook plate (HP). However, previous reports have indicated that acromial fractures may occur after HP fixation. The purpose of this study was to identify risk factors for acromial fractures. Methods: A retrospective study was conducted on 39 patients with AC joint dislocation who were treated using clavicle HP fixation in our hospital between 2006 and 2017. Related parameters, including Rockwood classification, hook angle, the degree of reduction, the coverage of the hook under the acromion, and the anteroposterior position of the hook under the acromion, were evaluated to identify risk factors for acromial fractures. Results: The mean age of the participants was 51.7 (range 19 - 81) years;34 were men and 5 were women. Injury occurred on the right side in 18 patients and on the left side in 21. Injuries were categorized as follows: 24 were Rockwood type III, one was type IV, and 14 were type V. Four of the 39 patients (10%) experienced acromial fractures. Statistical analyses indicated that the degree of reduction at the final follow-up was moderately correlated with the Constant score. Posterior positioning of the hook was the only identified risk factor for acromial fractures. Hook angle and the degree of reduction at the time of surgery were not significantly associated with acromial fractures. Conclusions: Postoperative shoulder function was associated with the degree of reduction at the final follow-up, suggesting that anatomical reduction is recommended for AC joint dislocation. Posterior positioning of the hook is a risk factor for acromial fractures;however, clavicle HP fixation provides a positive outcome for AC joint dislocation. Therefore, careful positioning of the hook is required for preventing acromial fractures.

Treatment of Fracture Dislocation of the Femoral Head in a Resource Limited Country (Burundi)

Introduction: Fractures of the femoral head are rare injuries which generally follow a traumatic dislocation of the hip or in a poly-trauma scenario. A fracture dislocation of the femoral head is an orthopedic emergency. The most frequent complications after a fracture of the femoral head are osteonecrosis, post traumatic arthritis and heterotopic ossification. Objective: To focus on the therapeutic aspect of fracture-dislocations of femoral head and their short- and long-term prognoses. Materials and Methods: This is a prospective study conducted at Kamenge teaching hospital and Rohero Christian medical and surgical clinic from January 2013 to August 2020. All patients diagnosed with fracture-dislocations of the femoral head were included in this study. Results: Five patients were admitted for fracture dislocation of the femoral head. The mean age was 40.4 years and varied between 25 and 55 years. The dashboard injury was the most common mechanism and was found in four patients (80%). A standard x-ray was performed for the five patients as well as CT scans in two cases. All patients had posterior iliac dislocations with fractures of the femoral head classified as Pipkin I in three patients and Pipkin III in two patients. Closed reduction under general anesthesia within six hours was possible in one among the five patients and within 12 hours in two patients. These three cases were managed with open reduction and internal fixation (ORIF) via anterior approach with screw fixation of the femoral head fragment. In the two remaining patients reduction was not possible and for one of them there was a femoral neck fracture following closed manipulation, making the fracture Pipkin III. The two patients with Pipkin III injuries were managed with total hip replacement. With an average follow up of five years, standard x-rays of the three patients who had ORIF showed fracture union without avascular necrosis, posttraumatic arthritis or heterotopic ossification. The functional results for the five patients with an average follow up of four years were very good (3/5) and good (2/5). Conclusion: The diagnosis of fracture dislocations of the femoral head was based on clinical, radiographic and computed tomography criteria. Early reduction and internal fixation can restore the natural anatomy of the hip joint, especially in young adults with a good long-term prognosis. Sometimes total hip replacement is necessary for management of fracture dislocations of the femoral head.

Closed reduction of hip dislocation associated with ipsilateral lower extremity fractures:A case report and review of the literature

BACKGROUND Traumatic hip dislocation usually occurs following high-velocity trauma.It is imperative that the dislocation be reduced in a timely manner,especially in a closed manner,as an orthopedic emergency.However,closed reduction can hardly be achieved in patients who also have ipsilateral lower extremity fractures.Herein,we focus on hip dislocation associated with ipsilateral lower extremity fractures,excluding intracapsular fractures(femoral head and neck fractures),present an early closed hip joint reduction method for this injury pattern,and review the literature to discuss the appropriate closed reduction technique for this rare injury pattern.CASE SUMMARY We report a case of a 37-year-old male who sustained a left acetabular posterior wall fracture,an ipsilateral comminuted subtrochanteric fracture and dislocation of the hip.The hip dislocation was reduced urgently in a closed manner using the joy-stick technique with a T-shaped Schanz screw.The fractures were reduced and fixed as a 2nd-stage surgery procedure.At the 17-month postoperative follow-up,the patient had full range of motion of the affected hip.CONCLUSION Closed reduction of a hip dislocation associated with ipsilateral lower extremity fractures is rarely achieved by regular maneuvers.Attempts at closed reduction,by means of indirectly controlling the proximal fracture fragment or reconstructing the femoral leverage rapidly with the aid of various external reduction apparatuses,were shown to be effective in some scenarios.Mandatory open reduction is indicated in cases of failed closed reduction,particularly in irreducible dislocations.

Early reoccurrence of traumatic posterior atlantoaxial dislocation without fracture:A case report

BACKGROUND In general,atlantoaxial dislocation is rare due to the stability of the C1-C2 complex.Traumatic atlantoaxial dislocations are usually anterior and accompanied by odontoid fractures.Posterior atlantoaxial dislocations are rare,and complete posterior dislocation without associated fracture is even more rare.A case of early recurrence of posterior atlantoaxial dislocation without fracture being in therapy of first closed reduction and then open reduction has not been previously reported.CASE SUMMARY A 45-year-old female presented with traumatic posterior atlantoaxial dislocation(TPAD)of C1-C2 without associated fractures,and Frankel Grade B spinal cord function.She was successfully managed by immediate closed reduction under skull traction.Unexpectedly,17 d later,re-dislocation was discovered.On day 28,closed reduction was performed as before but failed.Then,open reduction and posterior internal fixation with autologous iliac bone grafts was performed.By 6 mo after surgery,atlantoaxial joint fusion was achieved,and neurological function had recovered to Frankel Grade E.At 12 mo follow-up,she had lost only 15°of cervical rotation,and atlantoaxial complex instability in joint flexing and extending were no longer observed under fluoroscopy.CONCLUSION Early assessment of transverse ligament is critical for TPAD without fracture avoiding re-dislocation after closed reduction.

Unusual capitate fracture with dorsal shearing pattern and concomitant carpometacarpal dislocation with a 6-year follow-up:A case report

BACKGROUND Isolated capitate fractures are rare carpal fractures.Following high-energy injuries,capitate fractures are usually associated with other carpal fractures or ligament injuries.The management of capitate fractures depends on the fracture pattern.Here,we report an unusual capitate fracture with a dorsal shearing pattern and concomitant carpometacarpal dislocation,with a 6-year follow-up.To the best of our knowledge,this fracture pattern and surgical management have not been previously reported.CASE SUMMARY A 28-year-old man presented with left-hand volar tenderness and decreased grip strength that persisted for one month after a traffic accident.Radiography showed a distal capitate fracture with carpometacarpal joint incongruence.Computed tomography(CT)revealed a distal capitate fracture with carpometacarpal joint dislocation.The distal fragment was rotated by 90°in the sagittal plane,and an oblique shearing fracture pattern was noted.Open reduction and internal fixation(ORIF)with a locking plate were performed using the dorsal approach.The imaging studies performed 3 mo and 6 years following surgery revealed a healed fracture,and the Disabilities of the Arm,Shoulder,and Hand and visual analog scale scores were significantly improved.CONCLUSION CT can detect capitate fractures with dorsal shearing pattern and concomitant carpometacarpal dislocation.ORIF using a locking plate are possible.

Lunate dislocation with avulsed triquetral fracture: A case report

BACKGROUND Lunate dislocation is an uncommon traumatic wrist injury that require prompt surgical management.Misdiagnosis or delayed treatment often leads to a poor outcome.Open reduction and surgical repair of disrupted ligaments are done in most cases to prevent long-term joint dysfunction.However,this method has certain limitations that include partial functional improvement,which poses a high risk for degenerative arthritis and wrist instability.CASE SUMMARY A 37-year-old man presented to the Emergency Department of our hospital following a motorcycle accident.Physical examination revealed swelling and tenderness of the right hand and wrist.The patient was initially misdiagnosed with a wrist contusion by an emergency physician,but was eventually diagnosed with lunate dislocation associated with a triquetral avulsed fracture,indicated for open reduction and ligament repair.We performed closed reduction and two Kirschner wire fixations following Tavernier’s method.The injured hand was protected with a standard short-arm orthosis for one month.The patient returned to normal daily work without discomfort at five months postoperatively.Encouragingly,there was no lunate necrosis or arthritis in the latest radiologic examinations.CONCLUSION This case provides evidence that the closed reduction technique for addressing such cases can reduce soft tissue destruction.