Monteggia type-Ⅰequivalent fracture in a fourteen-month-old child:A case report

BACKGROUND Monteggia and equivalent lesions are relatively rare but result in severe injuries in childhood,typically affecting children between 4 and 10 years old.The diagnosis and treatment of an equivalent Monteggia lesion is more complicated than those of a typical Monteggia fracture.This type of lesion may be challenging and may lead to serious complications if not treated properly.Pediatric Monteggia equivalent type I lesions have been reported in a few reports,all of which the patients were all over 4 years old.CASE SUMMARY A 14-mo-old boy was referred to our clinic after falling from his bed 10 d prior.With regard to the clinical examination,an obvious swollen and angular deformity was noted on his right forearm.Plain radiographs and reconstructed computed tomography scans showed a Monteggia type I fracture and dislocation.Magnetic resonance imaging(MRI)confirmed a type I Monteggia equivalent lesion consisting of ulnar fracture and Salter-Harris type I injury in the proximal radius.The radial head was still in the joint,and only the radial metaphysis was displaced anteriorly.Open reduction and pinning of both displaced radial and ulnar fractures achieved an excellent result with full function.CONCLUSION We recommend MRI examination or arthrography during reduction,especially if the secondary ossification center has not appeared.

Case Report: A Rare Variety of Type 4 Monteggia Fracture Dislocation in A 28 Years Old Man

A Monteggia fracture is a fracture of the proximal ulna coupled with a radial head dislocation. Numerous classification systems have been developed to characterize these fractures. Bado classification is most commonly used. Bado type 1 Monteggia fractures are most common while type 3 & 4 are rare entities. In our case, after confirming the diagnosis as type 4 Bado Monteggia fracture dislocation, patient was posted for open reduction and internal fixation. The ulnar and radial fractures were rigidly fixed with 3.5 compression plate and ulnar length restored. However, the radial head was still found to be dislocated anteriorly on fluoroscopy. An attempt of closed reduction of the radial head failed. Open reduction of the radial head was performed under image intensifier and fixed with a Kirschner’s wire followed by immobilization in hyperflexion for 2 weeks. The patient followed up at the end of 2 weeks, 4 weeks and 6 weeks following injury and gradual mobilisation of the elbow joint was made. Further follow up at 6 months and 1 year showed complete return of routine function. As soon as the ulnar length is restored by rigid internal fixation, radial head is itself reduced in majority of Monteggia fracture dislocation where only ulnar fracture is involved. However, in cases of both bone forearm fracture with radial head dislocation, even after restoring the length of ulna and radius, operative reduction of radial head is essential.

Homolateral Combined Fracture of Monteggia and Galeazzi. Case Report and Review of the Literature

Introduction: Homolateral combined fractures of Monteggia and Galeazzi are very rare. Their treatment is exclusively surgical and should be proposed early in order to restore the anatomy of the antebrachial skeleton, pronosupination, and the flexion-extension of the elbow and wrist. Observation: We reported the case of a 45-year-old woman who presented a homolateral fracture of Monteggia and Galeazzi following a road accident. This combination of fractures posed a problem of diagnosis and management. Surgical follow-up presented functional issues. Conclusion: The association of Monteggia and Galeazzi fracture is very rare and poorly reported in the literature. This observation reminds us of the importance of performing a complete clinical and paraclinical assessment before any therapeutic decision.

Monteggia Bilateral Fracture: A Case Study

The authors report a rare case of Monteggia bilateral fracture combining bifocal fracture of the left ulna to a mid-shaft fracture of the radius with dislocation of the radial head and on the right;a fractured ulna with dislocation of the radial head occurring in a patient of 31 years after an accident of the public highway. In emergency, the treatment consisted of a fixation with radius special plates and a left pin ulnar upper radio. The evolution was marked by a good consolidation and after six months the patient had resumed operations.

Management of acute length-unstable Monteggia fractures in children:A case report

BACKGROUND Monteggia fractures are uncommon injuries in paediatric age.Treatment algorithms assert that length-unstable fractures are treated with plate fixation.In this case report,intramedullary fixation of an acute length-unstable Monteggia fracture allowed a stable reduction to be achieved,along with an appropriate ulnar length and alignment as well as radio capitellar reduction despite the fact that the orthopaedic surgeon did not use a plate for the ulnar fracture.The scope of treatment is to avoid the use of a plate that causes periosteal stripping and blood circulation disruption around the fracture.CASE SUMMARY A four-year-old girl presented at the Emergency Department following an accidental fall off a chair onto the right forearm.The X-ray highlighted a lengthunstable acute Bado type 1 Monteggia fracture of the right forearm.On the same day,the patient underwent surgical treatment of the Monteggia fracture.The surgeon preferred not to use a plate to avoid a delay in fracture healing and to allow the micromotion necessary for callus formation.The operation comprised percutaneous fixation with an elastic intramedullary K-wire of the ulnar fracture and,subsequently,humeroradial joint reduction through manual manipulation.The orthopaedic surgeon assessed the stability of the radial head reduction under fluoroscopic control through flexion,extension,pronation and supination of the forearm.Healing of the fracture occurred within six weeks after surgery,as indicated by the presence of calluses on at least three cortices on standard radiographs.Dislocation/subluxation or loss of ulnar reduction was not apparent at the final X-ray examination.CONCLUSION Intramedullary fixation of unstable Monteggia fractures results in excellent outcomes,provides reliable reduction and causes fewer complications.

Review of management of unstable elbow fractures

Stable and painless elbow motion is essential for activities of daily living. The elbow joint is the second most commonly dislocated joint in adults. The goals of treatment are to perform a stable fixation of all fractures, to achieve concentric and stable reduction of the elbow and to provide early motion. The treatment modality for complex elbow instability is almost always surgical. The treatment objectives are anatomic reduction, stable fixation, and early rehabilitation of the elbow. The common complications of these unstablefractures include recurrent instability, stiffness, myositis ossifications, heterotopic calcification, and neurovascular dysfunction. We analyzed the management of complex elbow fractures and instabilities on the basis of recent literature and suggested possible guidelines for the treatment in this paper. In conclusion, recognition of the injury pattern and restoration of the joint stability are the prerequisites for any successful treatment of an unstable elbow injury.

Comparison of the modified Wiltse’s approach with spinal minimally invasive system and traditional approach for the therapy of thoracolumbar fracture

Thoracolumbar fractures are usually treated by open posterior pedicle screw fixation.However,this procedure involves massive paraspinal muscle stripping,inflicting surgical trauma,and prolonged X-ray exposure.In this study,we observed 127 patients with single-segment injury thoracolumbar fractures.Thirty-six patients were treated by the modified Wiltse’s paraspinal approach with minimally invasive channel system,while 91 patients were treated via traditional posterior approach.Operation time,intraoperative blood loss,intraoperative fluoroscopy frequency,screw placement accuracy,visual analogue scale score,and Cobb’s angle of two groups were compared.The X-ray exposure times were notably reduced(4.2±1.6) in the new approach group(P<0.05).The pedicle screw placement accuracy and Cobb’s angle after surgery were similar in the two groups.We conclude that modified Wiltse’s paraspinal approach w ith spinal minimally invasive channel system surgery can significantly reduce the X-ray exposure times and is an alternative therapy for the thoracolumbar fracture.

Experimental study on the e ect of fracture scale on seismic wave characteristics

In fractured reservoir beds, fracture characteristics affect seismic wave response. Fractured models based on the Hudson＇s fractured medium theory were constructed in our laboratory by a backfilling technique. For the same fracture density, the variations of the velocity and amplitude of the primary wave and shear wave parallel and perpendicular to the fracture were observed by altering the diameter （scale） of the penny-shaped fracture disk. The model test indicated that an increase of fracture scale increased the velocity and amplitude of the primary wave by about 2%. When the shear wave propagated parallel to the fracture, the velocity of the fast shear wave hardly changed, while the velocity of slow shear wave increased by 2.6% with increasing fracture scale. The results indicated that an increase of fracture scale would reduce the degree of anisotropy of the shear wave. The amplitudes of slow shear waves propagating parallel and perpendicular to fractures decreased with increasing fracture scale.

Bennett's fracture associated with fracture of Trapezium——A rare injury of first carpo-metacarpal joint

Association of fracture of trapezium with Bennett'sfracture is very rare and makes reduction and stabilisation more difficult. We are reporting a rare case of Bennett's fracture with fracture of the trapezium and subluxation of the carpo-metacarpal joint(CMC) joint. The patient was a 47-year-old school teacher who fell from his motorbike on his outstretched right dominant hand. Radiographs and computed tomography showed fracture of the trapezium with subluxation of the CMC joint, associated with Bennett's fracture. Open reduction and internal fixation was carried out. Trapezium was reduced first and secured with a 2 mm diameter screw. Bennett's fracture was then reduced and fixed with two per-cutaneously placed Kirchner's wires. CMC was stabilised with percutaneous Kirchner's wires. Latest follow up at 12 mo showed a healed fracture with good reduction of the CMC joint. Clinically patient had no pain and normal extension, abduction and opposition of the thumb. QuickD ASH score was 3.9/100. Thus, fracture of trapezium associated with a Bennett's fracture is a rare injury and if ignored it may lead to poor results. This injury is more challenging to manage than an isolated Bennett's fracture as anatomical reduction of the trapezium with reduction of the first CMC is needed. Fracture of the trapezium should be fixed first as this will provide a stable base for reduction of the Bennett's fracture.

Strategy for prevention of hip fractures in patients with Parkinson's disease

Hypovitaminosis D and K due to malnutrition or sunlight deprivation,increased bone resorption due to immobilization,low bone mineral density(BMD)and an increased risk of falls may contribute to an increased risk of hip fractures in patients with Parkinson’s disease.The purpose of the present study was to clarify the efficacy of interventions intended to prevent hip fractures in elderly patients with Parkinson’s disease.Pub Med was used to search the literature for randomized controlled trials(RCTs)regarding Parkinson’s disease and hip fractures.The inclusion criteria were 50 or more subjects per group and a study period of 1 year or longer.Five RCTs were identified and the relative risk and95%confidence interval were calculated for individual RCTs.Sunlight exposure increased serum hydroxyvitamin D[25(OH)D]concentration,improved motor function,decreased bone resorption and increased BMD.Alendronate or risedronate with vitamin D supplementation increased serum 25(OH)D concentration,strongly decreased bone resorption and increased BMD.Menatetrenone(vitamin K2)decreased serum undercarboxylated osteocalcin concentration,decreased bone resorption and increased BMD.Sunlight exposure(men and women),menatetrenone(women),alendronate and risedronate with vitamin D supplementation(women)significantly reduced the incidence of hip fractures.The respective RRs(95%confidence intervals)according to the intention-to-treat analysis were 0.27(0.08,0.96),0.13(0.02,0.97),0.29(0.10,0.85)and 0.20(0.06,0.68).Interventions,including sunlight exposure,menatetrenone and oral bisphosphonates with vitamin D supplementation,have a protective effect against hip fractures elderly patients with Parkinson’s disease.

Outcome of application of primary versus secondary Illizarov＇s fixator in open tibial shaft fractures

BACKGROUND: The present study aimed to compare outcome of primary and secondary Illizarov's fi xator application as a treatment method for type III open tibial fractures in terms of nonunion and wound infection.METHODS: This prospective study was done in a tertiary care center. Forty-eight type III tibial fractures were treated with Illizarov's apparatus between 2008 and 2011. The patients were divided into two groups depending on the treatment protocol, timing of wound closure and Illizarov's application, primary(n=28) and secondary(n=20).RESULTS: In the primary group, healing was achieved in all 28 patients. The median time to recovery was 24 weeks, and the median number of operations was 3. There were 6 patients with a bone defect. In the secondary group, complete recovery was achieved in 18 out of 20 patients. The median time to recovery was 30 weeks, and the median number of operations 5. There were 9 patients with a bone defect. The median time to recovery and the number of operations were signifi cantly smaller in patients undergoing primary operation. Union was 100% in the primary group and more than 95% in the secondary group. Chronic osteomyelitis persisted in one patient and below amputation was done in one patient in the secondary group.CONCLUSION: Primary wound closure and Illizarov's fixation required a smaller number of operations and shorter time to recovery than secondary wound closure and Illizarov's fi xation, mostly due to a signifi cantly less number of patients with a bone defect in the primary group.

Effect of Plastic Deformation and H_2S on Dynamic Fracture Toughness of High Strength Casing Steel

The effects of plastic deformation and H2 S on fracture toughness of high strength casing steel（C110 steel） were investigated. The studied casing specimens are as follows： original casing, plastic deformation（PD） casing and PD casing after being immersed in NACE A solution saturated with H2S（PD＋H2S）. Instrumented impact method was employed to evaluate the impact behaviors of the specimens, meanwhile, dynamic fracture toughness（JId） was calculated by using Rice model and Schindler model. The experimental results show that dynamic fracture toughness of the casing decreases after plastic deformation. Compared with that of the original casing and PD casing, the dynamic fracture toughness decreases further when the PD casing immersed in H2 S, moreover, there are ridge-shaped feature and many secondary cracks present on the fracture surface of the specimens. Impact fracture mechanism of the casing is proposed as follows： the plastic deformation results in the increase of defect density of materials where the atomic hydrogen can accumulate in reversible or irreversible traps and even recombine to form molecular hydrogen, subsequently, the casing material toughness decreases greatly.

扭紧力矩对SWRM10K螺栓疲劳性能影响的研究

对扭紧力矩分别为0、12.5、22.0、29.5和35.0 Nm的SWRM10K钢螺栓进行轴向加载疲劳实验,获取螺栓的疲劳S-N数据。对比不同扭紧力矩下螺栓疲劳S-N特性,分析扭紧力矩对螺栓疲劳性能的影响。采用SEM观察螺栓试样的断口形貌,结合EDS分析裂纹萌生区元素分布,揭示螺栓疲劳断裂的规律。研究结果表明:增加扭紧力矩能有效提升该螺栓疲劳极限,但增加到一定程度提升效果明显下降,扭紧力矩值接近29.5 Nm较为合理。在该扭紧力矩下,螺栓疲劳极限为141 MPa,与未施加扭紧力矩相比提升了62.1%。螺栓疲劳断口分为3个区域:裂纹萌生区、扩展区和瞬间断裂区。在高应力幅下,裂纹萌生于试样表面,由晶体滑移引起;在低应力幅下,裂纹同样萌生于试样表面,但由晶体滑移或夹杂物引起。

High-cycle Fatigue Fracture Behavior of Ultrahigh Strength Steels

The fatigue fracture behavior of four ultrahigh strength steels with different melting processes and therefore different inclusion sizes were studied by using a rotating bar two-point bending fatigue machine in the high-cycle regime up to 107 cycles of loading. The fracture surfaces were observed by field emission scanning electron microscopy （FESEM）. It was found that the size of inclusion has significant effect on the fatigue behavior. For AtSI 4340 steel in which the inclusion size is smaller than 5.5 μm, all the fatigue cracks except one did not initiated from inclusion but from specimen surface and conventional S-N curve exists. For 65Si2MnWE and Aermet 100 steels in which the average inclusion sizes are 12.2 and 14.9 μm, respectively, fatigue cracks initiated from inclusions at lower stress amplitudes and stepwise S-N curves were observed. The S-N curve displays a continuous decline and fatigue failures originated from large oxide inclusion for 60Si2CrVA steel in which the average inclusion size is 44.4 pro. In the case of internal inclusion-induced fractures at cycles beyond about 1×10^6 for 65Si2MnWE and 60Si2CrVA steels, inclusion was always found inside the fish-eye and a granular bright facet （GBF） was observed in the vicinity around the inclusion. The GBF sizes increase with increasing the number of cycles to failure Nf in the long-life regime. The values of stress intensity factor range at crack initiation site for the GBF are almost constant with Nf, and are almost equal to that for the surface inclusion and the internal inclusion at cycles lower than about 1×10^6. Neither fish-eye nor GBF was observed for Aermet 100 steel in the present study.

臂丛颈丛神经阻滞麻醉联合瑞芬太尼在锁骨骨折中的应用及对OAA/S评分、VAS评分的影响

目的:观察臂丛颈丛神经阻滞麻醉联合瑞芬太尼用于锁骨骨折手术的效果。方法:选取吉安市永丰县中医院2019年1月~2022年11月就诊的锁骨骨折患者140例为研究对象,按照收治的先后顺序随机分为试验组和对照组各70例,对照组予以臂丛颈丛神经阻滞麻醉,试验组在对照组基础上加用瑞芬太尼。记录两组麻醉前(T0)、臂丛颈丛神经阻滞麻醉后15 min(T1)、辅助用药后3 min(T2)、手术开始后5 min(T3)、手术开始后15 min(T4)、手术结束时(T5)的平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO 2)。同时观察两组期间的不良反应以及血管活性药麻黄碱、阿托品、尼卡地平以及艾司洛尔的例数。比较两组患者麻醉满意度的差异。结果:对照组T2时血压降低、心率减慢均不明显,与T0比较差异无统计学意义(P>0.05)。试验组T3、T4时血压升高、心率增快明显,与T0和对照组比较差异有统计学意义(P<0.05)。试验组T2血压降低、心率减慢明显,与对照组和T0比较差异有统计学意义(P>0.05),随后趋于平稳。试验组血管活性药物尼卡地平以及艾司洛尔的例数少于对照组,差异有统计学意义(P<0.05)。两组视觉模拟评分(VAS)及镇痛效果满意率比较差异有统计学意义(P<0.05)。结论:臂丛颈丛神经阻滞麻醉联合瑞芬太尼用于锁骨骨折切开复位内固定手术,镇静镇痛效果确切,呼吸循环稳定,患者麻醉满意度高,是一种安全、有效的麻醉方法。

A Rare Case of Fracture of Radius Associated with Dislocation of Both Distal and Proximal Radio-Ulnar Joint

Single bone forearm fractures are usually associated with dislocation of one radio-ulnar joint. The association of ulnar fractures with dislocation of proximal radio-ulnar joint and radius fractures with distal radio-ulnar joint is well described. Classically they are better known as Monteggia and Galeazzi fracture dislocations respectively. These peculiar presentations are attributed to intricate relationship of the forearm bones joined together as a unit by two radio-ulnar joints at proximal and distal ends and the interosseous membrane in the middle part. However, simultaneous dislocation of the both radio-ulnar joints associated with fracture of single bone is a very rare event. Literature search does not reveal a single case of such type. We are presenting here a case of fracture shaft of radius associated with dislocation of both proximal and distal radio-ulnar joints. The patient was managed by open reduction and fixation of the radius by a compression plate and the dislocations were reduced by closed method and stabilized with small K wires.

EFFECTS OF POISSON’S RATIO ON SCALING LAW IN HERTZIAN FRACTURE

In this paper the Auerbach＇s scaling law of Hertzian fracture induced by a spherical indenter pressing on a brittle solid is studied. In the analysis, the singular integral equation method is used to analyze the fracture behavior of the Hertzian contact problem. The results show that the Auerbach＇s constant sensitively depends on the Poisson＇s ratio, and the effective Auerbach＇s domain is also determined for a given value of the Poisson＇s ratio.

Fractures in Parkinson’s Disease

Parkinson’s disease is a neurodegenerative disorder that is common in older people and is highly associated with depression, anxiety, apathy, psychosis, cognitive impairment, imbalance and sleep disturbances. These patients have an increased risk of fracture compared to the general population. Comprehensive searches of databases are performed to identify reviews about the risk of fractures in this disease. Parkinson’s patients are at increased risk for low bone mineral density due to the effect of drugs, Parkinson’s disease and age factor, leading to an increased risk of falling down and fractures, especially in the hip. So, improved and innovative treatments with the focus on minimizing inadvertent bone resorption with anti-Parkinson’s disease medication will be highly effective in reducing fear of the disease and providing the patient with a better quality of life.

Hoffa's fracture in a five-year-old child diagnosed and treated with the assistance of arthroscopy:A case report

BACKGROUND Hoffa’s fracture is a coronal-oriented fracture of the femoral condyle.It is rarely observed in pediatric patients that isolated coronal fracture of the medial femoral condyle accompanies an intact lateral femoral condyle.Only a few cases involving Hoffa’s fracture of the medial femoral condyle have been reported in patients with undeveloped skeletons.Such a fracture cannot be observed by routine imaging examinations,thus resulting in possible misdiagnosis and further treatment challenges.CASE SUMMARY A 5-year-old boy with Hoffa’s fracture of the medial femoral condyle suffered from right knee pain and severe swelling after being hit by a heavy object.The patient was misdiagnosed and initially treated in a local primary healthcare center.No improvement in his right knee’s extension was observed following conservative treatment for 2 wk.The patient was transferred to our hospital,rediagnosed using arthroscopy,and underwent open reduction and internal fixation.The therapeutic outcome was satisfactory with the screws removed 7 mo after fixation.At the final follow-up of 40 mo,the range of motion in the knee had recovered.There was no varus-valgus instability.CONCLUSION Hoffa’s fracture is rarely seen in children aged 5 years,let alone in the medial condyle,and can easily be misdiagnosed due to limited physical and imaging examinations.Suspected Hoffa’s fracture in preschool children should be confirmed based on arthroscopic findings.Open reduction and internal fixation should be performed to protect the articular surface and prevent long-term complications.

Seismic and Tectonic Correspondence of Major Earthquake Regions in Southern Ghana with Mid-Atlantic Transform-Fracture Zones

For four centuries now, southern Ghana has been known to be seismically active, and there is no clear geological explanation for the cause of the seismicity. By evaluating new field data and information with re-interpreted historical earthquake data of southern Ghana, the nature of the seismicity of southern Ghana has been elucidated. The mutual connection between the earthquake epicentres and the remote causes by Mid-Atlantic transform faults and fracture zones has been established. The seismic regions of southern Ghana have been linked separately to tectonic faults and activities of the St. Paul’s and Romanche transform-fracture zone systems offshore in the Gulf of Guinea to onshore. It is concluded that the seismicity of southern Ghana is due to tectonic activities of the St. Paul’s and Romanche transform-fracture systems. The Accra region earthquakes originate from reactivation of faults in the Romanche transform-fracture zone, and propagate onshore through Accra and environs. The Axim region earthquakes come from reactivated faults linked to the St Paul’s fracture zone, which go through southern Cote D’Ivoire to Ghana. Seismotectonic movements along the St Paul’s transform and fracture zones have quieted since 1879. But movement along the Romanche Transform fault and Fracture zone is active, causing ongoing seismicity of southern Ghana.