Hounsfield units in assessing bone mineral density in ankylosing spondylitis patients with cervical fracture-dislocation

BACKGROUND Cervical spine fracture-dislocations in patients with ankylosing spondylitis(AS)are mostly unstable and require surgery.However,osteoporosis,one of the comorbidities for AS,could lead to detrimental prognoses.There are few accurate assessments of bone mineral density in AS patients.AIM To analyze Hounsfield units(HUs)for assessing bone mineral density in AS patients with cervical fracture-dislocation.METHODS The HUs from C2 to C7 of 51 patients obtained from computed tomography(CT)scans and three-dimensional reconstruction of the cervical spine were independently assessed by two trained spinal surgeons and statistically analyzed.Inter-reader reliability and agreement were assessed by interclass correlation coefficient.RESULTS The HUs decreased gradually from C2 to C7.The mean values of the left and right levels were significantly higher than those in the middle.Among the 51 patients,25 patients(49.02%)may be diagnosed with osteoporosis,and 16 patients(31.37%)may be diagnosed with osteopenia.CONCLUSION The HUs obtained by cervical spine CT are feasible for assessing bone mineral density with excellent agreement in AS patients with cervical fracture-dislocation.

Dorsal approach for isolated volar fracture-dislocation of the base of the second metacarpal:A case report

BACKGROUND We report a case with the displacement of an articular fracture fragment of the base of the second metacarpal from the ulnar to the volar side,treated via the dorsal approach.The dorsal approach can be a good option not only because it allows direct observation of ligament damage and fixation of bone fragments but also because the thin subcutaneous tissue makes the approach easier.CASE SUMMARY A 45-year-old man with a right hand injury visited the hospital.A small bone fragment was identified using plain radiography.Lateral radiography revealed the fragment as lying over the volar aspect of the carpometacarpal(CMC)joint.Computed tomography revealed that approximately one-third of the CMC joint surface of the second metacarpal was damaged.We provisionally diagnosed an intra-articular fracture with significant CMC joint instability and performed open reduction and internal fixation.We made a dorsal longitudinal incision over the CMC joint between the second and third metacarpals.The dorsal ligament of the third CMC joint was torn.We thought it had been dislocated to the volar side and spontaneously reduced to that position.There are only few reports of volar dislocation of CMC joint fractures,particularly of the second and third metacarpals;our report is unique as our patient had an intact interosseous ligament between the second and third metacarpals.CONCLUSION Although past reports have used a palmar approach,the dorsal approach is a good option for these cases.

Bilateral Anterior Shoulder Fracture-Dislocation: About a Case

Bilateral anterior dislocations of the shoulder are rare lesions. They are even rarer when combined with a bilateral fracture of major tubercles. We report the case of a 28-year-old patient admitted to trauma emergencies after trauma by falling from the top of a stool. Clinical and radiographic findings revealed bilateral anterior shoulder dislocation associated with bilateral fracture of major tubercles. The patient was treated orthopedically by a reduction of dislocations under General Anesthesia, immobilization of the shoulders for 6 weeks followed by reeducation. The functional result after 12 months was satisfactory with a UCLA score of 30 points.

Thoracolumbar Spine Fracture-Dislocation without Neurological Deficit: A Case Report and Review of the Literature

Background: Thoracolumbar spine fracture-dislocations are very unstable and usually secondary to high energy trauma. Due to disruption of the entire vertebrae columns, the absence of neurological deficit is exceptional. Aim: The purpose of this work is to report our experience in the management of this entity in a context of limited resources and to make a review of the literature. Case presentation: A 30-year-old man was admitted with a severe low back pain after a traffic accident. Neurological functions were intact after examination. Radiological assessments revealed a complete L3-L4 fracture-dislocation. The patient underwent an open posterior reduction and internal long segment fixation. The post-operative was marked by a surgical site infection treated with surgical debridement and targeted antibiotic therapy. The neurological functions were preserved. Conclusion: Fracture-dislocations of the thoracolumbar spine are caused by high energy trauma and are remarkably unstable lesions. When they are associated with intact neurorological functions, reduction and stabilization of these fractures are a challenge.

Surgical Management of an Unstable Lumbar Fracture-Dislocation—A Case Report

The lumbar spine is the most common sites for fractures because of the high mobility of the lumbar spine. A spinal cord injury usually begins with a sudden, traumatic blow to the spine that fractures or dislocates vertebrae. A 32-year-old man presented to us after traffic accident. In our patient, unstable fracture-dislocation of the lumbar spine at the L2-L3 level due to traffic accident occurred. The vertebral bodies were fractured and the anterior dislocation happened without spinal cord injury. The patient was a candidate for an open reduction and internal fixation surgery. The posterolateral approach was performed. After insertion of all the pedicle screws, the rods were transversally placed on L2-L3-L4 vertebral bodies and tightened. The reduction of the dislocations was carried out by pushing downwards (foreside) L2 and L4 vertebras and upwards (backside) L3 vertebrae, simultaneously. After securing the reduction of the dislocations, the rods were opened and placed along the spinal column and tightened. This technique is more effective when the pedicle of fractured vertebrae is intact.

Complicated Bosworth fracture-dislocation:A case report and review of the literature

Bosworth fracture and dislocation is relatively rare,accounting for about 1%of ankle fractures.It is characterized by the proximal fibula fracture embedded in the posterolateral distal tibia.Due to an insufficient understanding of this fracture,it is easy to cause missed diagnosis and misdiagnosis in clinical practice.Due to the insertion of the fracture,it is challenging to perform closed reduction,and improper treatment is easy to cause complications.Surgical treatment is recommended for this type of fracture.In order to improve the understanding of orthopedic surgeons about Bosworth fracture and dislocation,this paper reports the diagnosis and treatment of 2 cases of Bosworth fracture and dislocation,and reviews the literature on Bosworth fracture's mechanism,diagnosis,classification,complications,and treatment options in recent years.

Posterior shoulder fracture-dislocation:A systematic review of the literature and current aspects of management

Purpose Posterior fracture-dislocation of shoulder is an infrequent traumatic event;however,most orthopaedic surgeons may face the challenge of treating it.The aim of this study is to review and summarise systematically the current principles of the management of this complex injury,and create a treatment algorithm.Methods Both PubMed and Scopus Databases were systematically searched for the terms“posterior shoulder fracture-dislocation”or“posterior glenohumeral fracture-dislocation”or“posterior glenoid fracture-dislocation”for articles written in English and published in the last decade.Results A total of 900 articles were identified,of which 13 were retained for analysis.A total of 153 patients(161 shoulders)were identified.These patients were treated either with open reduction and internal fixation,modified McLaughlin procedure,allograft/autograft humeral head reconstruction or shoulder arthroplasty.The mean age was 40.15 years.The mean postoperative Constant score in cases treated by open reduction and internal fixation was 86.45,whereas by bone graft was 84.18.Further,the mean postoperative Constant score was between 79.6 and 67.1 in those that were managed by modified McLaughlin and arthroplasty procedure,respectively.Conclusion The management of posterior shoulder fracture-dislocation may be challenging,and the best surgical option depends on many variables such as the chronicity of the injury,the presence of a fracture at the level of the surgical neck or tuberosities and the extend of the Hill-Sachs lesion if any.A treatment algorithm is proposed,based on the current literature in an effort to create a consensus for these injuries.For the acute shoulder fracture-dislocations,an open reduction should be performed.For the chronic fracture/dislocations in the elderly low-demand patients,conservative treatment should be performed.For the rest of the patients,depending on the severity of the Hill-Sachs lesion different surgical options are available such as the McLaughlin technique,the use of an allograft,osteotomy or arthroplasty.

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.

手法整复小夹板固定治疗肱骨外科颈骨折合并肩关节脱位

肱骨外科颈骨折合并肩关节脱位临床少见，治疗难度大，易遗留肩关节功能障碍。以往手术治疗复杂，创伤大，并发症多，远期效果不理想，不易被患者接受，手法整复难度大，需要拿握一定的技巧和方法，其主要原因是：(1)肱骨头脱向肩关节孟，喙突关节囊等阻碍，造成复位困难。(2)骨折合并脱位不能发挥杠杆力的作用，造成复位困难，故笔者自1994年以来，应用指压法整复脱位应用手法复位骨折起肩关节夹板固定，又因外固定日久会造成肩关节粘连，影响肩关节功能恢复。故笔者早期制定了一整套行之有效的功能锻炼方法，指导并督促患者进行功能锻炼，大大缩短了病人的康复时间。

A modified three-incision approach to treating three-column Lisfranc injuries

Purpose:The most popular surgical approach to manage Lisfranc fracture-dislocations is the double-incision approach,which frequently causes a variety of complications,such as skin necrosis,rotational malreduction of the first tarsometatarsal joint(TMTJ)and lateral column dorsoplantar malreduction of the TMTJ.We introduce a three-incision approach to treat Lisfranc fracture-dislocations with only minor postoperative complications and good foot function.Methods:We prospectively selected 30 previously healthy patients,ranging from 18 to 60 years of age,but only 23 patients completed the follow-up and thus were finally included,with an average age of 38.1±12.9 years.All patients have sustained Lisfranc fracture-dislocations involving all three-column;13.0%(3/23)were Myerson classification type A(medial),47.8%(11/23)were type A(lateral),and 39.1%(9/23)were type C2.All patients were treated via a three-incision approach:a long incision made along the lateral border of the second ray was used as a working incision to visualize and reduce the first three TMTJs,as well as to apply internal fixation instrumentation;a 2 cm medial incision was made at the medial side of the first TMTJ as an inspecting incision,ensuring good reduction of the first TMTJ in medial and plantar view;another 1 cm inspecting incision was made at the dorsal side of the fourth/fifth TMTJ to prevent sagittal subluxation of the lateral column.Mean±SD was used for quantitative data such as operation time,follow-up time and foot function scores.Postoperative complications were documented,and foot function was evaluated using the American orthopaedic foot&ankle society score,foot function index and Maryland foot score at follow-up.The foot function of the injured foot and contralateral foot of the same patient was at the end of follow-up,and independent samplet-test was used for statistical analysis.Results:The median operation time was 117.9±14.6 min(range 93-142 min).All complications occurred within three months after the operation,and included delayed wound healing(17.4%),superficial infection(8.7%),complex regional pain syndrome(4.3%)and neuroma(4.3%).There was no case of postoperative skin necrosis or malreduction.At the end of follow-up of 14.1±1.2 months(range 12-16 months),the median American orthopaedic foot&ankle society score of the operated foot was 89.7±5.7,the median foot function index was 21.7±9.9,and the median Maryland foot score was 88.7±4.8.There were no significant differences between the operated and contralateral sides,in terms of foot function,at the end of followup(p>0.05).Conclusion:The three-incision approach can provide adequate visualization of all TMTJs to ensure anatomical reduction and offer sufficient working space to apply internal fixation instrumentation,which is effective in treating three-column Lisfranc fracture-dislocations with minor soft tissue complications and satisfactory functional recovery.