Minimally invasive open reduction of greater tuberosity fractures by a modified suture bridge procedure

BACKGROUND Most greater tuberosity fractures can be treated without surgery but some have a poor prognosis.The surgical procedures for avulsion fractures of the humeral greater tuberosity include screw fixation,suture anchor fixation,and plate fixation,all of which have treatment-associated complications.To decrease surgical complications,we used a modified suture bridge procedure under direct vision and a minimally invasive small incision to fix fractures of the greater tuberosity of the humerus.AIM To investigate the clinical efficacy and outcomes of minimally invasive modified suture bridge open reduction of greater tuberosity evulsion fractures.METHODS Sixteen patients diagnosed between January 2016 and January 2019 with an avulsion-type greater tuberosity fracture of the proximal humerus and treated by minimally invasive open reduction and modified suture bridges with anchors were studied retrospectively.All were followed up by clinical examination and radiographs at 3 and 6 wk,3,6 and 12 mo after surgery,and thereafter every 6 mo.Outcomes were assessed preoperatively and postoperatively by a visual analog scale(VAS),the University of California Los Angeles(UCLA)shoulder score,the American Shoulder and Elbow Surgeon score(ASES),and range of motion(ROM)for shoulders.RESULTS Seven men and nine women,with an average age of 44.94 years,were evaluated.The time between injury and surgery was 1-2 d,with an average of 1.75 d.The mean operation time was 103.1±7.23 min.All patients achieved bone union within 3 mo after surgery.VAS scores were significantly decreased(P=0.002),and the mean degrees of forward elevation(P=0.047),mean degrees of abduction(P=0.035),ASES score(P=0.092)were increased at 3 wk.The UCLA score was increased at 6 wk(P=0.029)after surgery.The average degrees of external rotation and internal rotation both improved at 3 mo after surgery(P=0.012 and P=0.007,respectively).No procedure-related deaths or incision-related superficial or deep tissue infections occurred.CONCLUSION Modified suture bridge was effective for the treatment of greater tuberosity evulsion fractures,was easier to perform,and had fewer implants than other procedures.

Open reduction and internal fixation for radial head fractures: A prospective observational study

Objective: To evaluate the effect of open reduction and internal fixation on radial head fracture and assess the post-operative function. Methods: This prospective observational study was conducted from June 2016 to July 2017 at Liaquat National Hospital and Medical College, Karachi. Altogether, 28 patients with radial head and neck fractures were enrolled in our study. These patients were admitted to the hospital and their fractures were fixed with open reduction and internal fixation. Baseline information of the patients was collected, and patient-rated elbow evaluation scores were calculated. Results: Out of the 28 patients, 21 were male and 7 were female. Besides, 16 fractures were on the right side and 12 were on the left side and 17 involving the dominant hands. In addition, 8 patients had Mason type Ⅱ fracture and 20 had Mason type Ⅲ fracture. The mean age of patients was (31.0 ± 8.0) years, and the mean follow-up is (1.2 ± 0.5) years. The mean average patient-rated elbow evaluation scores were (27.64 ± 1.60) at 1-year follow-up. Conclusions:The majority of the patients who had radial head fractures and treated by open reduction and internal fixation have attained an excellent range of motion postoperatively.

Functional Outcomes of Traumatic Complex Acetabulum Fractures with Open Reduction and Internal Fixation: 200 Cases

Objective: Acetabular fractures are common injuries in Iran. We assess the functional outcome of open reduction and internal fixation management of displaced Complex acetabular fractures. Materials and Methods: We analyzed a case series of patients with open reduction and internal fixation (ORIF) for complex acetabular fractures. Two hundred patients (132 men, 68 women) in four age groups including with a mean age of 43.39 ± 6.18 years (range 20 - 59 years) and a mean follow-up of 82.34 ± 12.48 months (range 18 - 109 months) met the inclusion criteria. Functional outcome at final follow-up was graded assessed according to Harris score. Factors affecting were defined. Results: Anatomic reduction was achieved in 192 hips, imperfect in 8 and poor in none. Radiological outcome revealed excellent results in 128 (64%) hips, good in eight, fair in five and none in poor. Harris score were excellent in 139 (69.5%) hips, good in 43 (21.5%) and fair in 18 (9%) and poor in none. The anatomical reduction results had a favorable final functional outcome. (0.003) However, BMI (P Conclusion: Optimal functional and radiological outcomes have been achieved with anatomic postoperative reduction. Also experience of specialist, on time surgery and good recovery lead to receiving excellent functional outcome with at least complications.

Intracortical screw insertion plus limited open reduction in treating type 31A3 irreducible intertrochanteric fractures in the elderly

BACKGROUND In most elderly patients with intertrochanteric fractures,satisfactory fracture reduction can be achieved by closed reduction using a traction table.However,intertrochanteric fractures cannot achieve satisfactory reduction in a few patients,which is called irreducible intertrochanteric fractures.Especially for type 31A3 irreducible intertrochanteric fractures,limited open reduction of the broken end with different intraoperative reduction methods is required to achieve satisfactory reduction and fixation.AIM To discuss clinical efficacy of intracortical screw insertion plus limited open reduction in type 31A3 irreducible intertrochanteric fractures in the elderly.METHODS A retrospective analysis was performed on 23 elderly patients with type 31A3 irreducible intertrochanteric fractures(12 males and 11 females,aged 65-89-yearsold)who received treatment at the orthopedics department.After type 31A3 irreducible intertrochanteric fractures were confirmed by intraoperative C-arm,all of these cases received intracortical screw insertion plus limited open reduction in the broken end with intramedullary screw internal fixation.The basic information of surgery,reduction effects,and functional recovery scores of the hip joint were assessed.RESULTS All patients were followed up for 13.8 mo on average.The operation time was 53.8±13.6 min(40-95 min).The intraoperative blood loss was 218.5±28.6 mL(170-320 mL).The average number of intraoperative X-rays was 22.8±4.6(18-33).The average time to fracture union was 4.8±0.7 mo.The reduction effect was assessed using Kim’s fracture reduction evaluation.Twenty cases achieved grade I fracture reduction and three cases grade II fracture reduction.All of them achieved excellent or good fracture reduction.Upon the last follow-up,the functional recovery scores score was 83.6±9.8,which was not significantly different from the functional recovery scores score(84.8±10.7)before the fracture(t=0.397,P=0.694).CONCLUSION With careful preoperative preparation,intracortical screw insertion plus limited open reduction contributed to high-quality fracture reduction and fixation.Good clinical outcomes were achieved without increasing operation time and intraoperative blood loss.

Clinical effect of distal radius fracture treated with open reduction and internal plate fixation

Background For some specific comminuted unstable intra-articular fracture,the plaster cast can not maintain the alignment of the articular surface effectively.The aim of this study was to evaluate the clinical effects of distal radius fracture treated with open reduction and internal plate fixation retrospectively.Methods From January 2002 to March 2010,539 cases of distal radius fracture were treated with open reduction and internal fixation,including 184 males and 355 females aging 21-72 years （mean 57 years）.Fractures were caused by falling to the ground in 459 cases,by traffic accident in 62 cases and by athletic injuries in 18 cases.Of 539 cases,there were 523 cases of closed fracture and 16 cases of open fracture.According to Arbeitsgemeinschaft fur Osteosynthesefragen （AO） standards of classification,there were 14 cases of A2 type,22 of A3 type,18 of B1 type,24 of B2 type,62 of B3 type,91 of C1 type,162 of C2 type and 146 of C3 type.The time from injury to operation was 1-16 days （mean 5 days）.All patitents received open reduction and internal plate screw fixation.Forty-seven patients with bone defect were given 6-15 g autologous ilium and 75 cases were given 5 ml calcium sulphate artificial aggregate after reduction.Results All incisions healed by first intention after operation.Patients were followed up for 15 to 32 months postoperatively （mean 22 months）.The fractures healed within 10-18 weeks after operation （mean 12 weeks）.During the last follow-up,the mean palmar tilt was （7.0±0.9）° and the mean ulnar variance was （21.0±4.2）°,showing significant difference when compared with preoperation （（-5.0±1.2）° and （8.0±3.8）°）.The radial heights were not abbreviated.According to Gartland and Werley assessment system,the results were excellent in 314 cases,good in 163 cases,fair in 46 cases,and poor in 16 cases 12 weeks after operation,the excellent and good rate was 88.5%.Conclusions The clinical effect of distal radius fracture treated with open reduction and internal plate fixation was relatively satisfactory.Meticulous operation procedure and individual rehabilitation strategy contribute to the wrist joint functional recovery.

Three-dimensional printing combined with open reduction and internal fixation versus open reduction and internal fixation in the treatment of acetabular fractures:A systematic review and meta-analysis

Purpose:This meta-analysis compared the clinical outcome of three-dimensional(3D)printing combined with open reduction and internal fixation(ORIF)to traditional ORIF in the treatment of acetabular fractures.Methods:We searched the Cochrane Library,PubMed,Embase,VIP database,CNKI,and Wanfang data-base with keywords"acetabular fracture","3D printing","three-dimensional printing","open reduction and internal fixation","Acetabulum","Acetabula"from January 2000 to March 2020.Two reviewers independently selected articles,extracted data,assessed the quality evidence and risk bias of included trials using the Cochrane Collaboration’s tools and/or Newcastle-Ottawa scale.When the two analysts had different opinions,they would ask the third analyst for opinion.Randomized controlled trials or retrospective comparative studies of 3D printing combined with ORIF(3D printing group)versus traditional ORIF(conventional group)in the treatment of acetabular fractures were selected.The data of operation time,intraoperative blood loss,intraoperative fluoroscopy times,incidence of complications,excellent and good rate of Matta score for reduction,and excellent and good rate of hip function score were extracted.Stata14.0 statistical software was used for data analysis.Results:Altogether 9 articles were selected,including 5 randomized controlled trials and 4 retrospective studies.A total of 467 patients were analyzed,250 in the conventional group,and 217 in the 3D printing group.The operation time in the 3D printing group was less than that in the conventional group and the difference was statistically significant(standardized mean difference(SMD)=-1.19,95%CI:-1.55 to-0.82,p<0.05).The intraoperative bleeding volume of the 3D printing group was significantly lower than that of the conventional group(SMD=-1.08,95%CI:-1.65 to-0.51,p<0.05).The fluoroscopy times were less in the 3D printing group than in the conventional group and the difference was statistically significant(SMD=-1.64,95%CI:-2.35 to-0.93,p<0.05).The total incidence of complications in the 3D printing group was significantly lower than that in the conventional group(OR=0.43,95%CI:0.24-0.79,p<0.05).There was no significant difference in the excellent and good rate of Matta score for reduction between the two groups(OR=0.60,95%CI:0.34-1.06,p>0.05).There was no significant difference in the excellent and good rate of hip function score at the end of postoperative follow-up between the two groups(OR=0.84,95%CI:0.46-1.56,p>0.05),but the follow-up time varies from 6 months to 40 months.Conclusion:Compared with traditional ORIF,3D printing combined with ORIF has certain advantages in terms that 3D printing not only helps surgeons to understand acetabular fractures more intuitively,but also effectively reduces operation time,intraoperative blood loss,intraoperative fluoroscopy times,and postoperative complications.However,there were no significant differences in the excellent and good rate of Matta score for reduction and the excellent and good rate of hip function score at the end of follow-up.

Closed reduction external fixator fixation versus open reduction internal fixation in the patients with Bennett fracture dislocation

Background The Bennett fracture is either a common or a challenging problem to hand surgeons.It is still debated whether closed or open reduction gives optimal results.This study aimed to describe and assess a closed reduction and mini-external fixator fixation technique for the treatment of Bennett＇s fracture dislocation and to compare this technique versus open reduction and internal fixation.Methods From October 2002 to December 2012,56 patients with Bennett＇s fracture dislocation were treated by closed reduction and mini-external fixator fixation and 32 patients were treated by open reduction and internal fixation in Jishuitan Hospital.Patients with an articular step-off of more than 1 mm were excluded.All patients were assessed at a mean followup of 7 years （range 2-10 years） and the two groups were compared with pain levels,active range of trapeziometacarpal motion,grip strength and pinch strength,arthritic changes,and adduction deformity.Results Based on primary closed reduction maintained,the rate of anatomic reduction is 63.6％.Radiographic fracture union was achieved in all patients at a mean time of 5 weeks.At the final follow-up,there was no difference between the two groups in mean union time and pain levels （P=-0.2）.There was also no difference between the two groups regarding the active range of trapeziometacarpal motion （P=0.3）,grip stength （P=0.6）,pinch strength （P=0.2）,arthritic change and loss of reduction （P=0.2）.There was a significant correlation between adduction deformity and the development of arthritis （P=0.02）.Conclusion Closed reduction mini-external fixator fixation should be first tried to apply in the treatment of Bennett＇s fracture dislocation,and open reduction internal fixation should only be performed for irreducible fractures.

Improving Lives Forty years of reform and opening up helps drive poverty reduction in China and globally

Li Naluo still remembers how isolated and poor her native village was not so long ago： a few thatched huts,no roads or electricity, secluded in the mountains of south China＇s Yunnan Province. Who would have thought that a few years later, this poor village would rise like a phoenix from the ashes？

Pedicled abdominal flap using deep inferior epigastric artery perforators for forearm reconstruction: A case report

BACKGROUND Pedicled abdominal flaps are a widely used surgical technique for forearm reconstruction in patients with soft tissue defects.However,some drawbacks include restricted flap size,partial flap loss,and donor-site morbidity.To address these concerns,we present a case of a pedicled abdominal flap using the deep inferior epigastric artery perforators(DIEP)for forearm reconstruction in a patient with a large soft tissue defect.CASE SUMMARY A 46-year-old male patient was admitted to our hospital with forearm injury caused by a pressing machine.A 15 cm×10 cm soft tissue defect with complete rupture of the ulnar side structures of the forearm was found.One week after orthopedic management of the neurovascular injury and fractures using the first stage of Masquelet technique,the patient was referred to the plastic and recon-structive surgery department for wound coverage.Surgical debridement and negative-pressure wound therapy revealed a 20 cm×15 cm soft tissue defect.A pedicle abdominal flap with the DIEP was used to cover the defect.Three weeks later,the flap was detached from the abdomen,and the abdominal defect was directly closed.Subsequently,the second stage of Masquelet technique was performed at the fracture site at week 10.Finally,all donor and recipient sites healed without complications,such as flap dehiscence,infection,hematoma,or necrosis.Fracture site osteosynthesis was achieved without complications.CONCLUSION Pedicled abdominal flap using the DIEP provides a reliable option for forearm reconstruction in patients with large soft tissue defects.

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.

Simple lateral elbow dislocation:A case report

BACKGROUND Simple lateral elbow dislocation(SLED)is a rare type of elbow dislocation;however,its treatment may be complicated by accompanying soft tissue or neurovascular damage.Herein,we report a rare case of SLED managed secondarily with open reduction and soft tissue repair following failure of closed reduction.CASE SUMMARY A 67-year-old woman suffered SLED after falling on her outstretched left hand with her elbow extended.She developed pain,swelling,and movement restriction in the elbow;there were no neurovascular symptoms,except for numbness in the 4th and 5th digits.Radiologic investigation confirmed the SLED,and a closed reduction under anesthesia was performed.The follow-up radiographs at 1-wk revealed failure of reduction;accordingly,open reduction with lateral collateral ligament and common extensor origin repair were carried out.The patient regained full elbow range of motion by six weeks.CONCLUSION Adequate concentric reduction for SLED,conservatively or surgically,reduces complications and provides a more functional joint.

Therapeutic effect of two methods on avulsion fracture of tibial insertion of anterior cruciate ligament

BACKGROUND The tibial stop of anterior cruciate ligament(ACL) is fan-shaped and attached to the medial groove in front of the intercondylar spine,which is located between the anterior horn of the medial and lateral meniscus.The incidence of this fracture is low previously reported,which is common in children and adolescents.With the increase of sports injury and traffic injury and the deepening of understanding,it is found that the incidence of the disease is high at present.AIM To explore the difference between open reduction and internal fixation with small incision and high-intensity non-absorbable suture under arthroscopy in the treatment of tibial avulsion fracture of ACL.METHODS Seventy-six patients with tibial avulsion fracture of anterior cruciate ligament diagnosed and treated in Guanyun County People’s Hospital from April 2018 to June 2020 were retrospectively analyzed.According to the surgical methods,they were divided into group A(40 cases) and group B(36 cases).Patients in group A were treated with arthroscopic high-strength non-absorbable suture,and patients in group B were treated with small incision open reduction and internal fixation.The operation time,fracture healing time,knee joint activity and functional score before and after operation,and surgical complications of the two groups were compared.RESULTS The operation time of group A was higher than that of group B,and the difference was statistically significant(P < 0.05);the fracture healing time of group A was compared with that of group B,and the difference was not statistically significant(P > 0.05);The knee joint function activity was compared between two groups before operation,3 mo and 6 mo after operation,and the difference was not statistically significant(P > 0.05);the knee joint function activity of group A and group B at 3 mo and 6 mo after operation was significantly higher than that before operation(P < 0.05);the limp,support,lock,instability,swelling,upstairs,squatting,pain and Lysholm score were compared between the two groups before and 6 mo after operation,and the difference was not statistically significant(P > 0.05);the scores of limp,support,lock,instability,swelling,upstairs,squatting,pain and Lysholm in group A and group B at 6 mo after operation were significantly higher than those before operation(P > 0.05);the surgical complication rate of group A was 2.63%,which was lower than 18.42% of group B,and the difference was statistically significant(P > 0.05).CONCLUSION Both small incision open reduction and internal fixation and arthroscopic high-strength nonabsorbable sutures can achieve good results in the treatment of anterior cruciate ligament tibial avulsion fractures.The operation time of arthroscopic high-strength non-absorbable sutures is slightly longer,but the complication rate is lower.

Clinical study on the surgical treatment of atypical Lisfranc joint complex injury

BACKGROUND Lisfranc injuries have not received much attention by orthopedic doctors in the past,and there is little related research on the diagnosis and treatment of these injuries.In recent years with the rise in foot and ankle surgery,doctors are now paying more attention to this type of injury.However,there is still a high rate of missed diagnosis due to insufficient attention causing treatment delays or inadequate treatments,which eventually result in greater sequelae;including long-term pain,arthritis,foot deformity etc.In particular,for cases with a mild Lisfranc joint complex injury,the incidence of sequelae is higher.AIM To select an active surgical treatment for an atypical Lisfranc joint complex injury and to evaluate the clinical efficacy of the surgical treatment.METHODS The clinical data of 18 patients,including 10 males and 8 females aged 20-64 years with Lisfranc injuries treated in our department from January 2017 to September 2019 were retrospectively analyzed.All patients were treated with an open reduction and internal fixation method using locking titanium mini-plates and hollow screws or Kirschner wires.X-ray images were taken and follow-up was performed monthly after the operation;the internal fixation was then removed 4-5 mo after the operation;and the American Orthopedic Foot and Ankle Society(AOFAS)score was used for evaluation on the last follow-up.RESULTS All patients were followed up for 6-12 mo.A good/excellent AOFAS score was observed in 88.9%of patients.CONCLUSION For atypical Lisfranc joint complex injuries,active open reduction and internal fixation can be performed to enable patients to obtain a good prognosis and satisfactory functional recovery.

Hoffa’s fracture in an adolescent treated with an innovative surgical procedure:A case report

BACKGROUND Hoffa fracture is rare,especially in adolescents,and has a high rate of complications such as avascular necrosis and osteoarthritis;moreover,there are no definitive guidelines for its treatment.This report could provide a new potential treatment for Hoffa fracture.CASE SUMMARY A 16-year-old girl presented to the orthopedic emergency department of No.2 People’s Hospital of Yibin City with persistent pain following a right knee injury sustained during a sprint race.Her knee was swollen and tender,and the range of motion was restricted by the pain.X-ray and computed tomography revealed a Hoffa fracture in the right knee.After consultation,surgical treatment was performed,and the fracture was fixed with three 3.5-mm cannulated cancellous screws;osteochondral plugs that were harvested from the screw insertion site were re-implanted to cover the screw head.The patient’s fracture and osteochondral plug healed 6 mo postoperatively,and she presented a knee range of motion of 0–135 without pain,and was walking without support with a normal gait.CONCLUSION Here,we describe an innovative surgical procedure for Hoffa fracture that could provide a new possibility for the treatment of similar fractures,and further improve their management.

Pulmonary thromboembolism after distal ulna and radius fractures surgery: A case report and a literature review

BACKGROUND Pulmonary thromboembolism(PTE)is a serious postoperative complication that can occur after a fracture.Generally,PTE is caused by the falling off of lower extremity deep vein thrombosis(LEDVT)after lower limb fracture surgery.LEDVT and PTE after upper extremity fracture surgery are very rare.PTE is one of the most common clinical causes of sudden death.Venous thromboembolism includes PTE and DVT.We experienced one case of LEDVT and PTE after distal ulna and radius fracture surgery.The purpose of our report is to raise awareness for orthopedic surgeons that PTE can occur after distal ulna and radius fracture surgery,and patients with high risk factors should be considered for prevention and treatment of thrombosis in a timely manner.CASE SUMMARY We report a 51-year-old Chinese male who had severe fractures of the left distal ulna,radius and little finger after a motorcycle accident.The patient underwent external fixation,open reduction and internal fixation.On the third post-operative day,computed tomographic pulmonary angiography showed PTE.Doppler ultrasonography showed thrombus formation in the bilateral posterior tibial veins.After a period of anticoagulation therapy,on the 25th d after the PTE,computed tomographic pulmonary angiography showed that thrombus in both sides of the pulmonary artery disappeared.Furthermore,about 4 mo after the PTE,thrombosis in the deep veins of the lower limbs disappeared.About 1 year after the surgery,X-rays showed good fracture healing,and the function of the wrist joint recovered well.CONCLUSION Though rare,PTE can occur after distal ulna and radius fracture surgery and patients with high risk factors should be considered for prevention and treatment of thrombosis in a timely manner.

Diagnosis,treatment and complications of radial head and neck fractures in the pediatric patient

Radial head and neck fractures represent up to 14%of all pediatric elbow fractures and can be a difficult challenge in the pediatric patient.In up to 39%of proximal radius fractures,there is a concomitant fracture,which can easily be overlooked on the initial standard radiographs.The treatment options for proximal radius fractures in children range from non-surgical treatment,such as immobilization alone and closed reduction followed by immobilization,to more invasive options,including closed reduction with percutaneous pinning and open reduction with internal fixation.The choice of treatment depends on the degree of angulation and displacement of the fracture and the age of the patient;an angulation of less than 30 degrees and translation of less than 50%is generally accepted,whereas a higher degree of displacement is considered an indication for surgical intervention.Fractures with limited displacement and non-surgical treatment generally result in superior outcomes in terms of patient-reported outcome measures,range of motion and complications compared to severely displaced fractures requiring surgical intervention.With proper management,good to excellent results are achieved in most cases,and long-term sequelae are rare.However,severe complications do occur,including radio-ulnar synostosis,osteonecrosis,rotational impairment,and premature physeal closure with a malformation of the radial head as a result,especially after more invasive procedures.Adequate follow-up is therefore warranted.

Old unreduced obturator dislocation of the hip:A case report

Obturator dislocation is a rare type of hip dislocation,accounting for about 2%-5%of all hip dislocations.The occurrence of old unreduced obturator dislocation is even more infrequent,with only 17 cases reported in nine studies,most of which were from the 1950s to 1980s in developing countries.CASE SUMMARY A 38-year-old woman from Hunan Province,China presented with stiffness of the left hip in abduction,flexion,and external rotation after falling from a 2-meter-tall tree onto her left knee 1.5 mo prior.Pelvic radiograph and computed tomography revealed obturator dislocation of the left hip accompanied by impaction fracture at the superolateral aspect of the left femoral head without associated acetabulum fracture.Open reduction was performed,resulting in restoration of the concentric alignment of the left hip.After surgery,6-wk skin traction was applied and the patient was kept in bed for an additional 2 wk.At 3 mo after surgery,the patient reported experiencing some pain,which did not affect the function of the affected limb,and some movement restriction but no abduction deformity or claudication was present.An X-ray showed that the left hip was homocentric,and there was no sign of posttraumatic arthritis or avascular necrosis.CONCLUSION Open reduction may be an effective treatment strategy for the rare condition of old unreduced obturator dislocation with short neglect time.

Internal fixation and unicompartmental knee arthroplasty for an elderly patient with patellar fracture and anteromedial osteoarthritis:A case report

BACKGROUND Open reduction and internal fixation(ORIF)is the traditional surgical treatment for patellar fractures,and unicompartmental knee arthroplasty(UKA),especially Oxford UKA,has been increasingly used in patients with medial knee osteoarthritis(OA).However,the process of choosing treatment for patients with both patellar fractures and anteromedial knee OA remains unclear.We present the case of a patient with a patellar fracture and anteromedial OA.CASE SUMMARY We present the case of a 72-year-old woman with a history of bilateral medial compartment OA of the knees and a right Oxford UKA.She also experienced a recent left patellar fracture.ORIF and Oxford UKA were performed in a single stage.The patient showed excellent postoperative clinical results.CONCLUSION ORIF and Oxford UKA can be performed simultaneously for patients with patellar fracture and anteromedial OA on the same knee.

Surgical treatment of bipolar segmental clavicle fracture:A case report

BACKGROUND Shoulder injuries caused by trauma are common,including clavicle fractures.Even so,bipolar segmental fracture of the clavicle is extremely rare and seldom reported.Therefore,there is still a controversial issue about how to treat these bipolar segmental clavicle fractures.CASE SUMMARY A 56-year-old security guard arrived at our emergency room after falling on his electric bicycle.There was no loss of consciousness or other pain.He had no numbness in his fingers.X-rays and 3D computed tomography revealed that the patient’s right shoulder had a bipolar segmental clavicle fracture.The surgical procedure included both open reduction and internal fixation.At the 1-year follow-up,he had a full range of motion and minimal discomfort in the injured shoulder.CONCLUSION We provide a rare case of bipolar clavicle facture in the right clavicle.We hold the opinion that such patients would get better clinical and radiological outcomes by early and correct operation.

Radiographic evaluation of vascularity in scaphoid nonunions:A review

Scaphoid fractures,particularly those that occur more proximally,are unreliable in achieving union due to the retrograde blood supply of the scaphoid bone.Vascular compromise is associated with the development of nonunions and avascular necrosis of the proximal pole.Due to the tenuous blood supply of the scaphoid,it is imperative that the vascularity be assessed when creating diagnostic and treatment strategies.Early detection of vascular compromise via imaging may signal impending nonunion and allow clinicians to perform interventions that aid in restoring perfusion to the scaphoid.Vascular compromise in the scaphoid presents a diagnostic challenge,in part due to the non-specific findings on plain radiographs and computed tomography.Magnetic resonance imaging techniques have dramatically improved our ability to assess the blood supply to the scaphoid and improve time to intervention.This review aims to summarize these advances and highlights the importance of imaging in assessing vascular compromise in scaphoid nonunion and in reperfusion following surgical intervention.