An unprecedented case: Salter Harris II Gartland modified IV fracture of the humeral palette with metaphyseal fragment olecranon fossa. Review of literature.

Background. The Salter-Harris II fracture is the most common transphyseal fracture of all types of fractures, per-total and for each bone extremity that has a growth cartilage. This type of fracture rarely occurs in the humeral palette and the metaphyseal fragment is located laterally or medially. No cases with ventral or dorsal metaphyseal fragment have been described. Purpose. To bring into notice a fracture, type Salter-Harris II, with posterior metaphyseal fragment, represented by a posterior corticospongiosis lysereum(thickening) and the olecranon fossa, associated with periosteal rupture and soft tissue interposition. Study design: Case report Methods: A 9-year-old patient shows signs of traumatic injury, as a result of a direct impact on the right elbow. After a radiological examination, the diagnosis of Gartland type III supracondylar fracture is established, a closed reduction is practiced and it is immobilized in a plaster cast. The radiological control after the orthopedic reduction highlighted an unsatisfactory reduction. A surgery and an open reduction and internal fixing in "double X" were performed. Results: The preoperative diagnosis of Salter-Harris II fracture, with posterior Holland fragment, was made with difficulty and may be a surprise on intraoperative exploration. Open anatomical reduction and the fixation in "double X" allowed a firm synthesis of the fracture, verification of stability, intraoperatively, lack of mobilization in the plaster splint, starting recovery on the first postoperative day and full recovery of elbow mobility in 32 days. Conclusions: Salter Harris type II fracture with posterior fragment dislocated by tilting, translation and asymmetric rotation, irreducible is operated by open reduction and internal fixation. The fixation in "double X" ensured a better stabilization and allowed the recovery of flexion and extension in 32 days from surgery.

Bicondylar Tibial Plateau Fractures Involving the Posterior Fragment: Injury Mechanism and Fracture Characteristics

Background: Bicondylar tibial plateau fracture (BTPF) involving the posterior fragment is the most complex intra-articular fracture to treat. Although the fracture characteristics of BTPFs have been reported by many researchers, due to the sophisticated kinematics of the knee, reports focused on the injury mechanism are still scarce. The current injury mechanism is insufficient to explain the various fracture characteristics and to guide surgery. This study used a three-dimensional (3D) simulation method to investigate the injury mechanism and fracture characteristics of BTPFs involving the posterior fragment.Methods: Ninety-six BTPFs involving the posterior fragment were included. A computer-assisted 3D technique, which enabled us to move the femoral condyles to match the displaced fracture fragments of the tibial plateau, was applied to analysis the injury mechanism for all cases. The 3D and two-dimensional (2D) morphology of each fracture were reviewed thoroughly, and the main fracture lines were mapped and superimposed on a template. Results: After simulation andquantitatively analysis, three main types (extension, flexion-internal rotation, flexion-external rotation) and six sub-types (valgus and varus in each main type) of injury mechanism had been classified according to the degree of knee motion in three planes. In the extension type, femoral condyles compress the anterolateral tibial plateau and central medial plateau, resulting in an anterior-to-posterior fracture line. In the flexion-internal rotation type, the compressed areas are located on the posterolateral and anteromedial plateau, forming an oblique anteromedial-to-posterolateral fracture line. In the flexion-external rotation type, the compressed areas are located on the anterolateral and posteromedial plateau, exhibiting an anterolateral-to-posteromedial fracture line. Conclusions: Differentinjury mechanisms result in different fracture characteristics. A thorough understanding of the injury mechanisms underlying complex BTPFs involving the posterior fragment is meaningful not only for fracture characteristics reorganization but also for surgical decision making. The 3D simulation method employed in this study may be a useful supplemental method for investigating the mechanisms underlying fracture injuries.

Bicondylar Tibial Plateau Fractures Involving the Posterior Fragment: Injury Mechanism and Fracture Characteristics

Background: Bicondylar tibial plateau fracture (BTPF) involving the posterior fragment is the most complex intra-articular fracture to treat. Although the fracture characteristics of BTPFs have been reported by many researchers, due to the sophisticated kinematics of the knee, reports focused on the injury mechanism are still scarce. The current injury mechanism is insufficient to explain the various fracture characteristics and to guide surgery. This study used a three-dimensional (3D) simulation method to investigate the injury mechanism and fracture characteristics of BTPFs involving the posterior fragment. Methods: Ninety-six BTPFs involving the posterior fragment were included. A computer-assisted 3D technique, which enabled us to move the femoral condyles to match the displaced fracture fragments of the tibial plateau, was applied to analysis the injury mechanism for all cases. The 3D and two-dimensional (2D) morphology of each fracture were reviewed thoroughly, and the main fracture lines were mapped and superimposed on a template. Results: After simulation and quantitatively analysis, three main types (extension, flexion-internal rotation, flexion-external rotation) and six sub-types (valgus and varus in each main type) of injury mechanism had been classified according to the degree of knee motion in three planes. In the extension type, femoral condyles compress the anterolateral tibial plateau and central medial plateau, resulting in an anterior-to-posterior fracture line. In the flexion-internal rotation type, the compressed areas are located on the posterolateral and anteromedial plateau, forming an oblique anteromedial-to-posterolateral fracture line. In the flexion-external rotation type, the compressed areas are located on the anterolateral and posteromedial plateau, exhibiting an anterolateral-to-posteromedial fracture line. Conclusions: Different injury mechanisms result in different fracture characteristics. A thorough understanding of the injury mechanisms underlying complex BTPFs involving the posterior fragment is meaningful not only for fracture characteristics reorganization but also for surgical decision making. The 3D simulation method employed in this study may be a useful supplemental method for investigating the mechanisms underlying fracture injuries.

Three-Dimensional Custom-Made Titanium Ribs for Reconstruction of a Large Chest Wall Defect

Reconstruction of large chest wall defects always demand surgeons of having lots of means available (both materials and resourceful) to apply a cover to chest wall defects which can range from a few centimeters to the lack of a few entire ribs. In this study, we present the case of a teenager who suffered from a complete resection of three ribs because of Ewing sarcoma dependent on the sixth rib. Given the size of the defect, a multidisciplinary approach was chosen to provide rigid and soft tissue coverage and minimal functional and aesthetic impact. Custom-made titanium implants were designed based on three-dimensional computed tomography scan reconstruction. The surgical specimen via a left lateral thoracotomy (fifth, sixth, and seventh entire ribs) was resected, leaving a defect of 35 × 12 × 6 cm. A Gore-Tex patch (W. L. Gore & Associates, Arizona, United States) was placed and, after that, the implants were anchored to the posterior fragment of the healthy ribs and to the costal cartilage anteriorly. Finally, the surgical site was covered with a latissimus dorsi flap. The postoperative course was uneventful. After 9 months of follow-up, the patient has full mobility. This case shows that the implant of custom-made ribs, combined with other techniques, is a good surgical choice for reconstruction of large chest wall defects. The implant of custom-made ribs, combined with other techniques, is a good surgical choice for reconstruction of large chest wall defects.

The Growth of Sea cucumber Stichopus herrmanni After Transverse Induced Fission in Two and Three Fission Plane

Transverse induced fission proven could be done in Teripang Tril, Stichopus herrmanni. This present works aimed to analyze wound recovery, regeneration period and growth of Teripang Trill after asexual reproduction by fission using two and three fission plane. Observations were made every day until the sea cucumber body separated into two or more (depending on treatment) and reared for 16 weeks. The results showed that there are differences in wound recovery, regeneration period and growth of S. herrmanni depend on their different fission plane. The wound recovery and regeneration period (days) of anterior, middle and posterior individu S. herrmanni resulted from two and three fission plane were varied but the two fission plane the anterior individu recover for longer period than posterior part and the wound recover process in both end for thee fission plane was same. Average growth of anterior and posterior fragment were longer for two fission plane than three fission plane. The middle fragment (M1 and M2) both fission plane was able to grow but very low. It showed that three fission plane gave very slow growth in every fragment of the body. Keywords: growth, post-fission, fission plane, Stichopus herrmanni