Scaphocapitate fracture syndrome in a child

BACKGROUND: Scaphocapitate fracture syndrome involves transverse fracture of the scaphoid and capitate, with rotation of 90 or 180 of the proximal fragment of the capitate, commonly associated with other carpal lesions. It is a rare wrist injury, usually occurs in young men and is exceptional in children. The exact mechanism remains controversial. The injury is often misdiagnosed as a simple scaphoid fracture and there has been a controversy about the treatment of the capitate fracture in this syndrome. CLINICAL CASE: The authors report a rare case of a scaphocapitate syndrome in a 15-year-old boy. Early open reduction of both fractures was performed. It was obtained a good mobility, with a normal grip strength and the radiographs showed union of both bones without avascular necrosis. DISCUSSION: Most authors agree that regardless of the radiographic appearance of the injury, open reduction and internal fixation is the treatment of choice. The dorsal approach is the most used. The capitate fragment is usually devoid of any soft tissues and is reduced relatively easy with manual pressure, by applying traction to the hand. Reduction and fixation of the capitate must precede that of the scaphoid. K-wires or headless screws may be placed from the proximal to the distal side for the fixation of the scaphoid and capitate. The evolution is marked by the risk of occurrence of head capitate avascular necrosis CONCLUSIONS: This case report illustrates that the scaphocapitate syndrome can occur in children and is important an early diagnosis to initiate timely treatment. Our patient was successfully treated with open reduction and fixation using K-wires.

Evaluating the Efficacy of Combined P188 Treatment and Surgical Intervention in Preventing Post-Traumatic Osteoarthritis Following a Traumatic Knee Injury

Previous studies have shown that reconstructive surgery alone following injury to the anterior cruciate ligament (ACL) does not prevent the development of post-traumatic osteoarthritis (PTOA). Poloxamer 188 (P188) has been shown to prevent cell death following trauma in both articular cartilage and meniscal tissue. This study aims to test the efficacy of single or multiple administrations of P188 in conjunction with reconstructive surgery to help prevent or delay the onset of the disease. Thirty skeletally mature rabbits underwent closed-joint trauma that resulted in ACL rupture and meniscal damage and were randomly assigned to one of four treatment groups with varying doses of P188. ACL reconstruction was then performed using an autograft from the semitendinosus tendon. Animals were euthanized 1-month following trauma, meniscal tissue was assessed for changes in morphology, mechanical properties, and proteoglycan content. Femurs and tibias were scanned using microcomputed tomography to determine changes in bone quality, architecture, and osteophyte formation. The medial meniscus experienced more damage and a decrease in the instantaneous modulus regardless of treatment group, while P188 treatment tended to limit degenerative changes in the lateral meniscus. Both lateral and medial menisci had documented decreases in the equilibrium modulus and inconsistent changes in proteoglycan content. Minimal changes were documented in the tibias and femurs, with the only significant change being the formation of osteophytes in both bones regardless of treatment group. The data suggest that P188 was able to limit some degenerative changes in the meniscus associated with PTOA and may warrant future studies.

Stiffening in the carpus of Prosantorhinus germanicus (Perissodactyla, Rhinocerotidae) from Sandelzhausen (Germany)

Prosantorhinusgermanicus is a small, short-legged, teleoceratine rhino from the Miocene of Sandelzhausen (Bavaria, Germany). P.germanicus shows a high variation in some of its carpal bones. A unique modification of the articulation of Intermedium and Carpale 4 is described here. Special emphasis is given to additional articulation facets at the palmar processes of both bones. These additional contacts, working as stop facets, are unique among rhinos and restrict the flexion of the mid-carpal joint. Some individuals show these additional facets which prohibit the flexion within the wrist and therefore stiffen the carpus. Carpale 4 specimens without the additional facets show knob-like structures instead. These knobs are most likely precursory structures of those facets and the facets are fully developed in heavier males. A skeletal sexual dimorphism is not visible in the sample as all bones are in the same size range. The wrist stiffening in the mid-carpal joint supports a greater bodyweight and therefore could coincide with P.germanicus as a proposed dwarfed rhinoceros species. The stiffening can also be interpreted in favor of a semiaquatic mode of life. The stiffened carpus is more resistant against injuries while walking on muddy grounds in a wet environment.

Stochastic PCA-Based Bone Models from Inverse Transform Sampling: Proof of Concept for Mandibles and Proximal Femurs

Principal components analysis is a powerful technique which can be used to reduce data dimensionality. With reference to three-dimensional bone shape models, it can be used to generate an unlimited number of models, defined by thousands of nodes, from a limited (less than twenty) number of scalars. The full procedure has been here described in detail and tested. Two databases were used as input data: the first database comprised 40 mandibles, while the second one comprised 98 proximal femurs. The “average shape” and principal components that were required to cover at least 90% of the whole variance were identified for both bones, as well as the statistical distributions of the respective principal components weights. Fifteen principal components sufficed to describe the mandibular shape, while nine components sufficed to describe the proximal femur morphology. A routine has been set up to generate any number of mandible or proximal femur geometries, according to the actual statistical shape distributions. The set-up procedure can be generalized to any bone shape given a sufficiently large database of the respective 3D shapes.

FUNCTIONAL OUTCOME OF TIBIAL FRACTURES TREATED BY INTERLOCKING NAILING THROUGH SUPRAPATELLAR APPROACH – A PROSPECTIVE AND RETROSPECTIVE STUDY

The aim of this prospective study is to analyse the functional and radiological outcome of tibial fractures treated by intramedullary nailing through supra patellar approach.15 patients with tibial fractures were operated by intramedullary nailing through suprapatellar approach. Oxford knee scoring system was done to evaluate the functional outcome. Serial radiographs were taken to assess the fracture union at 2 weeks, 6 weeks and 12 weeks. Fifteen patients (male 11 female 4) with fracture both bones leg i Results : ncluded in our study. The most common cause was motor vehicle accidents (9 cases), self limiting fall (4 cases), assault (2 cases). The mean age was 45 years. All fractures united at a mean period of 3.5 months. To conclude, Suprapatellar tibial nailing has the benets of decreased operating time, good ouroscopy visualisation, minimal blood loss and ability to achieve and maintain good reduction throughout the procedure.

Prospective Study of Surgical Management of Diaphyseal Fractures of Both Bones Forearm in Older Children Using Titanium Elastic Intramedullary Nailing at a Tertiary Care Hospital in Srikakulam

BACKGROUND Diaphyseal fractures of the forearm are one of the common fractures in the paediatric population. Closed reduction and cast immobilisation remain the standard treatment for paediatric diaphyseal forearm fractures owing to their unique remodelling potential. The main concern of conservative management is re-displacement of fracture in cast resulting in the unacceptable angular deformity in the forearm. Intramedullary fixation with titanium elastic nails for paediatric diaphyseal forearm fractures is becoming the trending surgical technique in those cases that warrant surgical intervention. The purpose of this study was to evaluate the functional outcome of the management of fracture of both bones forearm in the older children with titanium elastic nailing system. METHODS This was a prospective study done among thirty patients aged 5 to 16 years admitted to the Department of Orthopaedics at GEMS & Hospital, Ragolu, Srikakulam with diaphyseal fractures of both bones forearm from September 2017 to September 2019. We treated the patients by closed / open reduction and internal fixation with elastic stable intramedullary nailing. The patients were followed-up for six months. RESULTS We evaluated the patients clinically and radiologically after surgery. We assessed the outcome using modified Anderson’s AO criteria for forearm fractures extracted from the international journal of current pharmaceutical and clinical research functions. All fractures united at an average of 9.1 weeks without any delayed or non-union. The results were excellent in 86.6 % of patients and good in 13.3 % of patients without significant complications. There were minor complications in 6 patients (20 %). CONCLUSIONS Titanium elastic intramedullary nailing is a safe, effective and minimally invasive surgical method for treatment of displaced both bones forearm diaphyseal fractures in older children. This technique gives relative stability with a three-point fixation principle resulting in secondary bone healing by promoting early callus, ideal for early mobilisation. The technique offers several advantages, including minimal incision, preservation of fracture haematoma, dynamic axial stabilisation, and shorter hospitalisation. KEYWORDS Both Bone Fracture Forearm, Titanium Elastic Nailing System, Early Mobilisation

Lung metastasis induced chronic compartment syndrome of the lower leg

<p class="abstract">Compartment syndrome occurs when the pressure within a defined compartmental space increases above a critical pressure threshold. Lung cancer is one of the world's most frequently diagnosed cancer whose metastases are rare cause of compartment syndrome. We present a 50 year old male patient who was admitted to our emergency department due to painful left lower leg, swelling and paresthesia of the medial side of the foot that lasted about 2 months back. The diagnosis of metastatic lung adenocarcinoma was set 9 months earlier. Physical examination revealed an ill-defined, tense, and tender swelling left calf and X-ray images confirmed periosteal reaction on all four cortices of both bones without osteolytic lesions. After an adequate laboratory analyses and preoperative preparation, debridement with biopsy and fasciotomy was performed. Histopathological evaluation showed necrotic tumor tissue that morphologically and immunohistochemically corresponds to lung cancer. We performed an above knee amputation and the next day, the patient was discharged home, due to his personal request.</p>

Traditional versus congruent-arc Latarjet anatomic and biomechanical perspective

The congruent-arc Latarjet (CAL) allows reconstruction of a greater percentage of glenoid bone deficit because the inferior surface of the coracoid is wider than the lateral edge of the coracoid used with the traditional Latarjet (TL). Biomechanical studies have shown higher initial fixation strength between the graft and the glenoid with the TL. In the TL, the undersurface of the coracoid, which is wider than the medial edge used with the CAL, remains in contact with the anterior edge of the glenoid, increasing the contact surface between both bones and thus facilitating bone consolidation. The shorter bone distance around the screw with the CAL is potentially less tolerant of screw-positioning error compared to the TL. Moreover, the wall of the screw tunnel is potentially more likely to fracture with the CAL due to the minimal space between the screw and the graft wall. CAL may be very difficult to perform in patients with very small coracoids such as small women or skeletally immature patients. Radius of curvature of the inferior face of the coracoid graft (used with the CAL) is similar to that of the native glenoid. This may potentially decrease contact pressure across the glenohumeral joint, avoiding degenerative changes in the long term. Cite this article: EFORT Open Rev 2021;6:280-287. DOI: 10.1302/2058-5241.6.200074

Management of acute paediatric fractures treated surgically in the UK: a cross-sectional study

Introduction The epidemiology of acute paediatric orthopaedic trauma managed surgically across the NHS is poorly described. Compliance against national standards for the management of supracondylar humeral fractures is also unknown at a national level. Methods Collaborators in 129 NHS hospitals prospectively collected data on surgically managed acute paediatric orthopaedic trauma cases. Data were collected over a seven-day period and included demographics, injury characteristics, operative details and timing of surgery. A national audit was also undertaken to evaluate compliance with the British Orthopaedic Association Standards for Trauma Guideline 11: Supracondylar Fractures of the Humerus in Children. Results Data were captured on 770 surgically treated cases. The three most common injuries were forearm fractures of both bones (n = 235), distal radius fractures (n = 194) and supracondylar elbow fractures (n = 89). The mode day of injury was Friday (n = 136) and the mode day of surgery was Saturday (n = 138). 88% of supracondylar fractures received surgery on the day of presentation or the following day. Only 14% of supracondylar fractures were treated surgically after 8pm; 33/89 used 2.0mm Kirschner wires, 38/89 used 1.6mm wires and 2/89 used 1.2mm wires. Conclusion Forearm fractures of both bones, distal radius fractures and supracondylar humeral fractures were the three most common injuries treated surgically. There is wide variation in compliance against national standards in the management of supracondylar humeral fractures with 88% undertaking surgery on the day of or the day following presentation but only 37% using the recommended 2.0mm Kirschner wires.