scholarly journals Bosworth Dislocation without Associated Fracture

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Austin D. Williams ◽  
Matthew Blue ◽  
Christian Douthit ◽  
Cyrus Caroom
Keyword(s):  
Intramedullary Nailing ◽  
Treatment Option ◽  
Intramedullary Nail ◽  
Closed Reduction ◽  
Open Reduction ◽  
Ankle Injuries ◽  
Fracture Dislocation ◽  
Good Reduction ◽  
Timely Manner ◽  
Distal Fibula

One of the rarest ankle injuries is the Bosworth fracture-dislocation, whereby the distal fibula fractures and is lodged behind the tibia and is often unable to be reduced in a closed fashion. Even more rarely, a Bosworth dislocation without any accompanying fractures may occur. In this case, a 19-year-old male presented with a Bosworth dislocation, with the ipsilateral tibia having previously undergone intramedullary nailing. After closed reduction was attempted, open reduction and fixation was performed, directly reducing the fibula and fixing the unstable syndesmosis with 2 quadricortical screws. Bosworth injuries are rare, yet severe, and should be treated in a timely manner. We were able to provide good reduction and fixation without requiring removal of the intramedullary nail, and we support the use of 2 quadricortical screws as a valid treatment option for the fixation of Bosworth dislocations.

Maisonneuve fracture

2020 ◽  
Vol 99 (2) ◽  
pp. 77-85
Keyword(s):  
Open Reduction ◽  
Lower Leg ◽  
Fracture Dislocation ◽  
Deltoid Ligament ◽  
Ct Reconstruction ◽  
Distal Fibula ◽  
Ct Examination ◽  
Maisonneuve Fracture ◽  
Fibular Fracture ◽  
Wide Range

Introduction: Maisonneuve fracture (MF) is a generally known entity in ankle trauma. However, details about this type of injury can be found only rarely in the literature. For these reasons we have decided to perform a study on MF epidemiology and pathoanatomy. Methods: The group comprised 70 patients (47 men, 23 women), with the mean age of 48 years, who sustained an ankle fracture-dislocation involving the proximal quarter of the fibula. Ankle radiographs in three views and lower leg radiographs in two views were performed in all patients. A total of 59 patients underwent CT examination in three views, including 3D CT reconstruction in 49 of these patients. MRI was performed in 4 patients. Operative treatment was used in 67 patients; open reduction of the distal fibula into the fibular notch was opted for in 54 of them. Results: The highest MF incidence rate was recorded in the 5th decade in the whole group and in men, while in women the peak incidence was in the 6th decade. After the age of 50, the share of women significantly increased. In 64 cases, the fibular fracture was subcapital, and in 6 cases it involved the fibular head. In 24% of the patients, the fibular fracture was seen only in the lateral radiograph of the lower leg. Widening of the tibiofibular clear space was shown by radiographs in 40 cases. Posterior dislocation of the fibula (Bosworth fracture) and tibiofibular diastasis were recorded in 2 cases each. An injury to the anterior and posterior tibiofibular ligaments was found in all 54 patients with open reduction of the distal fibula. A fracture of the medial malleolus was identified in 27 cases (39%) and a complete lesion of the deltoid ligament in 36 cases (51%); in 7 cases (10%) the medial structures were intact. A fracture of the posterior malleolus occurred in 54 (77%) patients. Osteochondral fracture of the talar dome was diagnosed in 2 patients and compression of the articular surface of the distal tibia in the region of the fibular notch in 1 patient. Conclusion: Maisonneuve fracture includes a wide range of injuries both to bone and ligamentous structures of the ankle. Therefore, CT examination is an indispensable part of assessment of this type of fracture.

scholarly journals Delayed Peroneal Neuropathy After Bosworth Fracture Dislocation of the Ankle

2021 ◽  
Vol 111 (4) ◽  
Author(s):  
Sung Hoon Choi ◽  
Jeong Min Hur ◽  
Kyu-Tae Hwang
Keyword(s):  
Soft Tissue ◽  
Internal Fixation ◽  
Closed Reduction ◽  
Open Reduction ◽  
Fracture Dislocation ◽  
Tibial Tubercle ◽  
Proximal Fragment ◽  
Rare Injury ◽  
Soft Tissue Swelling ◽  
Severe Soft Tissue

The Bosworth ankle fracture-dislocation is a rare injury and is often irreducible because of an entrapped proximal fragment of the fibula behind the posterior tibial tubercle. Repeated closed reduction or delayed open reduction may result in several complications. Thus, early open reduction and internal fixation enable a better outcome by minimizing soft-tissue damage. We report on a 27-year-old man who underwent open reduction and internal fixation after multiple attempts at failed closed reduction, complicated by severe soft-tissue swelling, rhabdomyolysis, and delayed peroneal nerve palsy around the ankle.

scholarly journals Does Open Reduction in Intramedullary Nailing of Femur Shaft Fractures Adversely Affect the Outcome? A Retrospective Study

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Syed Imran Ghouri ◽  
Abduljabbar Alhammoud ◽  
Mohammed Mubarak Alkhayarin
Keyword(s):  
Intramedullary Nailing ◽  
Closed Reduction ◽  
Open Reduction ◽  
Statistical Difference ◽  
Operation Time ◽  
Femoral Shaft ◽  
Union Rate ◽  
Femoral Shaft Fractures ◽  
Shaft Fractures ◽  
Reduction Group

Aim. This study aims to assess the results of open versus closed reduction in intramedullary nailing for femoral fractures and whether it delays union, predisposes to nonunion, or increases the rate of infection. Materials and Methods. A retrospective review of all adult patients with isolated femoral shaft fractures treated by intramedullary nailing was done. The primary outcome is union rate, and the secondary outcomes are operation time and the infection rate. Results. 110 isolated femoral shaft fractures, with 73 (66.4%) in the closed reduction group and 37 (33.6%) in the open reduction group, 90.4% males and 9.6% females, and the average age was 32.6 years. RTA is the most common cause of these injuries followed by the fall from height. The delayed union rate was 20% (22/110) with no difference between the two groups, p value 0.480, and the nonunion rate was 5.5% (6/110), and no statistical difference was observed between the two groups. The operation time was shorter in the closed groups, and no difference in the time to union was observed between two groups. No infection was found in the two groups. Conclusions. There is no statistical difference between the healing rates in closed and open reduction in femoral shaft fractures. In cases where closed reduction is difficult, it is better to open reduce the fracture if closed reduction cannot be achieved in 15 minutes, especially in polytrauma.

scholarly journals Radiographic Outcomes of Treatment of Complex Femoral Shaft Fractures by Intramedullary Nailing: A Retrospective Analysis of Different Techniques

2021 ◽  
Author(s):  
Yu-Hung Chen ◽  
Shang Ming Lin ◽  
Chih-Hung Chang ◽  
Tsung-Yu Lan
Keyword(s):  
Intramedullary Nailing ◽  
Closed Reduction ◽  
Open Reduction ◽  
Femoral Shaft ◽  
Union Rate ◽  
Femoral Shaft Fractures ◽  
Reduction Group ◽  
Diaphyseal Fractures ◽  
The Difference ◽  
Radiographic Union

Abstract BackgroundThis study aimed to determine whether the outcomes of femoral diaphyseal fractures (AO/OTA/32-C) were dependent on the treatment technique (closed vs. open reduction and internal fixation with an interlocking nail).This retrospective study was conducted at a level III trauma center. A total of 47 consecutive patients with femoral diaphyseal fractures (AO/OTA/32-C) were included. All patients underwent reduction and fixation and were divided into two groups according to the surgical techniques used: closed reduction and open reduction groups. The radiographic union score of the femur, mean union time, re-operation rate, and complication rate were assessed.ResultsAt 12 postoperative months, the union rate was 80.76% in the open reduction group and 82.35% in the closed reduction group; however, the difference was not significant (p=0.787). The rate of anatomical-to-small gaps was 96.15% and 47.05% in the open and closed reduction groups, respectively (p=0.01). The radiographic union score of the femur at 6 postoperative months (9.30 vs. 7.76, p=0.02) and postoperative months (9.94 vs. 10.80, p=0.03) was significantly higher in the open reduction group. Further, the required time to union in the open reduction group was significantly shorter (7.39 vs. 9.18 months, p=0.025). The difference in the need for revision surgery was not significant between the two groups (19.23% vs. 23.52%, p=0.964). ConclusionsCompared to closed reduction, intramedullary nailing of severe comminuted femoral shaft fractures with open reduction has similar outcomes and carries no increased risk of complications. Surgeons should consider open reduction if the outcomes of closed reduction are not satisfactory. This will aid in restoring anatomical reduction, enable primary bone grafting, and result in an optimal union rate, better strength of union, and shorter time to union.

scholarly journals Pitfalls and Remedial Technique of Intramedullary Nail for Subtrochanteric Femur Fractures: A Case Series

2021 ◽  
Author(s):  
Botao Chen ◽  
Xiaohong Fan
Keyword(s):  
Internal Fixation ◽  
Intramedullary Nailing ◽  
Intramedullary Nail ◽  
Locking Plate ◽  
Case Series ◽  
Trochanteric Fracture ◽  
Subtrochanteric Fracture ◽  
Chinese Patients ◽  
Good Reduction ◽  
Subtrochanteric Fractures

Abstract Background: Intraoperative technical complications are occasionally encountered while implanting intramedullary nails for subtrochanteric fractures. Surgeons must pay attention to the pitfalls and remedial technique of this operation.Methods: We report on three cases in which intraoperative difficulties occurred during the implantation of an intramedullary nail among Han Chinese patients from mainland China. In Case 1, during an operation on a 57-year-old man, a seinsheimer type V in a right subtrochanteric fracture was not fully realized, and the dislocation of intertrochanteric fracture was aggravated after reduction of the subtrochanteric fracture. The intramedullary nail fixation was completed with the aid of an additional anterolateral plate. Case 2 involved a transverse subtrochanteric fracture. The surgeon neglected the coronal dislocation when considering good sagittal reduction. Although an auxiliary reduction device was used during the operation, there was unacceptable coronal dislocation after the intramedullary nail was inserted. A temporary anterolateral locking plate fixation was used to complete the intramedullary nail fixation. Case 3 involved an old trochanteric fracture combined with a new subtrochanteric fracture in an 81-year-old woman. After reducing the subtrochanteric fractures, the intramedullary nail fixation was successfully completed by releasing the poorly healed intertrochanteric fractures and fixing the anterior lateral plate.Results: With the development of techniques, reliable results can be obtained with fewer complications. Of the various internal fixation methods, we favor using a trochanteric start intramedullary nail.Conclusions: The treatment of subtrochanteric fractures presents challenges. Good reduction and reliable temporary fixation are key to completing the intramedullary nailing. If percutaneous joysticks, finger reduction tools, blocking screws, clamps, and Schanz pins cannot be used for effective auxiliary reduction or temporary reliable fixation, reduction after intramedullary nailing will not be satisfactory. The temporary addition of a reconstruction locking plate can achieve good reduction and temporary stability, and an extra reconstruction locking plate should be retained when the temporary fixation device is removed to reduce the risk of internal fixation failure during fracture healing.

scholarly journals Traumatic pediatric shoulder fracture dislocation treated with closed reduction and intramedullary nailing: A case report

2017 ◽  
Vol 9 ◽  
pp. 22-26 ◽  
Author(s):  
Ghazi Fannouch ◽  
Yasser I. Al Khalife ◽  
Abdulaziz S. Al Turki ◽  
Ayman H. Jawadi
Keyword(s):  
Case Report ◽  
Intramedullary Nailing ◽  
Closed Reduction ◽  
Fracture Dislocation ◽  
Shoulder Fracture

scholarly journals The efficacy and safety of small incision open reduction and intramedullary nail fixation surgery in the treatment of simple tibial shaft fracture

2021 ◽  
Author(s):  
chen shi ◽  
he shan hai ◽  
zhang xiao lei ◽  
xu chun cheng ◽  
yang jian cheng ◽  
...  
Keyword(s):  
Clinical Efficacy ◽  
Intramedullary Nail ◽  
Closed Reduction ◽  
Open Reduction ◽  
Shaft Fracture ◽  
Control Group ◽  
Tibial Shaft Fracture ◽  
Observation Group ◽  
Tibial Shaft ◽  
Small Incision

Abstract Objective: To explore the clinical efficacy and safety of small incision open reduction and intramedullary nail internal fixation surgery in the treatment of simple tibial shaft fracture compared to the closed reduction surgery. Methods: A total of fifty patients with simple tibial shaft fractures admitted to our hospital were randomly and equally assigned into the observation group and the control group. Patients in the observation group received small incision open reduction surgery with intramedullary nail while patients in the control group received the closed reduction surgery. The clinical efficacy, prognosis as well as safety profile were compared between the two groups. Results: Our data indicated that the average bleeding volume of patients in the observation group was increased while the operation time was decreased compared to the control group. No significant difference of postoperative complications, fracture healing time, and Johner-Wruhs scores was identified between the two groups. Conclusion: The small incision open reduction surgery can significantly shorten the operation time while achieved a similar clinical efficacy compared to the closed reduction surgery in simple tibial shaft fracture.

scholarly journals Irreducible Volar DRUJ Dislocation with Distal Radius Fracture Dislocation

2019 ◽  
Vol 09 (02) ◽  
pp. 156-159
Author(s):  
Matthew T. Gulbrandsen ◽  
Jill G. Putnam ◽  
J. Tracy Watson ◽  
Michael D. McKee
Keyword(s):  
Distal Radius Fracture ◽  
Distal Radius ◽  
Closed Reduction ◽  
Open Reduction ◽  
Case Reports ◽  
Distal Radioulnar Joint ◽  
Fracture Dislocation ◽  
Radius Fracture ◽  
Level Of Activity ◽  
Fracture Dislocations

Abstract Background Volar dislocations of the distal radioulnar joint (DRUJ) are rare and often missed during initial evaluation. Chronic dislocations and disability can occur when DRUJ dislocations are unrecognized and not reduced. DRUJ dislocations often occur with other wrist injuries, which may complicate reduction. Closed reduction can fail to reduce DRUJ dislocations, in which case open reduction is necessary. Case Description This case describes a patient who had a volar dislocation of the DRUJ with an associated dorsal distal radius fracture dislocation. Initial attempts at closed reduction were unsuccessful which prompted surgical intervention. After open reduction and internal fixation of the distal radius fracture dislocation, closed reduction of the DRUJ remained unsuccessful. This prompted an open reduction of the DRUJ. Surgical exposure demonstrated that the extensor carpi ulnaris and the distal radius had prevented closed reduction of the DRUJ. Postoperatively, a splint was placed with the wrist in supination. The patient followed-up at the 2- and 4-month intervals with persistent subluxation. However, the patient also reported minimal pain and the ability to return to work and previous level of activity. Literature Review Current literature regarding irreducible volar DRUJ dislocations with distal radius fracture dislocations includes sparse case reports, which are reviewed in this report. Clinical Relevance This case illustrates successful treatment for an uncommon volar DRUJ dislocation associated with a dorsal distal radius fracture dislocation and can be utilized to help guide future treatment of similar complex cases.

Dorsal Fracture–Dislocation of the Proximal Interphalangeal Joint: A Comparative Study of Percutaneous Kirschner Wire Fixation Versus Open Reduction and Internal Fixation

2005 ◽  
Vol 30 (2) ◽  
pp. 120-128 ◽  
Author(s):  
A. ALADIN ◽  
T. R. C. DAVIS
Keyword(s):  
Internal Fixation ◽  
Closed Reduction ◽  
Open Reduction ◽  
Kirschner Wire ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Fracture Dislocation ◽  
Cerclage Wire ◽  
Kirschner Wire Fixation ◽  
Wire Fixation

Nineteen patients with a dorsal fracture–dislocation of the proximal interphalangeal joint of a finger were treated with either closed reduction and transarticular Kirschner wire fixation (eight cases) or open reduction and internal fixation, using either one or two lag screws (six cases) or a cerclage wire (five cases). At a mean follow-up of 7 (range 6–9) years, most patients reported satisfactory finger function, even though some of the injuries healed with proximal interphalangeal joint incongruency (seven cases) or subluxation (four cases). Those treated by open reduction complained of more “loss of feeling” in the affected finger and those specifically treated by cerclage wire fixation reported more cold intolerance and had a significantly larger fixed flexion deformity (median, 30°: range 18–38°) and a smaller arc of motion (median, 48°: range 45–60°) at the proximal interphalangeal joint, despite having the best radiological outcomes. Closed reduction and transarticular Kirschner wire fixation produced satisfactory results, with none of the eight patients experiencing significant persistent symptoms despite a reduced arc of proximal interphalangeal joint flexion (median=75°; range 60–108°). The results of this relatively simple treatment appear at least as satisfactory as those obtained by the two techniques of open reduction and internal fixation, both of which were technically demanding.

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