Unusual Kirschner wire migration as a late complication of Salter innominate osteotomy in developmental dislocation of the hip

Innominate osteotomy of Salter remains the most commonly used pelvic osteotomy for children in the age of 18 months to 6 years. Kirschner wire is inserted across the osteotomy site to fix the bone graft. We present an unusual case of migration of Kirschner wire through the abdominal region. Migration of pins to the femoral head is well-known complication. To our knowledge, this is the first case reporting migration of Kirschner wire through the abdominal region.     

Treatment of Lisfranc Fracture Dislocations with an Interosseous Suture Button Technique: A Review of 3 Cases

Lisfranc fracture dislocations are complex and difficult to treat. Making the correct diagnosis and achieving an anatomical reduction are important factors in regard to achieving a favorable outcome with this injury. We describe a new technique that we have found to be useful for stabilizing Lisfranc fracture dislocations. This method is relatively fast, minimally invasive, and effective, and it eliminates the need for implant removal. To date, we have achieved predictable results for stabilizing and treating these difficult injuries with the use of a suture endobutton, instead of traditional interfragmental screw fixation. In this report, we describe 3 cases in which this method was used with satisfactory short-term results. LEVEL OF CLINICAL EVIDENCE: 4.     

Dislocation of a fractured mandibular condyle into the middle cranial fossa: a case treated by an extracranial approach

INTRODUCTION: Penetration of the mandibular condyle into the middle cranial fossa is a rare complication usually due to blunt traumas to the chin. Particular anatomical and dynamic conditions can lead to the intracranial dislocation of the condyle in spite of the fracture of the condylar neck that usually prevents this event from dissipating the kinetic force of the impact. DISCUSSION: We report the case of a 10-year-old female patient suffering from symphyseal and bilateral condilar fracture with intrusion of the left condyle into the middle cranial fossa. The diagnosis of intracranial dislocation was initially missed because of the nonspecific symptomatology and insufficient radiologic data provided by conventional investigations (plain X-rays and panoramic views). The persistence of the limitation of the mouth opening and the worsening of the preauricular pain with irradiation to the temporal region led us to perform further radiological investigations (computed tomography scan and magnetic resonance imaging) that revealed the intracranial complication. A successful removal of the displaced condyle was carried out through an extracranial approach, and at a 3-year follow-up temporomandibular joint function is satisfactory. CONCLUSION: The case is reported to emphasize the need for careful radiological investigation in case of condylar fractures and the effectiveness of the extracranial route to surgically treat these rare complications.     

Association between dislocation, impingement, and articular geometry in retrieved acetabular polyethylene cups.

We used a novel analysis technique and retrieved acetabular polyethylene liners to investigate relationships between impingement damage, dislocation history, and polyethylene liner geometry. Forty-eight polyethylene liners with neutral rim elevation were visually assessed for peripheral rim damage consistent with impingement between the liner rim and femoral component. Liner articular geometry was measured using a digital stylus, and the geometric relationships between the liner rim and center of the femoral head were characterized by lip height, head center inset, and head penetration into the polyethylene liner. Thirteen (27%) retrieved liners had rim impingement damage and 12 (25%) had a history of dislocation. The proportion of liners with impingement was not significantly different among dislocated and stable liners. Lip height, head center inset, and head penetration were not significantly different between liners with and without impingement damage. Dislocated liners had a significantly shorter head center inset, with significantly less head penetration because of shorter functional duration. Designing polyethylene liners with a sufficiently deep articular surface that exceeds 0.95 mm may prove beneficial for decreasing the prevalence of early dislocation, independent of impingement damage.     

Atlas钛缆与钩钢板治疗完全性肩锁关节脱位的前瞻性对照研究

[目的]使用双股Arias钛缆和锁骨钩钢板治疗完全性肩锁关节脱位，并对其治疗效果进行比较。[方法]采用双股Atlas钛缆和锁骨钩钢板治疗Allman Ⅲ型肩锁关节脱位52例，均为单侧。其中双股Atlas钛缆组28例，锁骨钩钢板组24例。男38例，女14例，年龄22—65岁，平均38．5岁。新鲜脱位39例，陈旧性13例。钛缆固定采用喙突根部钻孔，从喙突上方偏内1．5cm处的锁骨干孔道中穿过，锁骨钩钢板均为6孔。术中常规作喙锁韧带修补。[结果]所有患者均获随访，随访时间6～42个月，平均18．8个月。对2组患者进行术后功能恢复及影像学评价，按照Lazcano标准对术后上肢肌力、肩部疼痛和关节功能进行评定。钩钢板组优14例，良6例，差4例，治疗优良率83％；钛缆组优22例，良5例，差1例，治疗优良率96％，与钩钢板组无显著差异。[结论]双股钛缆治疗完全性肩锁关节脱位的效果与锁骨钩钢板相当，且具有术后肩痛发生率低、利于早期功能锻炼的优点，此外钛缆生物相容性佳，可在体内长期存留而不必取出。     

人干腓骨上胫腓关节坡度测量

目的　探讨人类上胫腓关节坡度对关节本身的稳定性是否有影响。方法　采用两种方法分别对 10 9根干腓骨的上胫腓关节坡度进行测量。结果　腓骨干纵轴与关节面的夹角 (∠A)为 5 9 93°± 9 2 9° ,左右侧比较差异无显著性 (P =0 2 5 )。该角度越大 ,坡度越平坦 ;角度越小 ,坡度越陡直。关节面与水平线的夹角 (∠B)为 30 2 5°± 9 32°,左右侧比较差异无显著性 (P =0 2 5 )。该角度越大 ,坡度越陡直 ;角度越小 ,坡度则越平坦。两种方法测量结果之间呈负相关 (r =- 0 396 2 ,t =4 47,P <0 0 0 1)。结论　测量上胫腓关节坡度可了解国人上胫腓关节解剖结构和类型 ,估价上胫腓关节的稳定性 ,对上胫腓关节不稳 (半脱位 )的诊断具有参考价值。     

锁骨钩钢板治疗急性肩锁关节脱位喙锁韧带修补与不修补疗效比较

目的比较锁骨钩钢板治疗急性肩锁关节脱位喙锁韧带修补与不修补疗效。方法将31例Tossym型肩锁关节脱位患者按手术方式分成2组，均采用锁骨钩钢板治疗，对16例做喙锁韧带修补者分为喙锁韧带修补组，对15例不做喙锁韧带修补者分为喙锁韧带不修补组，平均随访12个月，根据Karlsson评分标准评估效疗结果。结果喙锁韧带不修补组手术时间40～45min、出血量30～35ml，喙锁韧带修补组手术时间70～80min、出血量70～80ml，2组差异有统计学意义（P〈0．05），喙锁韧带不修补比喙锁韧带修补对患者造成的创伤小；喙锁韧带修补组优良率93．8％（15／16），喙锁韧带不修补组优良率93．3％（14／15），2组差异无统计学意义（P〉0．05）。结论锁骨钩钢板治疗肩锁关节脱位喙锁韧带不修补疗效好且手术过程中对患者造成的创伤较小。     

Absorbable implants for open shoulder stabilization

Eighteen consecutive patients who had recurrent, unidirectional, post-traumatic shoulder instability were included. All these patients underwent surgery using an open Bankart technique involving absorbable suture anchors. The median age at the index operation was 27 (16–50) years. One subluxation and two re-dislocations occurred during the follow-up period of 90 (80–95) months. At the 90-month control, the Rowe and Constant scores were 94 (63–100) points and 88.5 (65–100) points, respectively. The strength measurements on the index side in 90° abduction revealed 8.1 (3.7–17.2) kg compared with 7.6 (2.7–17.6) kg on the contra lateral side (n.s.). The external rotation in abduction was 80 (60–95)° compared with 100 (70–120)° for the contra lateral side (p = 0.0015). Signs of minor or moderate degeneration were found in five of 18 patients (28%) on the preoperative radiographs. There was a significant continuous increase in degenerative changes during the follow-up period as seen on the seven, 33 and 90-month radiographs (p = 0.01, 0.03 and 0.01, respectively). On the 90-month radiographs, 12 of 18 patients (67%) had minor, moderate or severe degenerative changes (p = 0.0004 preoperative vs. 90 months). On the 7-month radiographs, two of 18 patients (11%) had invisible or hardly visible drill holes in conjunction with the absorbable implants. On the 90-month radiographs, 12 of 18 patients (67%) had invisible or hardly visible drill holes (p = 0.003 7 months vs. 90 months). In the long term, the method resulted in stable, well-functioning shoulders in 15 of 18 patients (83%). The stabilisation was not, however, able to prevent further increases in radiographic degenerative changes during the 7–8-year follow-up. The drill holes used for the absorbable suture anchors appeared to heal in the majority of patients during the follow-up period.     

Vertical dislocation of the talus without malleolar fractures

We report an unusual case of open vertical dislocation of the talus without malleolar fracture following motor vehicle accident.Most previously reported cases are medial, lateral, posteromedial and posterior dislocations. The anterolateral, posterolateral, and purely superior dislocations of the talus make up smaller a percentage. The mechanism of this injury appears to be forced eversion of the foot when it is maximally plantar flexed and axially loaded.Our case has treated by open reduction of the talus and anatomical repair of the disrupted deltoid ligament at the time of initial incision and open reduction with internal fixation of the calcaneus also achieved good long-term functional and radiographic results.