Timing of Surgical Debridement for Open Tibia Shaft Fractures: How Long Can We Wait?

Congenital pseudoarthrosis of the clavicle is a rare condition. It is diagnosed at an early age by a defect in the supraclavicular fossa and the absence of a central zone portion of the clavicle in the X-ray image. Origins of the condition are not well understood nor are the best age for, and need for treatment, since it is asymptomatic in many cases. If the clinical presentation is neurovascular compression or shoulder dysfunction, reconstruction of the clavicle with a plate and bone graft from the iliac crest seems to be the most commonly accepted option.

Our case corresponds to a girl aged 9 years with an established diagnosis and a dysfunctional clinical history of the shoulder, as well as a progressively worsening esthetic defect due to the progression of the malformation. The patient was treated using a 2.7 mm mandibular reconstruction plate shaped to resemble an adult clavicle plate with an iliac crest graft. Evolution after treatment was favorable.

Currently, mandibular reconstruction plates are broadly available for treatment in orthopedic and traumatology surgery departments, mainly in pediatric surgery, since they provide the same advantages as adult reconstruction plates but with lower profiles. Their main advantage lies in the availability of support materials for three-dimensional modeling systems allowing for the plate to be adapted to the particular anatomical site, which in this case would be the clavicle.

In this paper we have attempted at proposing a new classification of scapholunate instability that in our opinion can be used in majority of cases with scapholunate complex injury. Incomplete and isolated scapholunate interosseous ligament lesions are of no clinical relevance to SL dissociation or carpal instability. We have concluded that the new classification can be used in all types of SLIL lesions and we are convinced that it will help in choosing the right type of surgery.

Study Design: Repeated Measures.

Objectives: To determine the short term impact of cold water immersion on sensory and vascular functions in patients with Distal Radius Fracture (DRF) and compare responses in the injured and uninjured hands.

Background: Cold exposure is used to assess neurovascular function. Cold is also used as therapeutic agent to reduce pain and swelling. There is a scarcity of trials that have looked at the impact of cold exposure in patients with DRF.

Methods: Twenty patients with DRF, aged 18 to 65 yrs. were recruited after cast removal. All patients underwent Immersion in Cold water Evaluation (ICE) which consisted of 5 min of hand immersion in water at 12°C. Skin Blood Flow (SBF) in hands, Skin Temperature (S Temp.) in index and little fingers and sensory Perception Thresholds (sPT) at 2000Hz (for Aβ fiber) and 5 Hz (for C fiber) were obtained from ring finger, before ICE, immediately after (0 min, 1 min) and 10 min later. Differences were analyzed using repeated measures.

Results: In the DRF hand, SBF increased immediately (Mean Difference = -42.2 A.U), at 1 min (-35 A.U) and 10 min after ICE (-1 A.U). Skin Temp. In index and little fingers decreased immediately after ICE (9.9°C and 9.1° C) and did not return to baseline by 10 min (4°C and 4.1°C). ICE had no effect on sPT at 5 Hz (p>0.05). There was no difference between the DRF and uninjured hand on all measures(p>0.05) except for the sPT at 2000Hz, which remained high on the DRF side for up to 10 min (-1.8 m. A).

Conclusion: Normal cold responses consistent with ‘hunting reaction’ were observed after ICE in both hands. Aβ fibers on DRF side became less sensitive after ICE. These findings suggest that a brief immersion in cold water does not produce any adverse events associated with cold exposure.

Today orthopedic surgery is becoming progressively interesting. The rapid stride related to excellence of implants, technologies and techniques

We present a case of a 38-year-old right-handed male physical worker with traumatic divergent dislocation of both the scaphoid and lunate bones. He was referred to our ward five days post-accident. After open reduction, he was treated with a novel technique of free tendon reconstruction of the scapholunate ligament complex and internal fixation with K-wires through the dorsal approach. At a 18-month-follow up the patient was pain-free, had a good wrist function with no evidence of avascular necrosis of the scaphoid nor lunate, and was satisfied with the general result.

Tendon injuries are the second most common hand injuries in orthopedic patients. Tendon adhesions are one of the most concerning complications after surgical repair of the flexor tendon injury, particularly in zone II, which extends from the A1 pulley to the distal insertion of the Flexor Digitorum Superficialis (FDS) tendon in the finger

Based on the American Dental Association concept, Dentofacial Orthopedics is the branch of dentistry that has to do with the assessment, development and alignment of maxilla, mandible, and other cranial bones, with attendant improvement in airway, muscle and neurological tone.

Osteoarthritis is a disabling disease with no known cause. The role of muscle dysfunction as an etiological factor has however been discussed, and evidence in favor of this hypothesis has recently been sought.

To ensure the possible accelerated osteogenesis of long bone fractures in patients with concomitant spinal cord injury and to investigate the mechanism causing it with the understanding of a possible neuro-hormonal cause, a hormonal bioassay of the blood of 21 of these patients was measured in the prospective controlled study and compared to 20 patients with only spinal cord injuries, 30 patients with only long bone fractures, and 30 healthy volunteers.

The study results showed that Long bone fractures in patients with associated acute traumatic spinal cord injury of quadriplegia or paraplegia heal more expectedly, faster and with exuberant florid union callus (P>0.001) and showed statistically significant higher levels of parathyroid hormone and growth hormone (p<0.005) and normal corticosteroids levels. Patients with long bone fractures only showed consistent and statistically significant higher level of noradrenaline and adrenaline hormones compared to patients with spinal cord injury alone or associated with long bone fractures (p<0.001). Leptin hormone shows statistically significant consistent decrease in patients with spinal cord injury and concomitant long bone fractures compared to healthy subjects (p<0.001). We believe, according to the results of this study that bone healing is accelerated in long bone fractures in patients with associated spine fractures and spinal cord injuries. We also can conclude that bone healing has a central neuronal control and a combined neuro- hormonal mechanism with a relative inhibition of the sympathetic nervous system is a possible cause of accelerated healing of long bone fractures in patients with associated spinal cord injury.

 Globally, hundreds of millions of people are affected by musculoskeletal disorders (~10 million in the UK)