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Triple jeopardy: transscaphoid, transcapitate, transtriquetral, perilunate fracture dislocation
Bhavuk Garg,Tarun Goyal,Prakash P. Kotwal
Journal of Orthopaedics and Traumatology , 2013, DOI: 10.1007/s10195-012-0195-x
Abstract: Carpal injuries are frequently underdiagnosed and underreported injuries of the hand. Scapholunate perilunate dissociation is the most common perilunate instability pattern seen in clinical practice. Transscaphoid, transtriquetral, transcapitate dislocation with a volar intercalated segment instability pattern is a very rare pattern of carpal injury. We describe a case with this unique pattern of injury, explaining its mechanism and treatment. Good outcome can be achieved in these injuries following open reduction and internal fixation with ligamentous repair.
Staged reduction of neglected transscaphoid perilunate fracture dislocation: A report of 16 cases
Bhavuk Garg, Tarun Goyal, Prakash P Kotwal
Journal of Orthopaedic Surgery and Research , 2012, DOI: 10.1186/1749-799x-7-19
Abstract: 16 cases (14 males & 2 females) with neglected transscaphoid perilunate fracture dislocation (> 3?month old) were treated with staged reduction. Mean duration between injury and surgery was 4.5?months. In first stage an external fixator was applied across the wrist and distraction was done at 1?mm/day. Second surgery was done through dorsal approach and we were able to reduce all the fractures & dislocations. Herbert screws and K wires were used for fixation.The mean duration between two surgeries was 2.4?weeks (range 2–4?weeks). 9 cases had excellent results, 5 had good result. Two patients developed reflex sympathetic dystrophy and had fair results.Staged reduction should be considered for neglected transscaphoid perilunate dislocations. If properly executed, a good functional pain free range of motion is the usual outcome.
Transstyloid, transscaphoid, transtriquetral perilunate dislocation - A late presentation  [cached]
Majeed Shiju,Kumar S
Indian Journal of Orthopaedics , 2010,
Abstract: Transstyloid, transscaphoid, transtriquetral perilunate dislocations are extremely rare carpal dislocations. We report a 24-year-old male who presented with this rare injury pattern four weeks after sustaining trauma. The patient underwent open reduction and internal fixation via dorsal approach. Reduction was assisted by the use of Joshi′s Distraction System. Scaphoid fracture healed by 16 weeks. At 2 years follow-up patient has good range of motion around wrist without any discomfort.
Established non-union of an operatively managed trans-scaphoid perilunate fracture dislocation progressing to spontaneous union
Hiren M. Divecha,Jon V. Clarke,Steven J. Barnes
Journal of Orthopaedics and Traumatology , 2011, DOI: 10.1007/s10195-011-0143-1
Abstract: Perilunate dislocations and fracture dislocations represent uncommon and unusual injuries that are often missed at initial presentation and diagnosed late in up to 25% of cases. Prompt open reduction, carpal stabilisation and ligamentous repair is required to reduce the risk of complications. We report a case of an established scaphoid non-union in an operatively managed perilunate fracture dislocation that spontaneously united almost 2 years after the initial injury, just before a planned revision scaphoid fixation with bone grafting. This case highlights the importance of initial clinical assessment together with appropriate radiographs and follow-up of these injuries post-operatively, especially when complications such as non-union arise.
Bilateral dorsal perilunate dislocation of wrist  [cached]
Chari P
Indian Journal of Orthopaedics , 2010,
Abstract: We present a case of simultaneous dorsal perilunate dislocation of both wrists, without a history of fall on outstretched hands. In contrast, it appeared that the mechanism was reverse. His hands were held in radial deviation with wrists in full palmar flexion. The forearms were in neutral position and elbows in mid-flexion. The wrists were suddenly and forcibly pronated. The radiographs of both wrists showed dorsal perilunate dislocation with avulsion fracture of the tip of ulnar styloid process and avulsion fracture of posterior horn of lunate. Radial translation of the carpal bones was also noted. The mechanism is proposed and discussed.
Bilateral volar lunate dislocation- a rare case report  [cached]
Ebrahim Zonoozi,farid najd mazhar,Mehdi Khazai,Nima Nejadgashti
Journal of Research in Medical Sciences , 2009,
Abstract: Volar lunate dislocation is the fourth and last stage of perilunate dislocation. It is an uncommon injury of the wrist and its bilateral occurrence is so rare that only one case has been reported in the literature. We are presenting the second case of this kind of wrist injury, its treatment and outcome. KEYWORDS: Lunate Bone, Perilunate, Volar Plate, Bilateral, Dislocation.
Superior dislocation hip with anterior column acetabular fracture - open reduction and internal fixation using a twin incision technique
Nipun Jindal, Sohan S Sankhala
Pan African Medical Journal , 2012,
Abstract: Superior variety of anterior dislocation of the hip is a rare injury. Its occurrence with acetabular fractures has been documented infrequently. We report a case of superior dislocation of the hip with anterior column acetabular fracture. Open reduction of the hip and internal fixation of the fracture was carried out using a twin incision technique. The course to recovery has been uneventful. Pan African Medical Journal 2012; 12:41
A Novel Technique for Closed Reduction and Fixation of Paediatric Calcaneal Fracture Dislocation Injuries  [PDF]
Radwane Faroug,Paul Stirling,Farhan Ali
Case Reports in Orthopedics , 2013, DOI: 10.1155/2013/928938
Abstract: Paediatric calcaneal fractures are rare injuries usually managed conservatively or with open reduction and internal fixation (ORIF). Closed reduction was previously thought to be impossible, and very few cases are reported in the literature. We report a new technique for closed reduction using Ilizarov half-rings. We report successful closed reduction and screwless fixation of an extra-articular calcaneal fracture dislocation in a 7-year-old boy. Reduction was achieved using two Ilizarov half-ring frames arranged perpendicular to each other, enabling simultaneous application of longitudinal and rotational traction. Anatomical reduction was achieved with restored angles of Bohler and Gissane. Two K-wires were the definitive fixation. Bony union with good functional outcome and minimal pain was achieved at eight-weeks follow up. ORIF of calcaneal fractures provides good functional outcome but is associated with high rates of malunion and postoperative pain. Preservation of the unique soft tissue envelope surrounding the calcaneus reduces the risk of infection. Closed reduction prevents distortion of these tissues and may lead to faster healing and mobilisation. Closed reduction and screwless fixation of paediatric calcaneal fractures is an achievable management option. Our technique has preserved the soft tissue envelope surrounding the calcaneus, has avoided retained metalwork related complications, and has resulted in a good functional outcome. 1. Introduction Calcaneal fractures in children are comparatively rarer than in adults, making up around 0.005% of all fractures reported [1]. Treatment is usually conservative; however, open reduction and internal fixation are often used to manage displaced or intra-articular fractures. We describe the management of an extra-articular calcaneal fracture dislocation using closed reduction with K-wire fixation. 2. Case Report A seven-year-old previously healthy boy was hit by a bus in a 30 mile an hour urban zone. He was taken to the regional paediatric trauma centre where he was managed according to ATLS principles. The secondary survey revealed a closed fracture dislocation of his left calcaneus and bruising over his right hip, which CT scan showed to be an undisplaced fracture of the anterior column of the right acetabulum. Clinically, the calcaneal injury was evidenced by swelling, bruising, and localised tenderness over the left heel. Additional signs included skin puckering on the medial calcaneal aspect and bossing on the lateral side caused by the prominence of the displaced fracture fragment.
腕关节镜辅助微创治疗月骨周围脱位
Arthroscopic management of lesser arc perilunate injuries
 [PDF]

刘波,陈山林,朱瑾,王志新,杨辰,沈杰,田光磊
- , 2016, DOI: 10.3969/j.issn.1671-167X.2016.02.010
Abstract: 目的:评估腕关节镜辅助微创复位固定治疗月骨周围脱位的效果。方法:从2012年至2014年北京积水潭医院采用腕关节镜辅助微创治疗的5例月骨周围脱位患者进行随访,平均随访时间17.8个月(10~32个月)。临床治疗效果评估内容包括腕关节活动度、握力、Mayo腕关节评分、Quick DASH(disabilities of the arm, shoulder and hand)评分和PRWE(patient-rated wrist evaluation)评分。影像学评估内容包括腕关节力线恢复和保持情况,以及是否存在关节炎表现。结果: 患侧平均屈伸活动度为健侧的84%,握力为健侧的90%; 平均Quick DASH评分为1, PRWE评分为5。根据Mayo腕关节评分,术后功能5例患者平均得分92分,均为优,最后随访时的影像学检查显示所有患者术后腕关节力线都得以恢复和维持,未见腕关节骨性关节炎的征象。结论:腕关节镜辅助微创复位和固定治疗月骨周围脱位的早期随访结果满意,可能是一个有效和值得推荐的治疗选择。
Objective:To evaluate the outcomes of lesser arc perilunate injuries (Perilunate dislocations) treated with arthroscopically assisted mini-invasive reduction and fixation. Methods: Between 2012 and 2014, 5 patients who had a perilunate dislocation were treated with arthroscopically assisted reduction and percutaneous fixation. The mean follow-up was 17.8 months (range, 10 to 32 months). Clinical outcomes were evaluated on the basis of range of motion; grip strength; Mayo wrist score; Quick disabilities of the arm, shoulder and hand questionnaire; and patient-rated wrist evaluation score. Radiographic evaluations included carpal alignments and any development of arthritis. Results: The range of flexion-extension motion of injured wrist averaged 84% of the values for contralateral wrist. The grip strength of the injured wrist averaged 90% of the values for the contralateral wrists. The mean Quick Disabilities of the arm, shoulder and hand score was 1, and the mean Patient-Rated Wrist Evaluation score was 5. According to the Mayo wrist scores, the overall functional outcomes were rated as excellent in all the patients. Reduction obtained during the operation was maintained within normal ranges in all the patients. Arthritis had not developed in any patient at the end of the follow-up. Conclusion: Arthroscopic mini-invasive reduction with percutaneous fixation is a reliable and favorable alternative in the treatment of perilunate dislocations according to our early results.
Surgical Outcomes of Short-Segment Fixation for Thoracolumbar Fracture Dislocation  [PDF]
Shang-Won Yu,Kuo-Feng Fan,I-Chuan Tseng,Yi-Lee Chiu
Chang Gung Medical Journal , 2002,
Abstract: Background: Currently long-segment pedicle instrumentation for a thoracolumbar (T-L)fracture-dislocation is gaining in popularity. Otherwise, short-segment fixationmay be chosen as an another treatment method. This article evaluatesthe efficacy and complications of short-segment fixation for the treatment ofthoracic or lumbar spine fracture-dislocation.Methods: Twenty patients with thoracic or lumbar spine fracture-dislocation wereincluded in the study. The mean follow-up period was 3 years. Clinical,neurologic, radiologic (angle of deformity, displacement percentage, fusionrate), and complication outcomes were analyzed retrospectively.Results: The rate of failure, defined as an increase of 10o or more in local kyphosis, anincrease of 10% or more in displacement percentage, the development ofpseudarthrosis, and/or implant failure, was analyzed. Short-segment instrumentationhad a higher failure rate in the lower lumbar region (L3-L5) and alower rate at the thoracolumbar junction (T11-L2).Conclusion: Thoracolumbar fracture-dislocation required firmer fixation especially in thelow lumbar region, and short-segment fixation resulted in a high failure rate.Circumferential anterior and posterior fusion often played a role in certainseverely injured cases. Good postoperative spinal alignment is crucial to agood outcome.
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