Orthopaedic review
-
Review Case Reports
Displaced Salter-Harris type I injury in a gymnast. A slipped capital humeral epiphysis?
The case of an adolescent Olympic-level gymnast with insidious onset shoulder pain is presented. Radiographic evaluation revealed bilateral physeal irregularities of the proximal humerus similar to those seen in Little Leaguer's shoulder. Roentgenograms of the involved shoulder also demonstrated Salter-Harris type I displacement at this physis and a slipped capital humeral epiphysis was diagnosed. A discussion reviewing proximal humeral physeal injury follows the case presentation.
-
Regional nerve block anesthesia has been less commonly used and less successful in surgery on the lower extremity than on the upper extremity because of anatomic difficulties associated with lower-extremity nerve blockade. The authors have developed a technique that combines two peripheral nerve blocks with a nerve stimulator. ⋯ The technique has also facilitated rapid patient discharge from the same-day unit. No significant complications have been encountered.
-
This review focuses on the clinical history, diagnosis, and treatment of chronic exertional compartment syndrome (CECS) of the lower leg. Measurement of muscle compartment pressures, the most conclusive way to confirm the diagnosis, may yield significantly elevated values in CECS patients compared to normal controls. ⋯ Once a diagnosis of CECS is established, surgical decompression of the involved compartment is recommended. For as yet unknown reasons, the results of fasciotomy are almost always satisfactory in the anterior compartment and significantly less so in the posterior compartment.
-
Review Case Reports
Fracture-dislocation of the ankle with fixed displacement of the fibula behind the tibia.
Fracture-dislocation of the ankle with fixed displacement of the fibula behind the tibia (Bosworth fracture-dislocation) is infrequently encountered in clinical practice. The diagnosis of this entity is often overlooked due to an inability to correlate clinical findings with roentgenographic data. The mismanagement that follows an incorrect diagnosis may render a patient permanently disabled. The authors report a case of Bosworth fracture-dislocation and describe the steps leading to proper diagnosis and treatment of this rare injury.
-
Pilon fractures are relatively rare fractures of the distal metaphysis of the tibia resulting from axial and/or rotational forces. They involve varying degrees of metaphyseal disruption, articular damage, and malleolar displacement. When severe, these injuries represent a tremendous challenge to the orthopaedic trauma surgeon. ⋯ Open reduction and internal fixation in accordance with AO/ASIF principles has greatly improved the outcome in these often disabling fractures. Surgical technique involves anatomic restoration of fibular length, reconstruction of the plafond, bond grafting of the metaphyseal defect, and buttress plating of the medial tibia. Thorough preoperative planning and meticulous surgical technique produce predictably good results in the majority of cases.