Trans-scaphoid perilunate fracture dislocation; a technical note

Carpal fracture-dislocation is regarded as an unusual orthopedic injury and, thus, orthopedic surgeons are less experienced in dealing with and treating these fractures and dislocations. We report a 20-year-old worker man suffering from an unusual carpal fracture-dislocation. There was trans-scaphoid fracture and lunate dislocation with other carpal proximal bones toward volar of the wrist. Two volar and dorsal approaches were used to treat and stabilize the fracture. It was completely stabilized after open reduction and fixation using several pins. After two days, neural symptoms were completely recovered and the patient was discharged. Postoperative radiographies revealed complete restitution of lesser and greater arcs and normalization of Gilula's line. Scapholunate and lunatocapitate angles reached to less than 60degree and 10 degree, respectively. The combined approach had favorable results for treatment of this unusual type of carpus fracture dislocation. However longer follow up is need to evaluate the arthritis and degenerative changes in wrist

[Treatment of type C2 and C3 pilon fracture of distal tibia by limited open reduction and mini plate and transarticular kirschner wires fixation]

Background and Objectives: The optimal treatment for Pilon fractures remains controversial. This study was conducted to evaluate the clinical outcome of the treatment of type C2 and C3 Pilon fractures [AO/OTA Classification] using limited open reduction and fixation with mini-plate and supplementary transarticular Kirschner wire

Materials and Methods: 31 type C2 and C3 Pilon fractures, including 5 open fractures, were included in this study. For 10 patients, including 5 open fractures, temporary external fixation spanning ankle joint was conducted as early as possible. Other 21 patients were temporarily immobilized in splint. At the final stage, tibial and fibular fractures were reduced and fixed using limited open reduction and transarticular Kirschner wires and mini-plates. Clinical and radiographic evaluations were performed. The American Orthopedic foot and Ankle Society Score [AOFAS] were obtained for the evaluation of function

Results: Anatomic reduction in articular surface was obtained in 29 [94%] patients. No nonunion or skin necrosis was observed during the follow up period. Minor infection occurred in 2 patients and deep infection occurred in 1 patient. Malunion occurred in 3 [9%] patients. The final functional results, based on the AOFAS score, were excellent and good in 74.41%, average in 19.35% and poor in 3.22% of the patients

Conclusion: Limited open reduction and fixation with mini-plate and transarticular Kirschner wires is a reliable treatment for closed and open AO/OTA type C2 and C3 Pilon fracture of the distal tibia

Albumin and fibrinogen levels' relation with orthopedics traumatic patients' outcome after massive transfusion

Severe bleeding is common during limb trauma. It can lead to hemorrhagic shock required to massive blood transfusion. Coagulopathy is the major complication of massive transfusion-induced increased mortality rate. Aim of this study was evaluation of fibrinogen and albumin levels association with orthopedics traumatic patients' outcome who received massive transfusion. In a cross sectional study, 23 patients with severe limb injury admitted to orthopedic emergency department were studied. All the patients received massive transfusion, that is, >10 unit blood. Albumin and fibrinogen levels are measured at admission and 24 h later, and compared according to final outcome. Twenty-three traumatic patients with severe limb injuries were studied, out of which ten [43.2%] died and 13 [56.8%] were alive. There was significant difference between patients outcome in fibrinogen level after 24 h, but no difference was observed in albumin levels. Based on regression model, fibrinogen after 24 h had a significant role in determining the final outcome in traumatic patients who received massive transfusion [odds ratio 0.48, 95% confidence interval 0.15-0.92, P = 0.02]. According to our results, fibrinogen level is the most important factor in determination of orthopedics traumatic patients when received massive transfusion. However, serum albumin does not play any role in patients' outcome

Adolescence spinal epidural abscess with neurological symptoms: case report, a lesson to be re-Iearnt

Epidural abscess of the spinal column is a rare condition that can be fatal if left untreated. It promptly progresses and can cause neurologic paralysis, urinary retention or cauda equina syndrome. Compromised immune system that occurs in patients with diabetes mellitus, AIDS, chronic renal failure, alcoholism, or cancer is a predisposing factor. It mostly occurs in adults. Here we would like to report a case of spontaneous pyogenic lumbar epidural abscess with neurological deficit diagnosed in a 15 year old boy. We treated this case successfully with surgical microscopic decompression and drainage

Osteoid osteoma of a scapula: a case report in a 34 years old woman

Osteoid osteoma is a benign bone tumor and accounts for 10% of benign tumors. Almost any bones can be involved but half of cases involving femur or tibia. Osteoid osteoma is a rare tumor of the scapula with only 18 reported cases in the literature. We presented a case of osteoid osteoma of the scapula in right shoulder in angle of coracoid and geloneid in a 34- year old woman. She had right radicular shoulder pain increased at night for 4 years. An important point about this case is that, patient was treated in long-term with miss diagnosis of cervicospinal discopathy. The key of diagnosis in this patient was paying attention to the nature of night increasing pain and performing bone scan. After the operative curettage of the tumor, the pain dramatically stopped and a few weeks of physical therapy led to full range of motion in her shoulder