ABSTRACT
Carpal injuries are uncommon and are mainly seen in the younger age group. The incidence is unclear as many of the cases go undiagnosed. A 22-year-old male patient coming to the hospital after road traffic accident with head, face and left wrist injury. After immediate primary management the patient was taken up for a definitive procedure 4 days after the injury. Scaphoid fracture was fixed with the help of Herbert's screw via the dorsal approach. The base of the first metacarpal was fixed with the help of JESS fixator and the distal end radius was fixed with the help of K-wires. The scapholunate and lunato triquetral ligaments were repaired. The whole construct was stabilized with the help of an external fixator. Postoperative period was uneventful. The external fixator was removed after 4 weeks and patient had a good functional outcome with the patient related wrist evaluation score coming out to be 11 at the end of the third month. This uncommon case of Transradial, Trans scaphoid, transcapitate, and perilunate dislocation was managed successfully with no postoperative complications and a good functional outcome
ABSTRACT
Objective: To evaluate the functional outcome and extensor apparatus of operative management of intraarticular fractures of distal humerus using modification of the Triceps Tongue Flap approach
Methods: This prospective study was conducted between June, 2012 to April,2014 in NIMS Medical College and Hospital, Jaipur, Rajasthan[India]. We included 23 patients with intraarticular fractures of distal humerus that were managed surgically. Modification of Triceps Tongue Flap approach with Triceps flap in inverted 'V' shape was used. Follow-up was done using standard radiograph anteroposterior/lateral [AP/Lat] at immediate postoperative day, 1,3, 6 and 12 month intervals. Functional outcome was assessed using range of motion at elbow joint, Disability of Arm, Shoulder and Hand [DASH]Score and Objective Muscle Strength Testing [MRC Grade] of triceps muscle at 1,2, 3,6 and 12 month follow-up
Results: Overall we included 23 patients of whom 16 [69.5%] were men and 7 [30.5%] were women with mean age of 34.6 +/- 4.8years. Mean duration of the follow-up was 12.9 +/- 1.1 months. Mean DASH Score at final follow up was 7.7 +/- 1.1 [indicating mild residal impairment]. Mean muscle strength at final follow-up was 4.7 +/- 0.4 [Range 3 to 5]. Mean flexion deformity at elbow was 9.2 +/- 0.9 [Range 5 to 45] degrees and mean arc of flexion extension as 119 +/- 3.4[Range 65 to 140] degrees
Conclusion: This approach provides an excellent exposure as well as a good functional outcome as measured by DASH score and full range of motion at the elbow joint with return of almost complete power of the extensor apparatus in patients with intra-articular fractures of distal humerus