Transradial, transscaphoid, transcapitate, perilunate dislocation; a case report and approach to the patient

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

Short-term results of muscle-pedicle bone grafting with tensor fascia lata for delayed femoral neck fractures; case series and literature review

Neglected, untreated and delayed femur neck fractures are commonly encountered and the treatment dilemma arises especially when the patient is physiologically young and osteosynthesis is the preferred option. Controversy exists in the current literature as the various head salvage surgeries like valgus subtrochanteric osteotomy, nonvascularized fibular bone grafting, muscle pedicle bone grafting [Tensor fascia lata and Quadratus femoris graft] and vascularized bone grafting do not have clear lines of indications. The current study is a case series of 7 patients with femur neck fractures with delayed presentation beyond the vascular emergency period who were treated with osteosynthesis with muscle pedicle bone graft [MPBG] using tensor fascia lata muscle pedicle graft. Patients were followed clinical and radiologically at 6 weeks, 3 and 6 months, 1 year and 3 years and patients were regularly followed. The mean age of the patients was 47 +/- 1.1 ranging from 38 to 55 years. There were 6 [85.7%] men and 1 [14.3%] women among the patients. Overall 5 [71.5%] patients had transcervical and 2 [28.5%] had subcapital fractures. At the end of 6 months, 6 [85.7%] patients were pain free and on plain radiographs fracture union was noted. One [14.3%] patient developed collapse and persistent nonunion. Younger group less than 50 years presenting with neglected fracture neck femur should always be give an option of head salvage surgery in selected cases. Muscle pedicle bone grafting has been proven although inconsistently as a valid option for fracture neck femur. We encourage osteosynthesis with the use of tensor fascia lata muscle pedicle grafting along with cancellous cannulated screws as a first option in selected cases of neglected femur neck fractures