ABSTRACT
Although talus fractures are uncommon, proper management is important because they are often associated with severe complications. Talar neck and body fractures occupy most of the talar fractures. It remains controversial whether talar neck fractures require emergent or elective treatment. Elective definitive fixation, however, may reduce risks of wound complications. Many surgeons recommend dual surgical approaches—anteromedial and anterolateral—to allow accurate visualization and anatomic reduction. Although there are various methods of fixation, the use of plates is necessary in comminuted talar fractures. Outcomes may vary and will be dependent on the degree of the initial fracture displacement. It is necessary to restore articular congruency and axial alignment for normalizing hindfoot function. Common complications include posttraumatic arthritis, avascular necrosis, malunion, and nonunion.
Subject(s)
Arthritis , Neck , Necrosis , Surgeons , Talus , Wounds and InjuriesABSTRACT
Iatrogenic damage of the rotator cuff followed by postoperative shoulder function loss is a potential complication after antegrade intramedullary nailing (AIN) for a humeral fracture. The authors present a case of arthroscopic rotator cuff repair and subacromial decompression of a non-healed rotator cuff tendon (mainly supraspinatus) and secondary impingement syndrome caused either by the tear or a proud nail after AIN for a mid-shaft humeral fracture. At presentation, the patient complained of right shoulder pain and 'snapping', especially during forward elevation and abduction of the shoulder, of 4 years duration. Right shoulder pain started sometime after pain due to the humeral shaft fracture, operation had subsided, and persisted after nail removal. Arthroscopic findings showed a longitudinal rotator cuff tear at the nail entry point that had not healed and severe fibrous hypertrophy on the acromion underspace, which is a unique finding since most longitudinal splits of tendon fibers are more likely to heal than conventional rotator cuff tears detached from bone. The torn rotator cuff was repaired after debridement and placing side-to-side sutures. At his 34-month follow-up after rotator cuff repair, the patient showed complete recovery and had excellent clinical scores.
Subject(s)
Humans , Acromion , Arthroscopy , Debridement , Decompression , Follow-Up Studies , Fracture Fixation, Intramedullary , Humeral Fractures , Hypertrophy , Rotator Cuff , Shoulder , Shoulder Pain , Sutures , TendonsABSTRACT
Iatrogenic damage of the rotator cuff followed by postoperative shoulder function loss is a potential complication after antegrade intramedullary nailing (AIN) for a humeral fracture. The authors present a case of arthroscopic rotator cuff repair and subacromial decompression of a non-healed rotator cuff tendon (mainly supraspinatus) and secondary impingement syndrome caused either by the tear or a proud nail after AIN for a mid-shaft humeral fracture. At presentation, the patient complained of right shoulder pain and 'snapping', especially during forward elevation and abduction of the shoulder, of 4 years duration. Right shoulder pain started sometime after pain due to the humeral shaft fracture, operation had subsided, and persisted after nail removal. Arthroscopic findings showed a longitudinal rotator cuff tear at the nail entry point that had not healed and severe fibrous hypertrophy on the acromion underspace, which is a unique finding since most longitudinal splits of tendon fibers are more likely to heal than conventional rotator cuff tears detached from bone. The torn rotator cuff was repaired after debridement and placing side-to-side sutures. At his 34-month follow-up after rotator cuff repair, the patient showed complete recovery and had excellent clinical scores.
Subject(s)
Humans , Acromion , Arthroscopy , Debridement , Decompression , Follow-Up Studies , Fracture Fixation, Intramedullary , Humeral Fractures , Hypertrophy , Rotator Cuff , Shoulder , Shoulder Pain , Sutures , TendonsABSTRACT
PURPOSE: To present clinical results of proximal first metatarsal opening wedge osteotomy and low profile plate fixation in hallux valgus deformity. MATERIALS AND METHODS: Thirty-two patients (39 feet) underwent surgery for hallux valgus deformity. Fourteen patients (18 feet; Group A) underwent proximal first metatarsal opening wedge osteotomy fixed with low profile titanium plate (Arthrex(R)), and 18 patients (21 feet; Group B) underwent proximal chevron osteotomy with two K-wires. Improvement in hallux valgus angle (HVA), 1, 2 intermetatarsal angle (IMA), range of motion of 1st metatarsophalangeal joint, VAS score, and the length of first metatarsal on weight-bearing radiograph were evaluated preoperatively and at final follow-up. RESULTS: HVA improved from 36.2+/-6.6 degrees to 11.7+/-5.1 degrees, and 1, 2 IMA improved from 15.7+/-2.6 degrees to 7.2+/-1.9 degrees. VAS score improved from 7.2+/-1.2 to 1.4+/-0.9. There were no significant differences clinically and radiologically. CONCLUSION: Proximal first metatarsal opening wedge osteotomy with stable fixation using low profile plate may be an effective surgical option for correction of hallux valgus deformity.