ABSTRACT
PURPOSE@#Undisplaced subtle ligamentous Lisfranc injuries are easy to miss or underestimate, and many cases are treated without surgical fixation. It has not yet widely known whether conservative treatment for undisplaced subtle ligamentous Lisfranc injuries may lead to a poor outcome. The purpose of this study is to compare the outcomes of conservative versus surgical management (percutaneous position screw) of undisplaced subtle ligamentous Lisfranc injury.@*METHODS@#We analysed 61 cases in this retrospective study, including 38 males and 23 females. Forty-one patients were managed conservatively, while 20 patients received surgical treatment involving minimal invasive percutaneous position screw. American orthopaedic foot &ankle society (AOFAS), foot function index (FFI, including FFI disability, FFI pain score and activity limitation scale) scores, Maryland foot score and short form-36 (SF-36) were recorded and compared after a follow-up of 10-16 months (average 12.3).@*RESULTS@#Patients in the surgical management group had higher scores in all evaluation methods (p < 0.05). The complications in the conservative management group had higher incidence, mainly including secondary diastasis (34.1% vs. 5.0%), joint stiffness after 3 months (82.9% vs. 0%), and secondary arthrodesis (12.2% vs. 0%). The highest rate of complication in surgical management group was temporary forefoot pain (55.0%).@*CONCLUSION@#The results of this study suggest that the outcomes of the surgical management with percutaneous position screw fixation are better than the conservative management to treat undisplaced subtle ligamentous Lisfranc injuries. This study can serve as a resource for orthopaedic surgeons in recognizing and managing such injuries.
ABSTRACT
PURPOSE: People with dementia have poor mobility and discharge outcomes following hip fractures. The purpose of this study was to evaluate the clinical and radiological results of internal fixation of undisplaced femur neck fractures (Garden types 1 and 2) by proximal femoral nail antirotation (PFNA) in dementia patients. MATERIALS AND METHODS: We studied retrospectively 19 patients with undisplaced femur neck fracture. All patients were over 70 years of age, walked independently with a cane or crutches and suffered moderate-to-severe dementia. Patients were treated with PFNA and followed-up for more than 2 years. Revision, loss of fixation, complications, and walking ability outcomes were measured. RESULTS: In walking-ability evaluation, patients showed an average decrease of just 0.2 points at the final follow-up. Walking ability was evaluated from before injury to 4 weeks after surgery and decreased by less than 0.5 points. Radiological bone union was achieved in 17 cases; the average time to bone union was 4.14 months (range, 2.5-7 months). Complications included non-union in two cases and femoral head avascular necrosis in one case of non-union. CONCLUSION: We found that for patients with osteoporotic bone tissues in their femoral heads or patients (e.g., those suffering dementia) for whom cooperating with medical workers for postoperative walking control or rehabilitation exercises is difficult, implanting a mechanically stable spiral blade for fixation of femoral neck fractures could facilitate walking after surgery.
Subject(s)
Humans , Bone and Bones , Canes , Crutches , Dementia , Exercise , Femoral Neck Fractures , Femur Neck , Femur , Follow-Up Studies , Head , Hip Fractures , Necrosis , Rehabilitation , Retrospective Studies , WalkingABSTRACT
In mid-face, the zygomatic bone and arch represents the bridge between the maxilla, orbital cavity and temporal bone anterosuperior and posterior, respectively. Zygomatic arch plays a potential relation with the maxilla, petrous part of temporal bone, orbits and the multitude of structures contained within and posterior to it make the temporomandibular joint functionally. Fracture of the zygomatic arch of the bone is potentially disturb the function of the mandibular jaw while opening and closing as well as disfigure by forming depression on face even in case of undisplaced. In time and reduction of arch fracture provides the best chance to avoid facial deformity, jaw dysfunction and prevents unfavorable sequelae. We conclude that, Gillies approach for undisplaced arch fracture reduction will be considerable due to simple and effective method and cosmetically more acceptable.
ABSTRACT
PURPOSE: We wanted to evaluate the results of nonoperative treatment for acute, undisplaced, stable scaphoid fracture. MATERIALS AND METHODS: We retrospectively reviewed 24 cases of acute undisplaced scaphoid fracture that were treated at our department from May 1998 to January 2008. The immobilization method was a long or short arm cast. Flexion-extension exercise was permitted during the period of the short arm cast, but pronation-supination motion was prohibited. After the removal of the cast, active and passive range of motion exercise was started immediately. The result was assessed by the Maudsley scale. RESULTS: The twenty four cases were undisplaced or minimally displaced fracture (10 cases of Herbert type A1, 3 cases of A2 and 11 cases of B2) according to the Mayo classification. The average duration of immobilization was 7.16 weeks. According to the Maudsley scale, 19 cases had an excellent result and 4 cases had a good result. One case had a complication of scapho-lunate dissociation. CONCLUSION: We recommend conservative treatment with cast immobilization as the first treatment of choice for acute undisplaced scaphoid fracture.
Subject(s)
Arm , Dissociative Disorders , Immobilization , Range of Motion, Articular , Retrospective StudiesABSTRACT
Extensor pollicis longus tendon rupture is well known as a complication of fracture of the distal radius. There is a higher risk that the tendon of extensor pollicis longus will rupture in undisplaced distal radius fracture than in those which are displaced. We have experienced three cases of rupture of the extensor pollicis longus tendon after undisplaced distal radius fracture. Those were treated by tendon graft and tendon transfers. The results were satisfactory without complications. The patients with undisplaced distal radius fracture should be careful concerned about possibility of rupture of extensar pollicis tendon.