ABSTRACT
INTRODUCTION: Shoulder dislocation is a common injury presenting in emergency Department. Numerous methods have been described in the literature for glenohumeral reduction. These methods can be divided into two groups: traction maneuvers and the combination of traction with scapula manipulation techniques. In this article, we introduced a new maneuver for shoulder reduction, namely, the combination of traction with handling the scapula (scapulohumeral distraction, SHD) and compare it to the Hippocratic Method (HT). MATERIALS AND METHODS: The study took place from November 2021 to September 2023. A total of 96 patients with acute anterior shoulder dislocation were enrolled in the study. Eighty-seven patients, who met all inclusion criteria, were randomly assigned to one of the two groups (SHD and HM). We evaluated each method for success rate, time to relocation, complications over a follow-up period of one month, patients' satisfaction and pain level during the procedure. RESULTS: Both methods had comparable success rates (SHD 95.3% vs. HM 93.2%, p=.833) while no complications where observed. However, SHD method required significantly less procedure time (p=.001). Moreover, patients in SHD group reported significantly less pain (p=.012) and greater satisfaction (p=.003) levels. Furthermore, when we assessed relocation time, pain and patient satisfaction as a function of recurrence, there were no statistically significant differences between the 2 techniques. Similarly, the evaluation of relocation time for both techniques as a function of BMI and age did not indicate statistically significant differences. CONCLUSION: Scapulohumeral distraction technique (SHD) represents a safe, anatomically based and simple method for shoulder reduction. It showed a statistically significant decrease in relocation time and pain, with patients mentioned higher satisfaction rates compared to the classical Hippocratic method. Nonetheless, there were no statistically significant differences between the two techniques regarding success rate.
ABSTRACT
Introduction: Closed wedge osteotomy of the distal radius represents a treatment option for the advanced scaphoid pseudarthrosis. Few authors have reported good results with many of the cases achieving union of the scaphoid. The aim of this study is to inform about the functional long-term outcome of two patients in whom bone union was not achieved after this procedure. Case Report: In this article, we present two patients, one with 5 and one with 40 years of follow-up who were treated with closed wedge osteotomy of the distal radius due to advanced scaphoid nonunion. We evaluated the functional outcome which was excellent and in addition radial translocation of the carpus was found as it was compared the anteroposterior radiographs before surgery and at the end of the follow-up period. Conclusion: Closed wedge osteotomy of the radius is an extra articular procedure that can cause radial translocation of the wrist and change its biomechanics, while the functional outcome does not depend on whether fracture healing is achieved.
ABSTRACT
BACKGROUND: Avulsion fracture of the coracoclavicular ligament accompanied by upward displacement of the medial fragment of the clavicle represents a unique fracture pattern, first described by Latarjet and colleagues in 1975. Due to the function of the underlying articulations and the ligaments found in the area, this fracture pattern results in a combination of horizontal and vertical instability that must be taken into consideration when treating. Several surgical techniques have been proposed but none has been proven superior. CASE SUMMARY: Herein, we present a Latarjet fracture of the distal clavicle treated with a single endobutton. A 45-year-old male underwent open surgical stabilization of distal clavicular fracture 15 days after trauma. After stabilization of the fracture, we applied a single endobutton, passing through the medial fragment, inferior fragment and coracoid process. The patient was observed for 14 mo postoperative, during which time he achieved union in all three fragments of the fracture and an excellent functional clinical score. CONCLUSION: In Latarjet fracture treatment, augmentation of the coracoclavicular ligament is the most important parameter for a favorable result.
ABSTRACT
INTRODUCTION: Open fractures in children are uncommon and usually the result of a high-energy trauma. Open distal radius fractures are even more uncommon. In our clinic, we managed a pediatric open fracture separation of the distal radius due to hyper extension and axial load, with low-energy movement of the wrist. To the best of our knowledge, no other similar case or case series is published in literature. CASE REPORT: Our case involved a 14-year-old male who had been pushing a heavy object during a basketball match. The patient presented at our emergency department with metaphysis of the distal radius protruding through a transverse volar laceration in the wrist. The patient was immediately taken to the operating room and underwent debridement and internal stabilization of the fractures. The wrist was observed for 18 months and no complication occurred. CONCLUSION: Through this case report, we present an unusual type of injury that has never been described before; also, we show that the principles of treatment that stand for open fracture in adult patients can be used for children as well.
