ABSTRACT
INTRO: Distal growth core fractures of the femur are the third most common fracture in patients older than 10 years. These fractures result from high-energy trauma and have a high risk of evolving into growth disorders. The classification most used to describe these types of fractures is that described by Salter and Harris. Special clinical cases often occur in clinical practice that are not described in the classifications used. In our study, we analyzed and further focused on new fracture patterns related to pediatric epiphyseal detachments not easily described by the normal classifications currently used in the literature. MATERIALS AND METHODS: From January 2020 to December 2022, we treated 2 male clinical cases with epiphyseal detachments of the distal femur that could not be classified according to the Salter and Harris classification. age of the patients was 10 and 11 years, respectively; for both patients, the traumatic mechanism was a direct trauma to the right knee at high speed using an electric scooter; Serious clinical and radiographic follow-ups were performed at month 1, month 3, month 6, month 12, and month 24 from the date of surgery. DISCUSSION: Distal femur fractures represent a challenge for the orthopedics because they have a high incidence of complications. In our experience, there has been an increase in this type of injury caused using recently developed electric vehicles, which can reach considerable speeds. The Salter Harris classification is among the most widely used for fractures involving the growth physis. This classification proved to be rather limiting in the present case, so we decided to classify the fracture as 'Salter Harris III equivalent'. CONCLUSIONS: The fracture examined is a very rare fracture of the distal femur and is not reflected in the classifications currently in use. The patient presented an excellent clinical and radiographic result after surgery with the presence of a shortening of the affected femur in relation to the contralateral one, which suggests that the growth deficit may continue and increase over time for which reason future studies until skeletal maturity will be necessary to quantify the damage to the growth physis.
ABSTRACT
INTRODUCTION: The following is an original case report in the literature of a patient with post-traumatic bilateral calcaneum fracture, both type III of Sanders' classification, that was treated, by the same surgeon, in the left foot with open reduction and internal fixation and in the right foot with closed reduction and application of an external fixator. CASE REPORT: Patient 43 y.o., male, high fall accident, with bilateral calcaneum fracture, both type III of Sanders' classification. we have chosen to treat the left foot with ORIF (Fig. 3) and the right one with closed reduction and application of an external fixator. Patient was followed up radiologically with radiographs at 2, 12 and 24 months, and clinically at 15 days, 1, 3, 6, 12, 18 and 24 months with the Maryland Foot Score, as suggested by Sanders et al. CONCLUSION: In our patient, the one year clinical outcomes post-surgery was better in the foot treated with external fixation, regardless complex fracture and the not good status of soft tissue, due to open surgical treatment and hardwere inside. Long-term clinical follow-up given best outcomes in patients treated with ORIF, due to better reduction of subtalar joint facet and Böhler's angle.
ABSTRACT
The mechanical behaviour of the Castaman external fixator was determined using different mounting configurations in a system that simulated a long bone fracture during the formation of the bone callus. The first stage of the study was the determination of the stress-strain characteristics of the system with monolateral mounting. The second stage, the object of this study, is the analysis of the system with bilateral mounting and a comparison between the two configurations of the external fixator examined. Strain gauge analysis was used to determine the strains and stresses in the various elements of the system (fiches and external unit). Numerical techniques (FEM) were also used in order to confirm the results obtained using the simulation system. The results obtained show clearly the greater stiffness of the bilateral system. Combined bending and compressive stresses are present on both the screws and the external units, and reveal a little asymmetrical behaviour due to the conicity of the screws.
