A morphological review of medial malleolar fractures - A large single centre series.

BACKGROUND: Many approaches to management of medial malleolar fractures are described in the literature however, their morphology is under investigated. The aim of this study was to analyse the morphology of medial malleolar fractures to identify any association with medial malleolar fracture non-union or malunion. METHODS: Patients who had undergone surgical fixation of their MMF were identified from 2012 to 2022, using electronic patient records. Retrospective analysis of their preoperative, intraoperative, and postoperative radiographs was performed to determine their morphology and prevalence of non-union and malunion. Lauge-Hansen classification was used to characterise ankle fracture morphology and Herscovici classification to characterise MMF morphology. RESULTS: A total of 650 patients were identified across a 10-year period which could be included in the study. The overall non-union rate for our cohort was 18.77% (122/650). The overall malunion rate was 6.92% (45/650). Herscovici type A fractures were significantly more frequently mal-reduced at time of surgery as compared to other fracture types (p = .003). Medial wall blowout combined with Hercovici type B fractures showed a significant increase in malunion rate. There is a higher rate of bone union in patients who had been anatomically reduced. CONCLUSION: The morphology of medial malleolar fractures does have an impact of the radiological outcome following surgical management. Medial wall blowout fractures were most prevalent in adduction-type injuries; however, it should not be ruled out in rotational injuries with medial wall blowouts combined with and Herscovici type B fractures showing a significant increase in malunions. Herscovici type A fractures had significantly higher malreductions. LEVEL OF EVIDENCE: Level 3 - Retrospective Cohort Study.

Non-surgical Management of an Acute Isolated Volar Dislocation of the Distal Radioulnar Joint.

Introduction: Isolated distal radioulnar joint dislocations are rare and commonly missed on radiographs. Knowledge of the management of these injuries, therefore, has room for improvement. We present a case with an alternative method of closed reduction. Case Presentation: A young Caucasian male presented with severe pain and deformity of the left wrist, following a collision while playing rugby. This was easily diagnosed using plain radiographs and the initial attempted reduction methods in the Emergency Department failed. The patient was subsequently anesthetized in theatre, yet reduction by an accepted method of palmar to dorsal pressure over the interosseous membrane with simultaneous distraction of the wrist failed. A further attempt to manipulate the dislocated ulnar head was successful, with the same force applied, while the wrist was maximally flexed and pronated - thereby avoiding an open reduction. Conclusion: This technique has not previously been described in the literature and may be used in similar injuries in the future.

Thigh Abscess as an Uncommon Complication of Left-Sided Colonic Diverticulitis and the Pitfalls in Treatment: An Interesting Case Report.

Colonic diverticulitis is one of the common causes of surgical intervention in general surgical practice. In most cases, surgical intervention depends on the presence of a collection around the sigmoid colon, the feasibility of percutaneous drainage, and the patient's medical condition. The collection can occur in the thigh in rare cases due to a fistulous communication with the retroperitoneum and can track gravitationally along the psoas muscle into the thigh and leg without any discernible collection around the sigmoid colon or in the abdominal cavity. We came across a similar case of a 54-year-old man who presented with abdominal pain, and thigh and leg swelling. Left-sided colonic diverticulitis was seen without any discernible abdominal collection and a thigh abscess during the initial clinical presentation. He was treated with multiple drainages of the thigh abscess, ultimately followed by a Hartmann's procedure over a total hospital admission period of 52 days. Current literature does not throw much light on such a situation and makes it all the more critical to illustrate this case. We present this rare case and give a complete account of investigations, disease course, and the interventions done to throw light on the optimal management of such cases.

Dynamic Hip Screw Plate Length in Stable Intertrochanteric Fracture Neck of Femur: A Systematic Review.

There has always been a debate between the use of four and two-hole plate for the fixation of stable intertrochanteric fractures. The choice is usually influenced by the general practice of the particular institution and the surgeon's preference. While the dynamic hip screw (DHS) is the implant of choice for stable intertrochanteric fractures of the femur, the length of the side plate to be chosen for optimal results has no clear consensus and previous studies regarding the same have been inconclusive. In our systematic review, we aimed to review the evidence available on the selection of the optimal length of the side plate and bridge the glaring gap that exists in the literature. Our systematic review included a thorough search of databases like PubMed, Embase, MEDLINE, CINAHL, and the Cochrane Library, using the Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We included both clinical and biomechanical studies satisfying our search criteria on two- and four-hole DHS implants. A total of 4556 results were obtained from the above databases, sorting out led to final 15 studies on the topic. It was found that the two-hole DHS implant was inferior in terms of lab-controlled biomechanical properties, while only having a slight advantage in terms of real-life postoperative blood transfusions and operative time. At the same time, the two-hole plate was similar to the four-hole plate in other clinical parameters. In this study, the two-hole plate while appearing promising in a few areas did fall short in other aspects like biomechanical studies, and the use should be reserved for cases where a four-hole plate cannot be used until further randomised control trials are carried out.

Residual deformity versus recurrence following Dupuytren's palmar fasciectomy-a long term follow-up of 142 cases.

INTRODUCTION: and background: Surgical options for Dupuytren's disease (DD) are multiple, and Dupuytren's palmar fasciectomy (PF) is a common surgical procedure performed for contractures that cause functional and cosmetic disability. The recurrence rate for PF has been reported to be very variable, ranging from 12 to 73%, according to various studies. One of the reasons for the varied range is the inconsistency in the method followed to define recurrence. Subsequently, a consensus-based definition was formulated in 2016, and we analysed the outcome in our series of patients treated with PF based on this standard definition. We also analysed the residual deformity associated in these cases. METHOD: ology: Our study is a retrospective analysis of 142 consecutive cases of primary Dupuytren's palmar fasciectomy by a single surgeon in three different centres. We followed the international consensus definition for analysing recurrence in these cases, and we also analysed residual cases as a separate entity. RESULTS: The mean age of the cases was 67.13 years and the mean follow-up period was 3.95 years. Alcoholism, smoking, diabetes and hypercholesterolemia were the commonest associated risk factors. The commonest affected finger and the finger with the maximum deformity were the little finger. The overall rate of recurrence of deformity was 3.5% and the rate of residual deformity was 30.3%. The overall complication rate was 11.9%. CONCLUSION: Recurrence and residual deformity can be considered as separate entities. The term 'residual deformity' can be used to denote patients with persisting deformity or those who incur deformity within one year of the primary surgery.