Outcome of surgical treatment of type IV capitellum fractures in adults / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>Fractures of the capitellum and trochlea constitute less than 1% of all elbow fractures and a shear fracture involving the capitellum and extending medially into most of the trochlea is rarely reported. Type IV capitellum fracture is still controversial in regard to its radiographic appearance, surgical approach and osteosynthesis. We report 10 cases of type IV capitellum fracture with a view to elucidating its clinical features and treatment outcome.</p><p><b>METHODS</b>We treated 10 patients of type IV capitellum fracture with a mean age of 32 years. A uniform surgical approach and postoperative rehabilitation were followed.</p><p><b>RESULTS</b>Nine patients presented to us after a mean of 4 days of injury and one patient was nonunion after 6 months of injury who had been treated conservatively by a bone setter. Double arc sign was absent in 6 cases. Intraoperatively 6 capitellotrochlear fragments were devoid of soft tissue attachments. By Mayo Elbow Performance Score evaluation, 7 patients got excellent, 2 good and 1 fair results. One patient with associated elbow dislocation developed heterotopic ossification. There was no case of avascular necrosis, osteoarthrosis or fixation failures.</p><p><b>CONCLUSIONS</b>Type IV capitellum fractures are rare and belong to complex articular injuries. A good functional outcome can only be achieved with open reduction and stable internal fixation followed by early mobilization. Preoperative radiographic assessment and computed tomography help surgeons in choosing the right surgical approach and implants. Good surgical technique and stable internal fixation are the keys to early mobilization and good functional outcome.</p>

Nonunion of coronal shear fracture of femoral condyle / 中华创伤杂志(英文版)

Isolated coronal fractures of femoral condyle are rare in adults and nonunion of Hoffa fracture is reported only a few times in the literature. We analyzed six cases of nonunion of Hoffa fractures over a period of three years. Three patients were treated conservatively and three patients had fixation failures. Delay of presentation was 2 months to one year. Treatment protocol consisted of open reduction, excision of pseudoarthrosis, bone grafting and internal fixation along with knee arthrolysis. Union was achieved in all patients at mean 16 weeks. The treatment of nonunion of Hoffa fractures requires careful preoperative planning and meticulous surgical technique. The literature regarding the controversies in fracture management and surgical technique are reviewed.

Traumatic bilateral hip dislocation with bilateral sciatic nerve palsy / 中华创伤杂志(英文版)

Bilateral hip dislocation rarely occurs. In this paper, a case of bilateral hip dislocation associated with bilateral sciatic nerve palsy resulted from a road traffic accident is reported. Both hips were emergently reduced under general anaesthesia. Acetabular reconstruction was done bilaterally due to the unstable hips. The patient subsequently developed heterotopic ossification and avascular necrosis on the left hip and underwent total hip arthroplasty. The sciatic nerve on the right side achieved complete recovery but that on the left side only partly recovered and was augmented by tendon transfer. Such injuries are serious and one should be aware of the complications because they can resurface and so patients should be followed up for a long time. To the best of our knowledge, this kind of injury has not been reported in the English language literature.

Spondyloptosis of C6-C7: a rare case report / 中华创伤杂志(英文版)

A 35 years old female presented to us after falling from a height. She complained of a neck pain and a complete quadriplegia and was diagnosed as having spondyloptosis of the C6-C7. Skeletal traction was performed on her. CT scan showed fractures of the C5, C6, and C7 vertebral body. The patient underwent anterior approach partial corpectomy with anterior cervical locking plate and strut grafting from ipsilateral iliac crest. Intraoperatively it was found that the disc was completely ruptured and there was a dural tear and cerebrospinal fluid leak. Her postoperative period was complicated by cerebrospinal fluid collection and posterior instrumentation was not performed due to the poor general condition. She had no neural recovery at the last follow-up. Spondyloptosis is a severe and highly unstable injury with a three column ligamentous disruption and may be complicated, as in our case, with a dural tear. Management of these cases is fraught with complications, and prognosis for neural recovery is dismal.