Can Nondisplacement Osteoporotic Pubic Rami Fracture Be Life-Threatening Injuries? A Case Report, Overview, and Algorithm Protocol for Management.

Pubic rami fractures in the geriatric population are usually osteoporotic fractures resulting from low energy trauma and are characterized as stable injuries. Established treatment of these injuries is conservative, including rest, analgesic medication, and progressive active mobilization. These injuries are life-threatened when pubic rami fractures are accompanied by acute bleeding, either from an injury to a vessel (corona mortis) or from medication (anticoagulant or antiplatelet) for comorbidities, then. In this case study, we present the unusual case of an 82-year-old woman admitted to the emergency department 24 hours after a simple fall, causing nondisplacement osteoporotic pubic rami fracture, who, after 48 hours, developed a hematoma on the contralateral side of the pelvis, with progressive anemia and acute abdominal pain. This study has 2 objectives: to increase awareness of this life-threatening injury in the emergency department and to describe diagnosis and treatment modalities.

Bizarre Parosteal Osteochondromatous Proliferation of the Hand: A Report of an Atypical Case and Current Concepts.

Bizarre parosteal osteochondromatous proliferation (BPOP), or Nora's lesion, is an unusual, benign, bony lesion often found in the tubular small bones of the hand and foot. In general, two characteristic radiological signs are used to diagnose the lesion, namely, (1) the absence of corticomedullar continuity and (2) BPOP developed from the parosteal surface of bones with an intact underlying cortex. Here, we present an atypical case of Nora's lesion of the proximal phalanx of the index finger, in which BPOP was diagnosed only histologically, with preoperative imaging examinations (X-ray and MRI) suggesting another lesion (enchondroma). Therefore, imaging (X-ray and MRI) alone may be inadequate to achieve the correct diagnosis of the lesion because many cartilaginous neoplasms may surround a broad range of lesions that mimic BPOP. Only histopathological evidence can confirm the correct diagnosis of the lesion.

The effect of an exercise-based rehabilitation programme in functional recovery and prevention of secondary falls after a hip fracture in older adults: A systematic review.

We performed a systematic review to evaluate whether an exercise-based intervention programme, for older people with a hip fracture, is effective in functional recovery and in preventing secondary fall-related injuries. This systematic review was conducted according to Cochrane review guidelines and based on the PRISMA statement. Six electronic databases (Medline, PubMed, Cochrane Library, CIHNAL, Embase, Google Scholar) from 2010 to 31 December 2021 were searched for randomised controlled trials (RCTs) of functional recovery or fall prevention exercises after a hip fracture surgery in older people (≥65 years). Thirty-four references were identified initially, however, only 8 studies (1617 patients) met the eligibility criteria. Despite the heterogeneity of the onset, duration and of the characteristics of exercise-based intervention, as well as the type of setting it was delivered in, there was evidence that an exercise-based rehabilitation programme improved physical function and gait ability. There was no evidence about preventing a secondary fall after a hip fracture. In conclusion, an exercise-based intervention programme can generally improve functional recovery after a hip fracture. It remains uncertain if it affects the prevention of a secondary fall over a 1-year follow-up period.

Greek Translation, Cultural Adaptation and Validation of the Mini Sarcopenia Risk Assessment Questionnaire, to Evaluate Sarcopenia in Greek Elderly at a Hospital Setting.

Sarcopenia is a progressive aging syndrome with severe socioeconomic costs. Therefore, the early diagnosis of sarcopenia is required to secure early treatment and to enhance quality of life. The Mini Sarcopenia Risk Assessment (MSRA) questionnaire, which is available in seven-item (MSRA-7) and five-item (MSRA-5) versions, is a sarcopenia screening tool that was translated into Greek, adapted, and validated in this study. The present study was developed in an outpatient hospital setting, from April 2021 to June 2022. The MSRA-7 and MSRA-5 questionnaires were translated backwards and forwards and adapted to the Greek language. To validate the MSRA questionnaire as a pre-screening tool to identify the risk of sarcopenia in the older Greek population, both the MSRA-7 and MSRA-5 versions were correlated with the Greek version of the SARC-F questionnaire, which is a widely accepted and well-known tool used in sarcopenia screening. Ninety elderly subjects aged 65-89 years-old with no mobility impairments participated in this study. The questionnaires' content validity was assessed using the Content Validity Ratio, and the Content Validity Index was calculated for the instrument. The intra-rater reliability was assessed by calculating the Intra-class Correlation Coefficient between the initial assessment and the reassessment of the MSRA questionnaire, which was 0.986, with a 95% Confidence Interval of 0.961-0.995. Concurrent validity was assessed between the Greek MSRA questionnaires and the SARC-F questionnaire using the Spearman's rank correlation coefficient (p). The Greek MSRA-7 questionnaire had a very high correlation with the SARC-F questionnaire (rho = -0.741, p < 0.001), as did the Greek MSRA-5 questionnaire (rho = -0.724, p < 0.001). The proofs of content validity, concurrent validity, and intra-rater reliability provided for the Greek versions of the MSRA, designated them as reliable pre-screening tools for the detection of sarcopenia in the older population and in clinical practice.

Distal Humerus Fracture Malunion in Adults: A Case Report and a Review of the Literature.

Introduction: Neglected distal humerus fractures are rare injuries, which the orthopaedic surgeon will not deal many times in his career. We present a case of a young patient with such an injury, who was treated with a corrective osteotomy and fixation, resulting in a very good outcome. This case report highlights the importance of surgical intervention for distal humerus fracture malunion. A narrative review of the literature regarding this topic is presented as well. Case Report. A 42-year-old female patient presented to our department nine weeks after a displaced distal humerus fracture, which was treated conservatively in another institution. Ulnar nerve neuropathy, pain, and severe stiffness of the elbow were her main symptoms. Open correction of the deformity, anatomical reduction of the articular surface, and realignment of the metaphyseal level of the fracture were performed. Six months postoperation, a painless flexion-extension arc of 110° and a normal rotation of the forearm was achieved. Conclusion: Distal humerus fracture malunion is a challenge. The operation needed for this purpose is much more demanding, and postsurgical complications are more likely to occur as opposed to the treatment of acute fractures. If a proper surgery is performed though, a good clinical outcome can be expected.

An Unusual Localization of Lunate in a Transcaphoid Volar Lunate Dislocation: Current Concepts.

Perilunate dislocation and fracture dislocations are rare injuries corresponding to 10% of all carpal injuries. They usually come with high-energy trauma, with associated injuries representing 61%. Volar lunate dislocation or fracture-dislocation accounts for 3% of perilunate injuries. We present a case of a 42-year-old polytrauma male, transmitted to our department 48 hours after a car accident with a trans-scaphoid volar lunate dislocation. During operation, the lunate was displaced volarly to the ulnar side of the wrist, forward to the styloid process of the distal ulna, while the scaphoid fracture appeared at the waist with comminution, and the proximal pole of the scaphoid protruded under the dorsal capsule. Carpal injuries are often missed out in polytrauma patients, and these injuries are underestimated because of the severity of the other visceral or extremity lesions. Untreated or improperly treated, those injuries lead to serious morbidity and loss of function. Therefore, good functional prognosis with decreased percentage of complications can be achieved following early recognition and early open surgical ligamentous complex repair.

Isolated Radial Nerve Palsy as a Complication After Anterior Dislocation of the Glenohumeral Joint: A Case Report and Clinical Review.

Shoulder dislocation is the most common feature in emergencies, while the anterior dislocation of the glenohumeral joint is the most frequent and requires reduction. Accompanied nerve injury is common with an incidence of 21%, while radial nerve palsy is very rare. We describe the case of a 56-year-old man who presented with an anterior dislocation of the left shoulder due to a fall on an outstretched hand with wrist drop 8 hours after injury. Neurological examination revealed loss of sensation along the radial border of the forearm. Closed reduction with Kocher procedure was performed. Magnetic resonance image demonstrated a rotator cuff tear, and 3 weeks after the injury electromyography showed complete radial nerve palsy. A physiotherapy program was applied to the wrist and fingers with the goal of maintaining a full passive range of motion in all joints affected while shoulder rehabilitation started 6 weeks after his fall. Isolated radial nerve palsy associated with an anterior dislocation of the shoulder is very rare but not impossible to occur. Correct diagnosis of the nerve injury associated with the anterior dislocation is very important because it has serious implications on the management and activity morbidity.

Giant cell tumors of the tendon sheath of the hand: an 11-year retrospective study.

Purpose: Giant cell tumor of the tendon sheath (GCTTS) is a slowly progressing soft tissue tumor. The present retrospective study recorded and evaluated cases of GCTTS of the hand. Methods: A cohort of patients suffering from GCTTS of the hand and treated surgically were studied in terms of diagnosis, therapy, recurrence, as well as in terms of functional outcome with the use of the QuickDASH score. Results: A total of 36 patients (13 men; 23 women) with a mean age of 38.8 years (±standard deviation;SD=8.7) were evaluated. According to Al-Qattan classification 10 cases of type Ia, 11 cases of type Ib, 6 cases of Ic and 9 cases of IIa were found, while the mean tumor diameter was 2.6 cm (SD=1.1). The mean follow up was 21 months (SD=12). The mean QuickDASH Score was 6.3 (SD=6.7). Furthermore, a total of 31 patients (86%) characterized their outcome as satisfactory. Recurrence was observed in 4 patients, while none of them had initially undergone radiotherapy. Conclusions: This study has shown a direct correlation between the QuickDASH Score results and the objective level of satisfaction in cases of GCTTS treated surgically. The present study cohort had 11.11% recurrence rate during a mean follow-up of 21 months. It is of note that none of these cases had initially undergone radiotherapy. It is of utmost importance to carefully select the patients that meet the criteria for postoperative radiotherapy.