Plantar Subluxation of First Metatarsal with Intercuneiform Dislocation: A Case Report of a New Type of Lisfranc Injury.

Lisfranc injuries result when the bones or ligaments that support the midfoot are torn, and the classifications of these injuries are based on the coronal displacement of the metatarsals. On the saggital plane, the first metatarsal is usually dorsally dislocated due to dorsal ligament weakness. We present a case report of a 29-year-old woman who sustained a Lisfranc injury of her right foot with plantar subluxation of the first metatarsal, which was treated with open reduction and internal fixation of the first metatarsal and fusion of the second metatarsal.

Operative treatment of complex intra-articular scapular fractures: long-term functional outcomes in a single-center study.

BACKGROUND: Scapula fractures occur in the setting of high-energy trauma. Operative treatment of complex intra-articular scapular fractures can result in adequate surgical and functional outcomes. MATERIALS AND METHODS: Twenty-seven patients with complex, displaced intra-articular scapular fractures with or without involvement of the scapular body, were treated operatively in a single trauma center between 2010 and 2021. Associated injuries such as ipsilateral upper limb fractures and nerve injuries were identified in the majority of the patients. Fixation with anatomical medial and lateral border precontoured plates was utilized following posterior modified Judet approach or/and anterior deltopectoral approach. Functional outcome was assessed using the Oxford Shoulder Score and detailed shoulder range of motion and return to work/activities data were obtained. RESULTS: At a mean follow-up of 69 months (range 4-135 months), individual functional outcomes for 25 of the 27 patients revealed a mean Oxford Shoulder Score of 33 (69%), mean active flexion of 120 degrees, active abduction of 110 degrees, mean active external rotation of 35 degrees and mean internal rotation to the level of T5. All patients were pain-free at the latest follow-up, and 23 of 25 had returned to their preinjury occupation and activities. CONCLUSION: Operative treatment for these complex injuries is a viable option at centers equipped to handle critically ill patients and can result in satisfactory range of motion and functional score measurements along with a relatively low number of complications.

Bilateral Femoral Neck Fracture Following an Epileptic Seizure in a Patient with Severe Vitamin D Deficiency: A Case Report.

Simultaneous bilateral femoral neck fractures represent a rare entity and are usually associated with bone metabolism disorders, chronic steroid treatment, epileptic convulsions, or high-energy trauma. Here we report a case of bilateral femoral neck fracture in a patient with severe vitamin D deficiency following an epileptic seizure. Anteroposterior and lateral radiographs of the pelvis revealed Garden III femoral neck fractures on both hips. A single-stage operation involving bilateral uncemented bipolar hemiarthroplasties using the anterolateral approach was performed. Three months postoperatively, the patient was able to ambulate independently. Simultaneous bilateral femoral neck fractures following an epileptic seizure is a rare injury. In our case, severe vitamin D deficiency and chronic use of antiepileptics predisposed the patient to this condition. Orthopaedic surgeons and other clinicians should be aware of such an uncommon pathology. A multidisciplinary team approach is essential in identifying risk factors and optimizing inpatient management and postoperative rehabilitation. A single-stage bilateral procedure with an uncemented bipolar hip hemiarthroplasty in order to reduce cement disease in this frail patient has been successful in restoring functional capacity and allowing the patient to return to his preinjury ambulatory status.

Simultaneous bilateral fracture-dislocation of the talus: a case report.

A bilateral talar body fracture-dislocation in a 29-year-old multitrauma patient is presented. There was a comminuted fracture associated with an ankle, subtalar and talonavicular subluxation on the right lower limb and an open fracture with complete dislocation of the body of talus on the left side. We performed a minimal invasive reduction and stabilization of the fractures with the use of K-wires, due to severe contamination of the wounds and the patient's poor general condition. After a 28-month follow-up there were signs of posttraumatic arthritis but no signs of avascular necrosis of the talus bilaterally. The range of motion in both ankle joints was limited but the patient had a satisfactory level of activity.

Inferior dislocation of the proximal tibiofibular joint: a new type of dislocation with poor prognosis.

Dislocation of the proximal tibiofibular joint is an unusual injury. We report a patient, who developed inferior proximal tibiofibular dislocation after a severe motorcycle accident. The dislocation was associated with avulsion of the leg, fractures of the fibula and the ankle and neurovascular lesions. The patient was surgically treated and had a good final outcome. Classifications of proximal tibiofibular dislocations did not include inferior dislocation. This type is always associated with avulsion mechanism and has the poorest prognosis.