Medial peritalar fracture dislocation of the talar body.

Peritalar fracture dislocations typically involve the talar neck and are classified according to Hawkins. To our knowledge, peritalar fracture dislocation involving the talar body has not been formally reported. In this article, we describe a case of peritalar fracture dislocation of the talar body.

Sacroiliac joint fusion with fibular bone graft in patients with failed percutaneous iliosacral screw fixation.

BACKGROUND: Numerous studies have described screw fixation of sacroiliac (SI) joint, but there have been very few reports in the literature regarding long-term pain levels after SI joint fixation and their management. The objective of this study was to analyze the results of SI joint fusion with fibular bone graft in patients with persistent late pain after iliosacral screw fixation. METHODS: Eleven consecutive patients with persistent late pain following iliosacral screw fixation with failed conservative methods were managed with fibular bone grafting of the SI joint. The patients were followed up at 2, 6, 12, 24 weeks and every 3 months thereafter. They were clinically assessed for pain, infection, and ambulation. RESULTS: The average duration of follow-up was 18 months. There were neither intraoperative complications nor postoperative wound infection. Eight patients were pain free and returned to their work. The remaining three patients were having persistent-localized pain, but they were able to manage their daily activities. CONCLUSIONS: Fibular graft is feasible and apparently effective choice for SI joint fusion. This procedure avoids further metal work, which results in successful fusion and pain relief as well as stabilizing the SI joint.

Anatomical basis of the vascular risk related to the circumflex scapular artery during posterior approach to the scapula.

PURPOSE: The vasculature and anastomosis around the scapula is extremely intricate making surgical treatment complicated. We aimed to determine the "at risk area" for the circumflex scapular artery and its anastomosis with the suprascapular artery during posterior approach to the scapula. METHODS: Sixteen shoulders from eight embalmed adult cadavers were dissected through posterior approach to the scapula to study the relationship of the circumflex scapular artery and its anastomosis with the suprascapular artery to bony landmarks of the posterior scapula. Three measurements were obtained: from inferior glenoid rim to the point of the bony groove of the circumflex scapular artery; from the posterior glenoid rim to the spinoglenoid notch; and from the spinoglenoid notch to the circumflex scapular artery. RESULTS: The circumflex scapular was identified at a distance of 2.9 cm from the inferior glenoid rim and at a distance of 4.6 cm from the spinoglenoid notch, as it winds around the lateral border of the scapula to enter the infraspinous fossa. The suprascapular neurovascular bundle was identified at the spinoglenoid notch 1.8 cm from the posterior glenoid rim. CONCLUSIONS: We were able to identify the relationship of the circumflex scapular artery to the anatomic landmarks of the scapula and to define the "at risk area" for the ascending branch of the circumflex scapular artery and its anastomosis with the suprascapular artery. We believe our anatomical study may aid in the avoidance of vascular complications during internal fixation of scapular fractures.

Morphological changes in the cervical intervertebral foramen dimensions with unilateral facet joint dislocation.

BACKGROUND: Many investigators have conducted studies to determine the biomechanics, causes, complications and treatment of unilateral facet joint dislocation in the cervical spine. However, there is no quantitative data available on morphological changes in the intervertebral foramen of the cervical spine following unilateral facet joint dislocation. These data are important to understand the cause of neurological compromise following unilateral facet joint dislocation. METHODS: Eight embalmed human cadaver cervical spine specimens ranging from level C1-T1 were used. The nerve roots of these specimens at C5-C6 level were marked by wrapping a 0.12mm diameter wire around them. Unilateral facet dislocation at C5-C6 level was simulated by serially sectioning the corresponding ligamentous structures. A CT scan of the specimens was obtained before and after the dislocation was simulated. A sagittal plane through the centre of the pedicle and facet joint was constructed and used for measurement. The height and area of the intervertebral foramen, the facet joint space, nerve root diameter and area, and vertebral alignment both before and after dislocation were evaluated. RESULTS: The intervertebral foramen area changed from 50.72+/-0.88mm(2) to 67.82+/-4.77mm(2) on the non-dislocated side and from 41.39+/-1.11mm(2) to 113.77+/-5.65mm(2) on the dislocated side. The foraminal heights changed from 9.02+/-0.30mm to 10.52+/-0.50mm on the non-dislocated side and 10.43+/-0.50mm to 17.04+/-0.96mm on the dislocated side. The facet space area in the sagittal plane changed from 6.80+/-0.80mm(2) to 40.02+/-1.40mm(2) on the non-dislocated side. The C-5 anterior displacement showed a great change from 0mm to 5.40+/-0.24mm on the non-dislocated side and from 0mm to 3.42+/-0.20mm on the dislocated side. Neither of the nerve roots on either side showed a significant change in size. CONCLUSIONS: The lack of change in nerve root area indicates that the associated nerve injury with unilateral facet joint dislocation is probably due to distraction rather than due to direct nerve root compression.

Fixation of periprosthetic femoral shaft fractures adjacent to a well-fixed femoral stem with reversed distal femoral locking plate.

BACKGROUND: Numerous fixation methods have been described for the fixation of Vancouver type B1 periprosthetic fractures, but there have been a very few reports in the literature regarding the use of locking plates and their outcomes for this fracture. The objective of this study was to analyze clinically and radiographically, the results of fixation of Vancouver type B1 periprosthetic femoral fractures with a reversed distal femoral locking plate. METHODS: Thirteen consecutive patients with Vancouver type B1 periprosthetic femoral fracture were stabilized with reversed distal femoral locking plate. Patients were followed up at 2, 6, 12, 24, and 48 weeks and yearly thereafter. They were assessed clinically and radiographically for union, delayed union, malunion, hardware failure, nonunion, infection, and stability of the femoral prosthesis. RESULTS: The average duration of follow-up was 18 months. All fractures healed at an average of 14 weeks from fixation. Complications include superficial wound infection in one and flare-up of previous infection in one with union at 20 and 28 weeks, respectively. Twelve femoral prostheses were stable and all patients were ambulatory, with or without a walking aid at final follow-up. There was no hardware failure or nonunion. CONCLUSIONS: Reversed distal femoral locking plate treatment is a feasible and effective choice for stabilization with femoral stem retention after Vancouver type B1 periprosthetic femoral fracture in an elderly patient population.

Comparison of angled versus AP view radiography for post-operative evaluation of lumbosacral spondylolisthesis: a cadaveric study.

BACKGROUND: The objective of this study was to investigate if angled radiographic views of the L5-S1 junction result in quantitatively better images in patients with lumbosacral spondylolisthesis compared to conventional AP view. METHODS: Grade I lumbosacral spondylolisthesis was simulated in cadaveric specimens and repaired using pedicle screws and posterolateral bone grafting. Angled view AP radiographs were taken at different angles and analyzed at both grade I spondylolisthesis and complete reduction (to normal). RESULTS: The results indicated that angled view radiographs provide better visualization of intervertebral disc height, area, and posterolateral bone graft area compared with true AP views. The optimal view was at 40 degrees for grade I spondylolisthesis, and at 25 degrees -35 degrees for complete reduction. CONCLUSION: In addition to the dynamic radiographs currently used for evaluation of patients post-spondylolisthesis repair, an additional angled view radiograph (at 40 degrees or 25-35 degrees ) is recommended to evaluate intervertebral disc height, intervertebral area, bone graft area, and pedicle screw position.