Plate fixation of talar neck fractures: preliminary review of a new technique in twenty-three patients.

OBJECTIVE: To describe an unreported technique of fixation for talar neck fractures. DESIGN: Retrospective review and telephone interview of patients with fractures of the talar neck (OTA 72-A1.2, 72-A1.3, 72-C2). SETTING: Level-one trauma center with six trauma surgeons. PATIENTS/PARTICIPANTS: Twenty-three patients treated with minifragment plates over a four-year period. Follow-up intervals were an average of twenty months. INTERVENTION: Talar neck fractures were stabilized with one or two 2.0 or 2.4 plates, with additional 2.0, 2.7, or 3.5 lag screws when necessary. Most fractures were approached through medial and lateral incisions. MAIN OUTCOME MEASURES: Union rates, pain, and incidence of complications. Functional outcome will be best determined by a further review with longer follow-up. RESULTS: Mini fragment plates were placed on the side with the most comminution, and all wounds and fractures healed uneventfully. Four patients underwent hardware removal. Two patients developed a mild extension malunion, but there was no evidence of varus malunion, as measured on Canale views. CONCLUSIONS: Initial review suggests that plate fixation of comminuted talar neck fractures is a successful technique, with low rates of complications compared with those discussed in the literature. A further review in a few years will allow functional assessment studies.

Safe placement of S1 and S2 iliosacral screws: the "vestibule" concept.

OBJECTIVES: To determine the optimal starting points for placement of S1 and S2 iliosacral screws as well as the pertinent anatomy surrounding the S1 and S2 vertebral bodies. DESIGN: Normal subject study evaluating helical CT scans of thirty normal posterior pelvic rings. SETTING: Methodist Hospital, Indianapolis, Indiana, Level I trauma center. PARTICIPANTS: Consenting adults for limited pelvis CT. MAIN OUTCOME MEASUREMENTS: The three-dimensional anatomy of the posterior pelvic ring pertinent to S1 and S2 iliosacral screw placement. Safety of simulated S1 iliosacral screw placement using different lateral ilium starting points. RESULTS: The transversely placed (horizontal) iliosacral screw was the least safe of the screws tested. The safest lateral ilium starting point for our entire population was at the posterior sacral body sagittally and at the inferior S1 foramen coronally. S2 iliosacral screws had less cross-sectional area for placement than S1 screws. Placement of the S2 screw slightly to the S1 foraminal side of the S2 vertebral body increased the safety of placement. CONCLUSION: The iliosacral screw starting point at the posterior sacral body and inferior S1 foramen was the safest when considering the entire population. Careful attention to the size and orientation of the S2 vertebral body should be taken if S2 iliosacral screws are placed.

Irreducible fracture-dislocation of the distal radioulnar joint secondary to entrapment of the extensor carpi ulnaris tendon.

Entrapment of the extensor carpi ulnaris (ECU) tendon between the ulnar head and the sigmoid notch of the radius occurred in a 12-year-old boy. This led to an irreducible dorsal dislocation of the distal radioulnar joint (DRUJ). Irreducible DRUJ dislocations are uncommon, and the entrapped ECU has not been previously described in a skeletally immature patient. The physical and roentgenographic findings of a dorsally displaced ulna, a widened DRUJ, and the inability to obtain a closed reduction should alert the examiner to the need for exploration. A dorsal exposure is required to free the ECU and reconstruct the triangular fibrocartilage complex.