Scaphoid Dislocation: A Rare Pattern of Wrist Instability - A Case Report.

Introduction: Scaphoid dislocations are rare injuries, usually resulting from high-energy trauma and therefore associated to other lesions which may obscure the diagnosis. Case Presentation: The authors present a case of a 59-year-old man with a partial complex dislocation of the scaphoid, diagnosed 6 days after the initial injury. Closed reduction was unsuccessfully attempted, so the patient was submitted to open reduction and internal fixation. The functional and radiological results were good. Conclusion: Physicians should be aware of this rare lesion, because a delayed diagnosis may rend the treatment more difficult and compromise the results. The threshold for an open treatment should be low because rotatory subluxations of the scaphoid may not be detectable in simple radiographs and be responsible for the appearance of degenerative changes in the long term.

Peri-implant Atypical Fractures Associated with Bisphosphonates: Should this Clinical Entity be Included in the Definition of Atypical Femoral Fracture? Case Report.

INTRODUCTION: In recent years, growing evidence of the association between bisphosphonate use and incidence of atypical femoral fractures has emerged. Cases of peri-implant fractures associated with bisphosphonate use suggest the emergence of a new clinical entity because they are not currently covered by the definition of atypical femoral fracture. CASE REPORT: We present here two rare clinical cases treated in our hospital. Two women (68 and 76 years old) with peri-implant (cephalomedullary nail) fractures and history of prolonged bisphosphonate use (11 and 14 years). Both fractures occurred after minor trauma and showed an atypical fracture pattern. One of the patients underwent revision osteosynthesis and had a 12 months follow-up. The second patient was submitted to orthopedic treatment and had a 6months follow-up. CONCLUSION: Although reports of periprosthetic fractures and peri-implant(plate and screws) have been published, references to peri-implant cephalomedullary nail fractures were not found in the literature. Here, we question if these fracture types should be included in the current definition of atypical femoral fracture, or form a new clinical entity.