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Distal ulna fractures often occur with distal radius fractures, and their treatment method is still controversial. We considered reduction of the distal radio-ulnar joint (DRUJ) surface the most important factor when treating distal ulna fractures accompanied by residual dislocation. We herein presented a patient with a distal ulna fracture accompanied by dislocation of the DRUJ surface in whom an autogenous bone fragment collected from the radius was grafted onto the ulnar bone defect after open reduction and Herbert screw fixation. In this technique, the bone fragment was supported through the medullary cavity by inserting a Herbert screw, which was less likely to cause irritation between the screw and surrounding tissue, because the screw was almost entirely present in the bone. In addition, an autogenous bone graft from the same surgical field may be less invasive than that from another region.

Femoral head fracture associated with hip dislocation is relatively rare but very severe injury. Due to its severity and the need of joint exposure for the reduction of femoral head fracture, the surgical treatment cannot but accompany many complications, including the osteonecrosis of the femoral head, heterotopic ossification, and post-traumatic osteoarthritis. We report a case of less invasive percutaneous screw fixation for the femoral head fracture with excellent clinical result. Post operatively, the fracture was healed, and no acute complication was observed. At 4 years post operation, full Harris hip score was achieved, and there were no osteonecrosis of the femoral head, no heterotopic ossification, and no post-traumatic osteoarthritis. We suggest attempting less invasive percutaneous screw fixation for the femoral head fracture.

Purpose: Spinopelvic fixation and triangular osteosynthesis give firm internal fixation for unstable pelvic ring injuries (UPRI), but with sacrifice of mobility of the lumbar spine. Here, we describe the procedure and outcomes of a new approach, which we refer to as "within ring"-based sacroiliac rod fixation (SIRF).Methods: The patient was placed in a prone position and longitudinal skin incisions were made at the medial margins of the bilateral posterior superior iliac spines (PSIS). After reduction of fracture, a pedicle screw was inserted into the first sacral vertebra on the injured side and iliac screws inserted through the bilateral PSIS were bridged using rods.Results: SIRF was performed in 15 patients. The AO/OTA classification was 61-B2.3 in 1, C1.3 in 4, C2.3 in 7, C3.3 in 1, and H-type spinopelvic dissociation in two cases. The mean operative time was 179 (110-298) minutes, mean blood loss was 533 (100-2700) cc. One patient died during hospitalization and three patients stopped outpatient treatment. The other 11 patients achieved bone union without major loss of reduction in a mean post-operative follow-up period of 23.8 (4-50) months. The mean Majeed score at final follow-up was 86.7 (73-96) out of 96, excluding scoring sexual intercourse.Conclusions: "Within ring"-based SIRF not including the lumbar spine in the fixation range is a simple, safe, and low-invasive internal fixation method for UPRI. [ABSTRACT FROM AUTHOR]

Distal ulna fractures often occur with distal radius fractures, and their treatment method is still controversial. We considered reduction of the distal radio-ulnar joint (DRUJ) surface the most important factor when treating distal ulna fractures accompanied by residual dislocation. We herein presented a patient with a distal ulna fracture accompanied by dislocation of the DRUJ surface in whom an autogenous bone fragment collected from the radius was grafted onto the ulnar bone defect after open reduction and Herbert screw fixation. In this technique, the bone fragment was supported through the medullary cavity by inserting a Herbert screw, which was less likely to cause irritation between the screw and surrounding tissue, because the screw was almost entirely present in the bone. In addition, an autogenous bone graft from the same surgical field may be less invasive than that from another region. [ABSTRACT FROM AUTHOR]

Purpose: Malalignment of syndesmosis is generally associated with a poor outcome, yet occurs at a high rate in malleolar ankle fractures. In this study, we examine whether malreduction of syndesmosis injury associated with malleolar ankle fracture can be avoided using Weber's three indexes in the mortise view.Materials and Methods: Of 156 patients with malleolar ankle fracture who underwent surgery from December 2012 to March 2016 at two medical facilities, 24 patients who received syndesmotic screw fixation were included in the study. Fractures were Danis-Weber types B and C in 8 (8/134, 6.0%) and 16 (16/22, 72.7%) patients, respectively. Using axial computed tomography (CT), we calculated the difference between injured and non-injured sides for each of three parameters: tibiofibular clear space (TFCS), anterior tibiofibular interval (ATF), and fibular rotation (θfib). Malreduction was diagnosed if one or more of the three parameters had an abnormal value. Weber's three indexes in the mortise view on the injured side were used to determine whether reduction of syndesmosis was performed successfully. Consistency between the evaluation of reduction of syndesmosis in axial CT images and reevaluation of mortise views was examined by calculation of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).Results: The rate of malreduction of syndesmosis in axial CT images was 29.2% (7/24). Re-evaluation in the mortise view confirmed malreduction of syndesmosis in six of the seven subjects, all of whom also had malreduction based on axial CT images. The one subject in whom malreduction could not be detected in a mortise view showed an abnormal value only for ATF. Use of the mortise view for perioperative diagnosis had a sensitivity of 0.857, specificity of 1.000, PPV of 1.000, and NPV of 0.944.Conclusion: The results of our study show that malreduction of syndesmosis can be avoided by careful interpretation of intraoperative perspective mortise views based on Weber's three indexes. To increase the diagnostic accuracy further, it is important to detect anteroposterior deviation of the fibula in intraoperative lateral views. [ABSTRACT FROM AUTHOR]

Purpose: There are various types of intertrochanteric fractures that are unstable pertrochanteric fractures of the hip. The aim of this study was to develop a systematic and comprehensive classification of intertrochanteric fractures.Materials and Methods: This study enrolled 74 patients with intertrochanteric fractures treated by us between 2012 and 2015. The fractures were classified using 3D-CT images taken immediately after the fractures occurred based on the course of the lateral fracture line (LFL) that extends through the lateral femoral cortex distal to the vastus ridge of the greater trochanter in the intertrochanteric area. Furthermore, the presence or absence of additional typical fractures was also studied. Then, 4 orthopedic specialists examined the 3D-CT images of 20 patients randomly selected from the 74 patients to evaluate both the inter-rater and intra-rater agreement levels.Results: Intertrochanteric fractures were classified into three types according to the LFL patterns. Type I (41.9%), the Lateral Wall Pattern, has a LFL that extends towards the lateral fiber bundle attachment area of the iliofemoral ligament. Type II (24.3%), the Transverse Pattern, has a LFL that extends towards the medial bundle attachment area. Type III (33.8%), the Reverse Oblique Pattern, has a LFL that extends between the lateral and medial fiber bundle area of the iliofemoral ligament. Each type showed characteristic displacement and was associated with various combinations of typical fractures (fracture across the intertrochanteric line, posteromedial fragment, including the lesser trochanter, posterolateral fragment posterior to the femoral greater trochanter, and banana-shaped big fragment, including both the greater trochanter and the lesser trochanter). The mean κ values for the interobserver and intraobserver agreement levels were 0.77 (0.70-0.85) and 0.76 (0.70-0.85), respectively, which were considered substantial agreement levels.Conclusion: We believe our new classification is a useful communication tool for medical professionals in the diagnosis of fractures. [ABSTRACT FROM AUTHOR]