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Elbow injuries are common in judo, particularly among adolescents. This study investigated the incidence and patterns of three types of elbow injuries (sprain, dislocation, and fracture-dislocation) among Japanese adolescent judo players (12 to 18 years old) using data from a nationwide insurance database, covering the period from 2010 to 2019. A total of 4614 elbow injuries were recorded, with sprains being the most frequent (67.6% of cases). Female players had a 20% higher incidence of sprains than male players (6.8 vs. 5.4 per 1000 athlete-years). Severe injuries, such as dislocations and fracture-dislocations, were more common in high school players, with male middle school students exhibiting a higher rate of elbow fracture-dislocations (+15%) compared with female students. Elbow injuries frequently occurred during te-waza techniques, particularly seoi-nage, when players extended their arms to prevent being thrown. Peripheral nerve injuries, predominantly ulnar nerve injuries, accompanied elbow dislocations in 74% of the cases. This study highlights the importance of proper instruction in defensive and ukemi techniques, particularly those that discourage the use of hands to prevent falls during throws, to reduce the risk of elbow injuries. [ABSTRACT FROM AUTHOR]

Objective: Hamatometacarpal fracture-dislocations (HMFD) are rare hand injuries resulting from axial loading. This study aimed to present the clinical presentation and outcomes of HMFD, which is rare and likely to be missed in the emergency department. Methods: A retrospective analysis of 15 patients who underwent surgical intervention for HMFD between 2015 and 2023 was conducted. At the last follow-up, the presence of union, malunion, residual subluxation, and Kellgren-Lawrence grading scale were evaluated. Time to diagnosis, time to return to work (RTW), level of difficulty in working, grip strength, and disabilities of the arm, shoulder, and hand (DASH) scores were evaluated. Results: The mean patient age was 30.6 years. Most injuries (93.3%) were due to punching. Open reduction was performed in 73.3% of cases. No complications were reported during the mean of 52.3-month follow-up. Open reduction was associated with a lower DASH scores. Hand-intensive work was correlated with a longer time to RTW and higher difficulty to RTW. Delayed diagnosis was correlated with worse grip strength, but not with significantly different DASH scores. Conclusion: HMFD is a rare hand injury that presents as a diagnostic challenge. Achieving anatomical reduction is crucial for restoring hand function. Therefore, comprehensive treatment strategies should be planned individually, taking into account patients's injury patterns. [ABSTRACT FROM AUTHOR]

Background: Anterior fracture dislocation of the shoulder may have associated injury to the glenoid labrum and/or capsule. There is a need to look at the possible patterns of capsulo-labral injuries intra-operatively and correlate them with pre-operative radiographs and CT scans. It can enable surgeons to predict the patterns of soft-tissue injuries in a specific fracture type. Methods: Patients operated for ORIF of 3- and 4-part anterior fracture dislocation between January 2017 and December 2022 were included in the study. The following data were collected: demographic details, fracture morphology and classification on radiograph and CT scan, neurovascular injury, the subtype of anterior dislocation, and intra-operative identifiable injury to glenoid labrum and/or capsule. Results: A total of 24 cases (mean age 40 ± 10 years) of anterior fracture dislocation of the shoulder were included in the study and were grouped based on Neer's classification. 12 patients had 3-part anterior fracture dislocation (3-part Group) with a mean age of 34 ± 9 years, while 12 patients had 4-part anterior fracture dislocation (4-part Group) with a mean age of 46 ± 7 years (p = 0.001). 10 out of 12 patients in the 3-part Group had the subcoracoid position of the dislocated head, whereas the head was present in 9 out of 12 patients of the 4-part Group at the preglenoid position (p = 0.003). The head position was at a mean distance of 1.85 cm from the anterior glenoid rim in the 4-part Group, whereas the head was engaged at the anterior rim of the glenoid in the 3-part Group. The medial metaphyseal beak was present in 11 out of 12 patients in the 3-part Group, whereas it was absent in all the cases of the 4-part Group (p = 0.001). 92% of the included patients in our study had capsulo-labral injury. 11 out of 12 patients in the 3-part Group had labral injury compared to 10 out of 12 patients in the 4-part Group with severe capsular stripping (p = 0.001). Conclusion: The 3-part fracture dislocation with radiological findings such as the long medial metaphyseal beak and subcoracoid position of the dislocated head had a strong association with a glenoid labral injury, whereas the 4-part fracture dislocation type had a widely displaced preglenoid position of the dislocated head with an absent metaphyseal beak and had a strong association with a capsular type of soft-tissue injury. Level of Evidence: III. [ABSTRACT FROM AUTHOR]

Purpose: To describe our institutional experience and results in the surgical management of multiligament knee injuries (MLKI). Materials and methods: Retrospective series of MLKI consecutively operated on at a single, level I Trauma Center. Data on patients' baseline characteristics, injuries, treatments, and outcomes were recorded up to one-year follow-up. Recorded outcomes included the Tegner–Lysholm Knee Scoring Scale (TLKSS), return to work, and patient satisfaction. Results: MLKI incidence was 0.03% among 9897 orthopedic trauma admissions. Twenty-four patients of mean age 43.6 years were included in analysis. The mean Injury Severity Score was 12.6. Five patients presented with knee dislocations and six had fracture-dislocations, two of them open fractures. There was one popliteal artery injury requiring a bypass and four common peroneal nerve palsies. Staged ligamental reconstruction was performed in all cases. There were seven postoperative complications. The median TLKSS was 80 and, though patient satisfaction was high, and dissatisfaction was largely restricted to recreational activities (only 58.3% satisfied). Seventeen patients returned to their previous employment. Conclusions: We found a high aggregation of fracture-dislocations secondary to road traffic accidents. One in four patients experienced complications, particularly stiffness. Complications were more common in cases involving knee dislocation. Most patients had good functional results, but 25% were unable to return to their previous work, which demonstrates the long-lasting sequelae of this injury. [ABSTRACT FROM AUTHOR]

Purpose: Proximal humerus fracture occurring simultaneously with shoulder dislocation in children is extremely rare, with only a few reports of such cases having been reported. A systematic review of case reports was conducted to document outcomes after different treatment methods. Methods: A systematic search of literature from 1980 to 2021 was performed from the PubMed/Medline, ScienceDirect, and SCOPUS databases. All case reports on traumatic fracture dislocation of the shoulder in children were included. Results: A total of 18 studies were included with a mean follow-up of 1.5 years. There were 7 boys and 11 girls with an age range from 11 months to 16 years with a median of 6 years. These cases were grouped into two, based on the involvement of the epiphysis with fracture-dislocations. In group A, there were 11 cases (61%) of shoulder dislocation involving the epiphysis. While in group B, there were seven (38%) cases with fracture metaphysis but not involving the epiphysis. Both groups were treated by closed or open reduction with or without internal fixation. All fractures healed in a mean of 7 weeks while the full function was achieved in an average of 21.58 weeks. Conclusion: This systemic review supports the treatment of patients in group A by open reduction with K-wire fixation. While in group B, closed reduction with intramedullary fixation is a better option as it provides satisfactory clinical and radiological results in a short time. [ABSTRACT FROM AUTHOR]

Background: Proximal ulna fracture-dislocations are challenging injuries with a myriad of existing classification systems. The Coronoid, proximal Ulna, Radius, and Ligaments classification (CURL) is a simple framework designed to focus attention on the key components affecting outcome and guide surgical management. This study evaluates interobserver and intraobserver reliability of this new classification. Methods: Four observers independently reviewed plain radiographs and computed tomography (CT) scans of patients with proximal ulna fracture-dislocations. Each observer scored the Coronoid (C), proximal Ulna (U), and Radius (R) components for each fracture on 2 occasions. The osseous components were subclassified as ‘intact’, ‘simple’, or ‘complex’. The Ligament component (L) was not rated as this requires intraoperative classification. Interobserver and intraobserver reliability was calculated using Cohen’s weighted kappa coefficients. X-ray and CT were compared for patients with both imaging modalities. The Landis and Koch criteria were used to interpret the strength of the kappa statistics. Results: One hundred seventy seven patients had plain X-rays; 58 patients had both X-ray and CT scans. Overall, in the X-ray only cohort, there was ‘almost perfect’ interobserver reliability for the radial head (k = 0.94) and coronoid (k = 0.83), and ‘substantial’ reliability (k = 0.68) for the proximal ulna. For the X-ray and CT cohort, interobserver reliability was ‘almost perfect’ across both modalities for the radial head (k = 0.88 and k = 0.93, respectively) and ‘moderate’ for the proximal ulna (k = 0.48 and k = 0.52, respectively). For the coronoid, interobserver reliability for X-ray interpretation was ‘substantial’ (k = 0.74) and for CT was ‘almost perfect’ (k = 0.89). Intraobserver reliability was ‘almost perfect’ for all components, other than CT assessment of the proximal ulna which demonstrated ‘substantial’ reliability (k = 0.74). Conclusion: The Coronoid, proximal Ulna, Radius, and Ligaments classification demonstrates strong interobserver and intraobserver reliability, supporting use of the classification for proximal ulna fracture-dislocations. CT is recommended for improved characterization of any fracture with a coronoid component.

Purpose: Although there are concerns about nonunion of the greater tuberosity or shoulder weakness, hemishoulder arthroplasty (HSA) is a viable treatment option for irreducible four-part proximal humerus fractures-dislocation without rotator cuff tear arthropathy. This study aims to analyze the long-term radiological and functional outcomes of HSA. Methods: This study enrolled 36 patients who underwent HSA due to irreducible four-part proximal humerus fracture-dislocation without rotator cuff tear arthropathy between March 2005 and May 2020. The exclusion group included 10 reverse total shoulder arthroplasty patients. The mean age and mean follow-up period were 68.6 years old and 48.6 months, respectively. Radiological assessments, such as vertical and horizontal greater tuberosity position, greater tuberosity healing, and implant position, were evaluated. Clinically, American Shoulder and Elbow Surgeons Score (ASES), Constant-Murley Score (CMS), and range of motion were evaluated. Results: The greater tuberosity union rate was 55.6% (n = 20), with 44.4% (n = 16) experiencing nonunion, malunion, and bone resorption. The mean vertical and horizontal greater tuberosity positions showed significant difference at last follow-up compared to immediate postoperation. The retroversion of the implant was 23.8 ± 4.61°, and the acromio-humeral interval was 7.6 ± 1.34 mm. The mean last follow-up ASES and CMS were 39.5 ± 4.03 and 55.4 ± 10.41, respectively. The mean active forward flexion, abduction, internal rotation, and external rotation were 100.9 ± 15.04°, 92.5 ± 14.47°, 44.2 ± 12.83°, and 42.5 ± 15.32°, respectively. Conclusion: In long-term follow-up, the greater tuberosity was superiorly migrated and externally rotated. Active forward flexion and abduction in the last follow-up were significantly limited. However, in terms of pain relief, a satisfactory result was seen. [ABSTRACT FROM AUTHOR]

Soccer is one of the most popular sports with millions of active professional and non-professional players worldwide. Traumatic hip dislocations are rare in soccer but can lead to major sequelae both physically and psychologically. The aim of this review was to obtain insight into the outcomes after surgerically repaired hip fracture-dislocation in soccer players as well as rehabilitation and prevention. Two cases of a posterior hip fracture-dislocation that occurred during an amateur soccer match are presented and mechanism of injury, complications and rehabilitation were analysed. Follow-up of both patients was at least one year after surgery. Questionnaires and physical examinations were obtained to quantify and qualify outcome. In both cases the hip-dislocations were reduced within 3 h after injury. Semi-elective open reduction and internal fixation was performed within seven days. In one case, there was a concomitant Pipkin fracture and sciatic nerve neuropathy. There were no postoperative complications. Follow-up showed full of range of motion and normal hip functionality in both cases. However, both patients indicated a reduced quality of life and anxiety related to the accident. Traumatic hip fracture-dislocations during soccer practice are extremely rare. Despite uncomplicated fracture healing after surgery and return of hip function, both patients still suffer from psychological problems resulting in a decreased quality of life. Further research is required to enhance psychological outcomes, as well as to facilitate return to pre-injury levels of participation and engagement in sports following traumatic hip fracture-dislocations related to soccer. [ABSTRACT FROM AUTHOR]

Bosworth fracture and dislocation is relatively rare, accounting for about 1% of ankle fractures. It is characterized by the proximal fibula fracture embedded in the posterolateral distal tibia. Due to an insufficient understanding of this fracture, it is easy to cause missed diagnosis and misdiagnosis in clinical practice. Due to the insertion of the fracture, it is challenging to perform closed reduction, and improper treatment is easy to cause complications. Surgical treatment is recommended for this type of fracture. In order to improve the understanding of orthopedic surgeons about Bosworth fracture and dislocation, this paper reports the diagnosis and treatment of 2 cases of Bosworth fracture and dislocation, and reviews the literature on Bosworth fracture's mechanism, diagnosis, classification, complications, and treatment options in recent years.

Study design: Prospective cohort study. Introduction: Management of the severe thoracolumbar (TL) spine fracture-dislocation injuries have been further complicated by the COVID-19 pandemic. The need to optimize resources and minimize the personnel in the operating room (OR) led us to develop a novel technique to reduce TL fracture-dislocations (AO type-C) using an orthopedic distractor device (ODD). Methods: This prospective study was conducted at a tertiary care spine center with a study duration from March 2020 to May 2020 coinciding with the nationwide lockdown and travel restrictions imposed in view of the COVID-19 crisis. Only patients with AO type C fracture-dislocation managed using the ODD operated by a single surgeon were included in the study. Results: Of 12 cases, the most commonly affected level was D12-L1. Nine patients were American Spinal Injury Association Impairment Scale (AIS) A at presentation, two patients were AIS B, and one AIS C. The mean operative time was 125 min and mean blood loss was 454 ml. Eight patients remained AIS A, one patient improved from AIS B to C. Two patients became independent walkers, one remained AIS B. The post-operative VAS score improved to a mean value of 2.33. The improvement in kyphosis was 26.24° immediate postoperatively and maintained at 25.9°, percentage height loss reduced to 2.75% immediate postoperatively and maintained at 3.16% at 3 months follow-up. Conclusions: Management of TL fracture-dislocations in COVID times of health care resource scarcity can be challenging. Single surgeon with ODD is a useful technique for achieving good results in these injuries. [ABSTRACT FROM AUTHOR]

Bosworth fracture and dislocation is relatively rare, accounting for about 1% of ankle fractures. It is characterized by the proximal fibula fracture embedded in the posterolateral distal tibia. Due to an insufficient understanding of this fracture, it is easy to cause missed diagnosis and misdiagnosis in clinical practice. Due to the insertion of the fracture, it is challenging to perform closed reduction, and improper treatment is easy to cause complications. Surgical treatment is recommended for this type of fracture. In order to improve the understanding of orthopedic surgeons about Bosworth fracture and dislocation, this paper reports the diagnosis and treatment of 2 cases of Bosworth fracture and dislocation, and reviews the literature on Bosworth fracture's mechanism, diagnosis, classification, complications, and treatment options in recent years. [ABSTRACT FROM AUTHOR]

Dorsomedial fracture dislocations of the tarsal navicular are extremely rare injuries which commonly occur secondary to high energy, complex multidirectional forces involving an abduction force to a pronated and plantar-flexed foot. A 44-year-old female presented in the emergency room following a motor vehicle accident with a dorsomedial fracture dislocation of her navicular. Management required acute fusion of the talonavicular joint. There are few reports in the literature discussing the treating, outcomes, and complications of these injuries. Our report represents one method of treating these rare injuries with a favorable outcome.

BACKGROUND: Few studies have compared the clinical efficacy of unilateral and bilateral pedicle screw fixation and fusion in treating atlantoaxial fracture-dislocation. OBJECTIVE: To compare the efficacy of unilateral and bilateral fixation and fusion for atlantoaxial fracture-dislocation and to explore the feasibility of the unilateral surgical procedure. METHODS: Twenty-eight consecutive patients with atlantoaxial fracture-dislocation were included in the study from June 2013 to May 2018. They were divided into a unilateral fixation group and a bilateral fixation group (14 patients in each group with an average age of 43.6 ± 16.3 years and 51.8 ± 15.4 years, respectively). The unilateral group had a unilateral anatomical variation of the pedicle or vertebral artery, or traumatic pedicle destruction. All patients underwent atlantoaxial unilateral or bilateral pedicle screw fixation and fusion. Intraoperative blood loss and operation time were recorded. The visual analog scale (VAS) and Japanese Orthopedic Association (JOA) scoring systems were used to evaluate pre- and postoperative occipital-neck pain and neurological function. X-ray and computerized tomography (CT) were used to assess atlantoaxial stability, the implants' position, and bone graft fusion. RESULTS: All patients were followed up for 39–71 months postoperatively. Intraoperatively, no spinal cord or vertebral artery injury was observed. At the last follow-up, occipital-neck pain and neurological function in the two groups were significantly improved (P < 0.05). The X-ray films and CT showed satisfactory atlantoaxial stability, implant position, and osseous fusion in all the patients at 6 months postoperatively. CONCLUSION: Unilateral and bilateral pedicle screw fixation and fusion can restore atlantoaxial stability and improve occipital-neck pain and neurological function in patients with atlantoaxial fracture-dislocation. The unilateral surgical procedure can be a supplementary option for patients with unilateral abnormal atlantoaxial lesions. [ABSTRACT FROM AUTHOR]

Background: We aimed to find the prevalence of peroneal tendon instability (PTI) accompanying different types of calcaneal fractures and to determine predictors of PTI based on preoperative CT scanning. Methods: In a retrospective cross-sectional study, preoperative CT scans of 400 consecutive calcaneal fractures undergoing surgery were reviewed for comminuted fragments in the lateral gutter of the ankle, fractures at the tip of the lateral malleolus, dislocated peroneal tendons, excessive displacement of the lateral calcaneal wall, calcaneal fracture-dislocation, superior peroneal retinaculum (SPR) avulsion fracture (fleck sign), and shape of the retromalleolar groove. The correlation of these variables with intraoperative SPR stress test, defined as the diagnostic criteria for PTI in calcaneal fractures, was evaluated. Results: In total, 369 patients (mean age, 39 ± 13; range, 11-72 years), with 321 (87.0%) of them male, were included. Among all calcaneal fractures, 67 cases (16.7%) had associated PTI as confirmed intraoperatively by an SPR stress test. A statistically significant association was found between PTI in calcaneal fractures and comminuted fragments in the lateral gutter of the ankle (P =.03), dislocated peroneal tendons (P <.001), calcaneal fracture-dislocation (P <.001), SPR avulsion fracture (P <.001), and Sanders type IV of calcaneal fracture (P =.02). There was no statistically significant relationship between PTI and the mechanism of injury (P =.98), side of fracture (P =.30), uni- or bilateral calcaneal fractures (P =.27), a fracture at the tip of lateral malleolus (P =.69), shape of the retromalleolar groove (P =.78), or excessive displacement of the lateral calcaneal wall (P =.06). The most specific CT finding to predict PTI accompanying calcaneal fractures was calcaneal fracture-dislocation (99.1%). Conclusion: Following calcaneal fracture fixation, PTI was confirmed with intraoperative SPR stress test in one-sixth of cases. With the exception of calcaneal fracture-dislocation, preoperative findings on CT scanning and calcaneal fracture pathoanatomy are insufficient to diagnose PTI accompanying calcaneal fractures. Level of Evidence: Level III, retrospective case control study. [ABSTRACT FROM AUTHOR]

Background: Heterotopic ossification (HO) is a well-recognised complication of after elbow trauma. The prevalence and risk factors of HO have been previously reported. However, these reports were based on elbow trauma that had undergone surgical treatment and most of them were from Western countries. This study aimed to assess the incidence of HO in patients with elbow fractures who were treated surgically and non-surgically in Japan. Methods: We retrospectively identified consecutive patients who were treated of elbow fractures and fracture–dislocations at our institution in recent consecutive 3-year periods. We extracted patient demographics, injury mechanisms and treatment details from the medical records. Furthermore, we reviewed radiographs to classify the fracture pattern and identify the presence or absence of HO. Results: HO was identified in 6/97 (6%) patients. Fracture–dislocation was noted in 4/6 patients. The fracture types with HO included terrible triad injury (n = 2), isolated coronoid process fractures (n = 2), distal humerus A-type fractures (n = 1) and radial head fracture (n = 1). According to the Hastings and Graham classification, HO was classified as Class I in five patients and Class II B in one patient who underwent additional surgery for HO resection. Conclusions: The incidence of HO was relatively low in our patients. However, of the 20 conservatively treated elbows, one patient developed clinically relevant HO and required excision of HO. Even patients with elbow fractures treated conservatively should be informed of the potential risk of developing severe HO requiring surgical excision. In addition, surgeons in this region could use these data to inform patients about the risk of HO development after an elbow injury. Level of Evidence: Level IV (Therapeutic) [ABSTRACT FROM AUTHOR]

INTRODUCTION: Bosworth fracture dislocations of the ankle are rare injuries of the ankle caused by extreme external rotation of the supinated foot where the proximal fibula fracture fragment is posteriorly dislocated and entrapped behind the posterior-lateral ridge of the tibia. This case series aims to document three such cases treated in our institution over a nine year period. We also provide a review of 129 cases in the existing literature. MATERIALS AND METHODS: Medical records and relevant radiographs for each patient were analysed and collected from the time of presentation till the point of latest follow- up. During each clinic visit, all physical exam findings as well as all complications were recorded. The American Foot and Ankle Society (AOFAS) Hindfoot score was also tabulated for each patient at the point of latest review. RESULTS: Closed reduction was unsuccessful in all three patients, and all required open reduction. One patient had an uncomplicated recovery whilst the remaining two suffered significant soft tissue complications. One patient suffered severe soft tissue swelling preventing primary closure at the time of surgery, whilst another suffered post-operative wound dehiscence and infection. Eventually all fractures healed, and all three patients obtained satisfactory AOFAS scores. CONCLUSION: The diagnosis of Bosworth fracture dislocations of the ankle is often delayed or missed, due to its rare occurrence. Closed reduction is often unsuccessful, and early open reduction is required to avoid poor clinical outcomes due to severe soft tissue damage or even compartment syndrome.

Bosworth lesions are fracture-dislocations of the ankle and are characterized by entrapment of the proximal segment of the fibula behind the posterior tubercle of the distal tibia. Treatment is challenging, mainly due to failure of a closed reduction. The aim of this study was to review the literature concerning this type of injury. A total of 103 patients with Bosworth fractures were included in the study. The analyzed studies yielded a total of 103 cases, of which 68% (n = 70) were male and 32% (n = 33) were female. Bosworth fractures are mainly due to accidental trauma (58.2%), sports-related injuries (18.4%), and traffic accidents (18.4%). More than 76% of the patients presented a Danis–Weber B fracture, 8.7% a type C fracture, and only 0.97% presented a type A fracture. In 92.2% of the patients, the attempted closed reduction was unsuccessful. A definitive treatment with open reduction and internal fixation (ORIF) was used in 96 patients (93.2%). The most frequent complication was post-traumatic arthritis (10.7%). Bosworth fractures are challenging. The available literature lacks adequate information about this fracture, and an approved standardized algorithm for treating such fractures is not available. [ABSTRACT FROM AUTHOR]

Although medial epicondyle fractures are responsible for 12% of pediatric elbow fractures, they rarely occur concurrently with a capitellar fracture, and the treatment approach and indications are controversial. According to the case report (CARE) guidelines, here we present a case of the medial epicondyle and capitellar fractures with elbow dislocation in a 4-year-old girl who underwent K-wire fixation and splint application. After four months of follow-up, the patient showed good results and a full range of motion. Open reduction and internal fixation may be reasonable options for medial epicondyle and concomitant capitellar fractures using the medial and lateral approaches. We suggest using K-wires, especially in the pediatric population. [ABSTRACT FROM AUTHOR]

Background: Open reduction and internal fixation with a plate is one of the alternative treatments for fracture–dislocation of the proximal interphalangeal (PIP) joint. However, it does not always lead to satisfactory results. The aim of this cohort study is to describe the surgical procedure and discuss the factors affecting the treatment results. Methods: We retrospectively reviewed 37 cases of consecutive unstable dorsal fracture–dislocation of the PIP joint treated using a mini-plate. The volar fragments were sandwiched with a plate and dorsal cortex, and screws were used as subchondral support. The average rate of articular involvement was 55.5%. Five patients had concomitant injuries. The mean age of the patients was 40.6 years. Mean time between injury and operation was 11.1 days. The average postoperative follow-up duration was 11 months. Active ranges of motion, % total active motion (TAM) were evaluated postoperatively. The patients were divided into two groups according from Strickland score and Gaine score. Fisher's exact test, Mann–Whitney U test and a logistic regression analysis were used to evaluate the factors affecting the results. Results: The average active flexion, flexion contracture at the PIP joint, and % TAM were 86.3°, 10.5° and 80.6%, respectively. Group I included 24 patients who had both excellent and good scores. Group II included 13 patients who had neither excellent nor good scores. When the groups were compared, there was no significant relationship between the type of fracture–dislocation and the extent of articular involvement. There were significant associations between outcomes and patient age, period from injury to surgical intervention and presence of concomitant injuries. Conclusions: We concluded that meticulous surgical technique leads to satisfactory results. However, factors, including the patient's age, time from injury to surgery and the presence of concomitant injuries needing adjacent joint immobilisation, contribute to unsatisfactory outcomes. Level of Evidence: Level IV (Therapeutic) [ABSTRACT FROM AUTHOR]

Aim and background: Intra-articular fractures of the proximal interphalangeal (PIP) joint are a difficult entity to treat, commonly leading to stiff and painful fingers. There are multiple techniques described for treatment. We utilize a simple technique consisting of a static traction assembly and early mobilization of the finger to treat this pathology. In this study, we present results obtained with this modality. Materials and methods: We utilize a malleable aluminum splint for traction against the injured finger. No. 1 polypropylene suture through nail plate of injured finger applies traction to hold joint in reduced position for 2 weeks. At 2 weeks, active-assisted mobilization of the injured finger is begun. Patients were evaluated for the range of motion achieved, radiograph picture, presence of pain, and ability to return to work. Results: There were 11 cases of intra-articular fractures of the middle phalanx base. The median period of follow-up was 15 months (range 7.5-31 months). The average active flexion possible at the injured joint was 87.7°(range 55-110°). Two patients reported mild pain on terminal flexion without functional limitations. In unstable injuries, suboptimal alignment of fracture was common [9 out of 11]. Despite suboptimal radiographs, patients had a functional, painless range of motion. All patients went back to previous work. Conclusion: Static traction technique with early mobilization protocol is a safe, relatively simple, and effective technique in the management of intra-articular fractures of the PIP joint. Early mobilization of joint facilitates remodeling of the articular base of the middle phalanx with the recovery of painless motion at the PIP joint despite radiological abnormalities.

Large posterolateral tibial fragments, known as Volkmann fractures, are common in ankle fracture-dislocations and typically require open reduction and fixation with interfragmentary screws and often buttress plates using a prone posterolateral approach. In this setting, fibula plating often necessitates dissection of the lateral window between the peroneal tendons and the skin, increasing wound-related complications. In recent years, intramedullary nailing of fibula fractures has gained popularity as a minimally invasive technique that allows load-sharing stabilization. However, this procedure has traditionally been performed in the supine position, which can pose challenges if a Volkmann-type fracture is present, requiring repositioning and losing access to the fibula through the posterolateral approach. Our objective is to describe a technique for fixing ankle fracture-dislocations with large posterolateral fragments using tibial buttress plates and fibula nails through a prone posterolateral approach without dissecting the lateral window. Additionally, we will present a case series with preliminary results. [ABSTRACT FROM AUTHOR]

PurposeTo evaluate the long-term curative effect analysis of trans-articular plate combined with Kirschner wires in the treatment of fracture-dislocation of the fifth carpometacarpal joint.MethodsFrom July 2016 to September 2021, 21 patients with fracture-dislocation of the fifth carpometacarpal joint were treated with trans-articular plate combined with Kirschner wires internal fixation. Each patient's gender, age, dominant hand, injured hand, trauma mechanism, the time between injury and surgery, the range of motion of the bilateral wrist in flexion, extension, radial deviation and ulnar deviation, grip strength of each side, the time of return to work, and follow-up time were recorded. The QDASH score and Cooney wrist function score were used to evaluate the postoperative function. The VAS system was used to evaluate postoperative pain.ResultsThe follow-up time was 37.0 ± 19.0 months and the time between injury and surgery was 1.3 ± 0.5 days. In the injured side and the contralateral side, the range of motion of the wrist flexion were 58.3 ± 4.0° and 60.5 ± 3.1°, the range of motion of the wrist radial deviation were 25.7 ± 3.3° and 26.9 ± 2.9°, the range of motion of the wrist ulnar deviation were 28.1 ± 3.7° and 29.5 ± 3.1° respectively with no significant difference. The range of motion of the wrist extension (54.0 ± 3.4°) in the injured side was smaller than that in the contralateral side (56.7 ± 3.7°) with significant difference. The grip strength of the injured side and the contralateral side were 96.1 ± 9.5 LB and 100.7 ± 9.7LB respectively with no significant difference. The QDASH score was 3.8 ± 1.8, Cooney wrist function score was 94.5 ± 4.2, VAS score was 1.0 ± 0.8 and the time of return to work was 5.1 ± 0.9 weeks. In the 21 cases, no postoperative complications such as incision infection, failure of internal fixation, fracture nonunion or fracture malunion occurred.ConclusionThe method of trans-articular plate combined with Kirschner wires is one of the alternative treatments for the fracture-dislocation of the fifth carpometacarpal joint. The long-term follow-up results were satisfactory.

The long-term outcomes of extension block pinning used to treat unstable dorsal fracture-dislocations of the proximal interphalangeal joint have been investigated in a single centre. Thirty-one patients (33 fingers) had a clinical and radiological assessment at a mean follow-up of 16 years. Excluding one joint salvaged with an arthrodesis, the mean active range of motion of the joints was 80° with a mean 5° extension deficit. The mean active range of motion of the distal interphalangeal joint was 64°. The mean Patient-Rated Wrist and Hand Evaluation score was 6, indicating, minimal disability. The mean numeric rating scale for overall subjective pain on a scale of 0–10 was 1 and was not associated with the active range of movement. The Kallman osteoarthritis score and the range of movement of the proximal interphalangeal joint had a negative association. The long-term outcomes were satisfactory and similar to the mid-term follow-up results of the same patient cohort reported 11 years earlier. Level of evidence: IV [ABSTRACT FROM AUTHOR]

Introduction: Introduction: Lumbar facet fracture-dislocations are rare injuries that are generated from a significant trauma. Literature regarding these injuries is limited to case reports, and there are even more limited reports concerning whether the delay of operative intervention in neurologically intact patients can achieve good clinical results if concomitant injuries and/or medical issues preclude urgent operative intervention. There has been no consensus on which operative techniques are effective in achieving an anatomic reduction of these injuries., Objectives: A case report of an L4-L5 facet fracture-dislocation with delayed operative intervention and previously not reported adjunctive reduction technique is presented with an excellent clinical outcome result being achieved., Case Report: A 38-year-old female who presented with an L4-L5 facet fracture-dislocation without neurological deficit after an unknown mechanism of injury. Due to concerns for elevated risk of intra and perioperative complications from general anesthesia secondary to recent drug use, the patient ultimately underwent open reduction and L4-L5 posterior instrumentation and fusion, with a resection of the superior aspect of the L5 pedicle being performed to help achieve reduction. The patient did not report any significant lower back pain and remained motor intact at 6-month post-operative, with the only neurological symptom during her post-operative course being hypesthesias in the right L5 dermatome at 6-week post-operative., Conclusion: Excellent clinical results can be achieved with delayed open reduction and posterior stabilization in patients that sustain lumbar facet-fracture dislocations. The precise timing for operative management for patients who sustain these injuries is unknown, but medical stability should be considered before proceeding with an operative intervention in neurological intact patients. Partial resection of the pedicle is a safe and effective reduction technique in certain fracture-dislocation patterns., Competing Interests: Conflict of Interest: Nil, (Copyright: © Indian Orthopaedic Research Group.)

Introduction: posterior glenohumeral fracture dislocation (PGHFD) is a rare injury. It may present secondary to a seizure, electrocution or due to direct trauma. It is usually missed, and late diagnosis is common which increases the rate of complications and sequalae. Case report: 52 year old male, transferred to a reference trauma center due to a tonic-clonic seizure and a right PGHFD. Upon admission radiographs are requested and right shoulder injury is confirmed. Additionally, a simple left posterior glenohumeral dislocation (that was missed in the initial assessment of the patient) is observed. A computed tomography (CT) scan is obtained for both shoulders to plan surgery. The CT scan showed a bilateral PGHFD with severe comminution in the left shoulder, showing considerable worsening of the left shoulder since admission. Open reduction and bilateral locked plate osteosynthesis were performed in a one stage surgery. At two years follow up the patient evolved favorably with a Quick DASH score of 5% and a CONSTANT score of 72 and 76 for his right and left shoulder, respectively. Conclusion: PGHFD is an infrequent injury, which requires a high level of suspicion to avoid diagnostic delay and prevent complications and sequelae. Bilateral cases may be seen in cases of seizure. With prompt surgical treatment, satisfactory results can be achieved with a complete return to normal activities. [ABSTRACT FROM AUTHOR]

Complex pelvic ring injuries in childhood can be difficult to treat, and literature mentions several techniques for fixing SIJ fracture-dislocations. In accordance with the CAse REport (CARE) guidelines, this study describes a five-year-old boy with a complex pelvic ring fracture caused by a car accident: vertically unstable pelvic fracture consists of bilateral superior rami fractures and type I of Denis sacral fracture. Fixation was achieved by inserting a 6.5 mm major diameter cannulated screw with a 60 mm length and 16 thread into the SIJ at the level of S1. The pelvic inlet view corrected the anterior-posterior position, and the pelvic outlet view adjusted the superior-inferior position to determine a suitable sacral level. After three months, the SI joint has shown an anatomically fracture consolidation, and he could ambulate with full weight-bearing and full ROM with no pain. A 3-year follow-up showed promising results in radiological and functional terms.We conclude that percutaneous SI screw fixation using a cannulated screw is a suitable technique for pediatrics because it provides anatomic reductions and is minimally invasive. Children as young as five can be treated safely with SI screws for sacral fractures and SIJ injuries.

Objective To report a case series of calcaneal fracture–dislocations, which have not been described previously in China, and to provide a systematic review to explore the clinic manifestations, methods for diagnoses, and treatments. Methods Between January 2018 and December 2019, 4 patients (4 men; average age, 33.0 ± 16.67 years; range, 15–50 years) were diagnosed with fracture–dislocation of the calcaneus and treated by surgery. We also reviewed published cases and studies of calcaneal fracture–dislocations through the databases of PubMed and Web of Science between January 1977 and December 2019. Results Between January 2018 and December 2019, 4 cases were identified as calcaneal fracture–dislocations in our hospital. The main clinical manifestations include hindfoot pain, swelling, and deformity. The diagnoses were confirmed via radiographic examination. Two patients underwent open reduction and internal fixation (ORIF) and two were treated with a minimally invasive approach. Diagnosis had been missed in one patient and, consequently, presented with early signs of post‐traumatic arthritis, which may require extra subtalar arthrodesis in the future. Two patients were diagnosed inaccurately but achieved satisfactory outcomes through open reduction and internal fixation. The average follow‐up period was 9.75 ± 5.19 months. Except for the 1 misdiagnosed patient, the other 3 patients showed functional improvement. Only 23 fracture–dislocations of calcaneus cases were reported in the literature between January 1977 and December 2019. There were 15 Sanders type II fractures (65.22%) and 7 (30.43%) Sanders type III fractures, and there was 1 grade II open calcaneal fracture. Among them, 1 was a medial dislocation and 2 were “joint‐elevation” dislocations; the rest of them (20/23, 86.96%) were lateral dislocations. A total of 11 patients (47.83%) exhibited the double‐density sign, and varus tilt of the talus was revealed on plain radiographs for 9 patients (39.13%). Increased Bohler's angle was evident in lateral X‐ray films for 2 patients (2/23, 8.70%). A total of 21 cases (86.96%) were treated with surgical intervention and achieved satisfactory outcomes. Only 1 patient was treated with external fixation. Another 2 patients were treated conservatively and had poor clinic outcomes. Conclusion Calcaneal fracture–dislocation is a rare injury that is challenging to treat. Clinical manifestations such as fibular tendon dislocation, the double‐density sign on profile radiography, and abnormal talar tilt in the distal talofibular joint are important signs that may indicate this rare injury pattern. Timely surgical intervention is essential for satisfactory clinic outcomes. Orthopaedic surgeons should be aware of this uncommon injury to avoid misdiagnosis or inappropriate treatment.

Perilunate injuries are complex and rare lesions with circumferential carpal bones, ligamentous and cartilage involvement. Despite optimal surgical treatment, poor prognosis is expected and usually gets worse over time. Our aim was to address clinical and radiological outcomes after 2 years of follow-up. Seven wrists were revised with average age of 35.59 ± 14.01 (range 21–56) years old and mean follow-up of 44.10 ± 14.24 (range 25.60–68.63) months. At the latest follow-up, mean postoperative VAS score for pain was 2.71 ± 3.40 and DASH score was 10.48 ± 10.54. Patients returned to work in 5.00 ± 3.15 months. Strength and Range of Motion (ROM) parameters were ∼80% of the contralateral side, with exception for extension (61%) and radial deviation (73%). After 2 years of follow-up, radiographic arthrosis was observed in 29% of the cases. One of these patients was symptomatic and was proposed for arthrodesis. Mean carpal height was 1.51 ± 0.81 and scapholunate angle was 41.58 ± 22.82°. A correlation was observed between arthritis found at final follow-up and grip (r = −0.8660; p

C7-T1 translational injuries are relatively rare, unstable, and usually associated with neurological impairment. We aim to analyze the C7-T1 translational injury based on Allen and Ferguson's classification and to highlight the clinicoradiologic and neurologic outcomes in these patients. Patients with C7-T1 translational injury were retrospectively analyzed and demographic data, mechanism, mode of injury, surgery details, and associated injuries were obtained. The initial neurologic status was recorded as American Spinal Injury Association (ASIA) grade. All the injuries were classified as per Allen and Ferguson classification and stage 4 compressive extension (CE) injury was further classified into stage 4a and stage 4b according to Rebich et al. Among 44 patients, the most common mechanism of injury was CE injury seen in 27 patients (61.4%) followed by distractive flexion (DF) in 16 patients (36.4%) and compressive flexion in 1 patient (2.2%). Neurologic deficit was noted in 14 of 27 patients (51.85%) with CE injury, which was less compared to 12 of 16 patients (75%) with DF injury. However, there was no significant difference in terms of neurologic recovery. One patient with standalone anterior fixation had implant loosening and underwent additional posterior fixation. We present the largest series of C7-T1 translational injuries in the literature to our best knowledge. CE injury is nearly 2 times more common than DF injury and is associated with a lower incidence of neurologic deficit and easier fracture reduction techniques. Staging the injury severity aids in better planning in terms of surgical approach and levels of fixation. [ABSTRACT FROM AUTHOR]

Following dislocation of the glenohumeral joint with an isolated greater tuberosity fracture, closed reduction in the emergency department can lead to fracture propagation or iatrogenic fractures. This article assesses the evidence regarding when anterior dislocations of the shoulder with an isolated fracture of the greater tuberosity can be safely reduced in the emergency department, as there is currently no clear guidance on this. A total of eight articles described 172 cases which underwent closed reduction, which resulted in 22 cases of iatrogenic fractures. Female sex, increased patient age and fragments of the greater tuberosity were associated with an increased risk of iatrogenic fractures. Closed reduction in the emergency department appears to be a safe option in younger patients and those with greater tuberosity fractures less than 40% of the width of the humeral head. [ABSTRACT FROM AUTHOR]

Purpose: Posterior fracture-dislocation of shoulder is an infrequent traumatic event; however, most orthopaedic surgeons may face the challenge of treating it. The aim of this study is to review and summarise systematically the current principles of the management of this complex injury, and create a treatment algorithm. Methods: Both PubMed and Scopus Databases were systematically searched for the terms “posterior shoulder fracture-dislocation” or “posterior glenohumeral fracture-dislocation” or “posterior glenoid fracture-dislocation” for articles written in English and published in the last decade. Results: A total of 900 articles were identified, of which 13 were retained for analysis. A total of 153 patients (161 shoulders) were identified. These patients were treated either with open reduction and internal fixation, modified McLaughlin procedure, allograft/autograft humeral head reconstruction or shoulder arthroplasty. The mean age was 40.15 years. The mean postoperative Constant score in cases treated by open reduction and internal fixation was 86.45, whereas by bone graft was 84.18. Further, the mean postoperative Constant score was between 79.6 and 67.1 in those that were managed by modified McLaughlin and arthroplasty procedure, respectively. Conclusion: The management of posterior shoulder fracture-dislocation may be challenging, and the best surgical option depends on many variables such as the chronicity of the injury, the presence of a fracture at the level of the surgical neck or tuberosities and the extend of the Hill-Sachs lesion if any. A treatment algorithm is proposed, based on the current literature in an effort to create a consensus for these injuries. For the acute shoulder fracture-dislocations, an open reduction should be performed. For the chronic fracture/dislocations in the elderly low-demand patients, conservative treatment should be performed. For the rest of the patients, depending on the severity of the Hill-Sachs lesion different surgical options are available such as the McLaughlin technique, the use of an allograft, osteotomy or arthroplasty.

Background: The purpose of this study was to identify the risk factors for posttraumatic osteoarthritis (OA) after surgery for ankle fractures in patients aged ≤50 years. Methods: We performed a retrospective review of consecutive patients who underwent surgery for ankle fractures and were followed up for a minimum period of 5 years. The patients were assigned to 2 groups according to the presence of advanced OA at the last follow-up. Binary logistic regression was used to model the correlation between risk factors and OA. Functional outcomes were assessed using the Foot and Ankle Outcome Score. Results: The data of 332 patients who met the inclusion criteria were included in the analysis. The overall rate of posttraumatic arthritis was 27.7% (nonarthritis group: 240 patients, arthritis group: 92 patients). The arthritic change was significantly affected by BMI (95% confidence interval [CI] 1.29-19.76; adjusted odds ratio [OR] ≥ 30, 6.56), fracture-dislocation injury (CI 1.66-11.57; adjusted OR, 4.06), posterior malleolus (PM) fracture (CI 1.92-12.73, adjusted OR > 25% of the articular surface, 5.72), and postoperative articular incongruence (CI 1.52-18.10; adjusted OR, 7.21). The mean scores of the arthritis group were lower than those in the nonarthritis group (P <.05). Conclusion: Obesity, fracture-dislocation injury, concomitant large PM fracture, and articular incongruence were risk factors of posttraumatic OA after surgery for ankle fractures. Surgeons should be aware that accurate reduction is critical in patients with ankle fractures with associated large PM fractures, especially those with obesity or severe initial injuries such as fracture-dislocation. Level of Evidence: Level III, case control study. [ABSTRACT FROM AUTHOR]

Background: Cervical spine fracture-dislocations in patients with ankylosing spondylitis (AS) are mostly unstable and require surgery. However, osteoporosis, one of the comorbidities for AS, could lead to detrimental prognoses. There are few accurate assessments of bone mineral density in AS patients., Aim: To analyze Hounsfield units (HUs) for assessing bone mineral density in AS patients with cervical fracture-dislocation., Methods: The HUs from C2 to C7 of 51 patients obtained from computed tomography (CT) scans and three-dimensional reconstruction of the cervical spine were independently assessed by two trained spinal surgeons and statistically analyzed. Inter-reader reliability and agreement were assessed by interclass correlation coefficient., Results: The HUs decreased gradually from C2 to C7. The mean values of the left and right levels were significantly higher than those in the middle. Among the 51 patients, 25 patients (49.02%) may be diagnosed with osteoporosis, and 16 patients (31.37%) may be diagnosed with osteopenia., Conclusion: The HUs obtained by cervical spine CT are feasible for assessing bone mineral density with excellent agreement in AS patients with cervical fracture-dislocation., Competing Interests: Conflict-of-interest statement: All authors declare no conflicts of interest., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Introduction: Fracture-dislocations of the proximal interphalangeal joint (PIPJ) can have a significant impact on digital motion and hand function if inappropriately treated. While these injuries are commonly encountered, they can be quite challenging to manage. It is critical to ensure a concentric reduction and early motion when treating these injuries., Case Report: A 17-year-old woman sustained a fracture-dislocation of the PIPJ of the left small finger. Despite a concentric closed reduction, she had pain and a mechanical block to PIPJ motion. Advanced imaging revealed volar plate entrapment in the retrocondylar space. She was treated with open reduction and direct volar plate repair. Postoperatively, the patient had an excellent outcome with no complications., Conclusion: Our case highlights the importance of both performing an anesthetized examination and investigating the etiology of any limitations to motion even if there is an initial acceptable closed reduction., Competing Interests: Conflict of Interest: Nil, (Copyright: © Indian Orthopaedic Research Group.)

Many different surgical techniques have been used to treat unstable dorsal proximal interphalangeal joint fracture-dislocations. The authors have used the base of the middle phalanx of the second toe base as an alternative autograft to treat this type of injury. This retrospective study assessed the clinical outcomes of this procedure in 11 patients. Range of motion, grip strength, Disability of the Arm, Shoulder and Hand score and donor site morbidity were assessed at regular intervals postoperatively. Nine patients had acute injuries and two had chronic injuries. The mean range of motion in the proximal interphalangeal joint at final review was 65° for patients with acute injuries and 41° for patients with chronic injuries. Other outcomes were satisfactory and there were no complications. Level of evidence: IV [ABSTRACT FROM AUTHOR]

Proximal humeral fracture-dislocation associated with neurovascular injury is rare events, associated with poorer outcomes and higher risk of complications. A multidisciplinary approach including the orthopaedic and vascular department is essential in treating such kind of injury. The goal of the treatment is to restore the vascular supply and stabilize the fracture. Usually the orthopaedic surgical stabilization provides a stable substrate for the vascular repair.We report a case of 70 years old woman who sustained a 4 part proximal humerus fracture-dislocation with vascular injury at the level of the transition of the subclavian into axillary artery. Because of the impending severe limb ischemia, the priority of the treatment was given to vascular surgical intervention with a by-pass procedure. After 14 days a reverse shoulder prosthesis was thought to be the best alternative in the second stage surgery. At 18 months follow-up we achieved good clinical and radiological outcomes. Although a lack of consensus on the priority of treatments, we achieved good result following our proposed algorithm of treatment.

Lateral elbow dislocation is a rare injury with few reported cases. Most elbow dislocations are posterior and many have associated fractures of either humeral condyles. The medial epicondyle fracture in the setting of lateral elbow dislocation is a rare injury pattern. We report a case of lateral elbow dislocation with medial epicondyle displaced fracture in a 15-year-old male patient following a contact-sports-related injury. The elbow was reduced in the emergency and the medial fracture was fixed later with a pin and screw. There was no ulnar nerve injury associated primarily with the injury and was also not observed after surgery or during follow-up. The functional outcome was good and fracture united uneventfully. The patient had stable elbow with good range of motion and no clinical instability noted in the follow-up of 13 months. There was, however, gradual loosening of the screws noted in the follow-up and implants were removed at 9 months. There was 10° of cubitus valgus noted at last follow-up and the Mayo Elbow Performance Score was 90 depicting excellent outcome. The lateral elbow dislocation requires careful identification and exclusion of any associated nerve injury, soft tissue injury or bony fracture or their incarceration. The standard management and early rehabilitation leads to the optimum outcome.

To report the sequential treatment of a Type II odontoid fracture combined with a severe lower cervical (C6–7) fracture-dislocation featuring bilateral facet joint interlocking. A 58-year-old male who had suffered an injury in a car accident, He presented neck pain and extremity paralysis. His neurological function was classified as per the American Spinal Injury Association (ASIA) impairment scale as Grade A, indicating complete deficits below the C6 spinal cord level. A cervical CT scan and magnetic resonance image showed a type II odontoid fracture, C6 slipped anteriorly, C6–7 bilateral facet joint fracture and interlocking, slightly compression change of C7 upper endplate. Emergency closed reduction using cranial tong traction was success 6 h after the injury. A subsequent CT scan proved the successful reduction of bilateral facet joint dislocations and the odontoid fracture. After careful overall assessment, anterior cervical decompression and fusion (ACDF) was performed at C5–6 and C6–7 segments three days later，while odontoid fracture was treated conservatively. At the 4 months follow-up, a CT scan demonstrated solid bone fusion at C5–6, C6–7 segments, along with successful healing at the odontoid fracture site. However, spinal cord was necrosis at C5–7 segments, and the patient's neurological function had no improvement. The initial closed reduction could restore the alignment and preliminary stability of cervical spine at sub-axial cervical fracture-dislocation segment as well as displaced odontoid fracture. This timely and effective closed reduction significantly diminished sequential surgical trauma and mitigated associated risks. • Odontoid fracture concomitant with lower cervical fracture-dislocation was rare to report. • Initial closed reduction could restore anatomic alignment of both the upper and lower cervical spine; • Type II odontoid fracture could be treated conservative under the condition of complete reduction. [ABSTRACT FROM AUTHOR]