Background: Diaphyseal non-unions and malunions constitute significant morbidities in fracture care. Fracture treatment modalities seek to restore anatomic orientation and functional rehabilitation as soon as possible...Background: Diaphyseal non-unions and malunions constitute significant morbidities in fracture care. Fracture treatment modalities seek to restore anatomic orientation and functional rehabilitation as soon as possible after a fracture incident. Malunions and non unions present a treatment challenge with the need for prolonged hospitalization, multiple surgical interventions and economic burden. In the developing world, traditional bonesetting practices are popular and these often result in a host of preventable complications. The added socioeconomic costs of treating these complications present a considerable strain on the resources of these already fragile economies and households. Aim: To document the risk factors, treatment options and outcomes for diaphyseal non-unions and malunions in our environment. Patients and Methods: Fifty-two consecutive patients comprising 37 non-unions and 15 malunions who presented in the orthopaedic unit of a tertiary hospital in Southern Nigeria were evaluated. Information sought included biodata, location of pathology, type of incident fracture, local risk factors including traditional bonesetting;treatment options and final outcomes. Information obtained was analyzed using SPSS version 20 (IBM, New York). Results are presented in simple frequency tables. Results: There were 34 males and 18 females (M:F = 1.9:1) with a mean age of 38.76 ± 14.55 years. There were 37 non-unions and 15 malunions. The femur was the commonest site of pathology in 21 (40.4%) cases, and among the non-unions, the atrophic variety was the commonest type (n = 26;70.3%). The mean fracture-to-surgery interval was 11.35 ± 7.95 months and traditional bonesetting was the commonest risk factor (n = 36;69.2%). Plate and screw Osteosynthesis with bonegraft augmentation was the commonest treatment modality and the overall union rate was 94%. Conclusion: Traditional bonesetting plays a major role in the health seeking behaviour of many African societies. The complications are varied and add to the overall socioeconomic burden of fracture care in these developing economies. Identification of traditional bonesetting practices as an important risk factor should translate into a focus on these practices in preventive public health decisions in fracture care. Continuing public health education backed by political will and can potentially drive a paradigm shift in health seeking attitudes in the developing word.展开更多
BACKGROUND Traumatic radial head dislocation(RHD)is a well-described injury in the pediatric population.It is usually associated with an injury to the ulna in Monteggia fracture-dislocation,although it can occur as an...BACKGROUND Traumatic radial head dislocation(RHD)is a well-described injury in the pediatric population.It is usually associated with an injury to the ulna in Monteggia fracture-dislocation,although it can occur as an isolated injury.Traumatic RHD with ipsilateral radial shaft fracture has rarely been reported.Delayed RHD secondary to the malunion of an isolated radial shaft fracture is extremely rare.CASE SUMMARY We report a 9-year-old boy with limited pronation of the right elbow.The patient was diagnosed with delayed RHD associated with the malunion of a distal radial fracture.Since the annular ligament was disrupted with forearm rotation causing subluxation of the radial head,a modified double-strip Bell Tawse procedure was performed to reconstruct the annular ligament without corrective osteotomy for the malunited site.Four years after surgery,the angulation deformity of the distal radius was corrected with the restoration of the normal curvature of the radius.There was no recurrence of RHD.CONCLUSION Annular ligament reconstruction without corrective osteotomy could reduce RHD and restore the normal curve of the radial shaft in children with delayed dislocation of the radial head associated with malunion of the radial shaft.Annular reconstruction using double triceps tendon strips might be useful for maintaining a more stable reduction by augmenting anterolateral parts.展开更多
Intracapsular fracture of femoral neck is treated by anatomical reduction （preferably closed） and can- nulated cancellous lag screw fixation. Malunion of these fractures have been described in the coronal plane （co...Intracapsular fracture of femoral neck is treated by anatomical reduction （preferably closed） and can- nulated cancellous lag screw fixation. Malunion of these fractures have been described in the coronal plane （coxa valga or coxa rata）. We reported a case of young adult patient with displaced intracapsular fracture of femoral neck that had malunited in sagittal plane with callus formation with excellent functional outcome. The radiographs revealed intracapsular fracture of femoral neck right side （Garden type 4 and Pauwel type 3）. The patient was operated and closed reduction and internal fixation with three cannulated cancellous screws was performed. The postoperative radiograph revealed a loss of reduction in the lateral view. Due to this technical error, the patient was counselled for revision fixation for which he refused. At 9 months we observed union of the fracture in the displaced position by callus formation. Harris hip score at 2 years was 96 that indicate excellent functional outcome and the ra- diographs did not reveal any evidence of avascular necrosis of femoral head. We advised revision surgery to our patient as he had increased chances of implant failure and nonunion. However he refused the revision surgery and was continued with the suboptimal reduction. However, the fracture united and that too with callus formation, which is not a described phenomenon in neck of femur fracture.展开更多
目的探讨距骨骨折后发生骨不连或畸形愈合的原因及处理方法。方法回顾性分析2015年7月至2023年3月南方医科大学南方医院收治的距骨骨折后骨不连或畸形愈合病例10例,均存在后足疼痛及畸形情况,按照Zwipp距骨畸形分型,Ⅰ型1例、Ⅱ型6例、...目的探讨距骨骨折后发生骨不连或畸形愈合的原因及处理方法。方法回顾性分析2015年7月至2023年3月南方医科大学南方医院收治的距骨骨折后骨不连或畸形愈合病例10例,均存在后足疼痛及畸形情况,按照Zwipp距骨畸形分型,Ⅰ型1例、Ⅱ型6例、Ⅱ型2例、Ⅳ型1例。Ⅰ型采用截骨切开复位内固定,Ⅱ型采用植骨内固定重建术,Ⅲ采用型切开复位植骨重建术,Ⅳ采用型自体骨移植关节融合术相应处理,分析发生畸形的原因,并观察翻修重建术前后的疗效及并发症发生情况。结果距骨骨折后畸形发生的原因包括骨折漏诊、复位不良、切口选择不正确、内置物安放不合理及保守治疗等。10例患者均获得随访,随访时间6~24个月,所有病例均无伤口并发症。美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝-后足评分术前(36.7±14.3)分、术后(87.3±11.0)分(P<0.001),Maryland评分术前(36.7±14.3)分、术后(85.8±16.0)分(P<0.001),健康调查简表(the MOS item short from health survey,SF-36)评分术前(38.8±10.7)分、术后(87.8±6.7)分(P<0.001)。2例Ⅲ型患者中1例未发生距骨头缺血性坏死进展,1例距骨塌陷;Ⅳ型患者行后足融合术后取得了满意效果。结论距骨骨折术后发生骨不连或畸形愈合的原因多样,距骨解剖形态复杂,应防止漏诊。手术应注意解剖修复重建距骨形态及充分保护血运,根据生物力学需求合理放置内置物,对开放性损伤注重清创及分期治疗。距骨骨折术后畸形根据不同分型个性化处理后疗效满意。展开更多
The choledochal cyst(CC)can be better termed as biliary tract malformation because of the close association of embryology and etiology in the causation of CC.Contrary to Babbitt's postulation of reflux,damage and ...The choledochal cyst(CC)can be better termed as biliary tract malformation because of the close association of embryology and etiology in the causation of CC.Contrary to Babbitt's postulation of reflux,damage and dilatation,reflux was not demonstrable as the causative factor in all varieties of CC.High pressure in the biliary system,otherwise termed ductal hypertension,is put forth as an alternative to explain the evolution of CC.The forme fruste type,which does not find a place in the standard classification,typifies the ductal hypertension hypothesis.Hence a closer,in-depth review would be able to highlight this apt terminology of biliary tract malformation.展开更多
文摘Background: Diaphyseal non-unions and malunions constitute significant morbidities in fracture care. Fracture treatment modalities seek to restore anatomic orientation and functional rehabilitation as soon as possible after a fracture incident. Malunions and non unions present a treatment challenge with the need for prolonged hospitalization, multiple surgical interventions and economic burden. In the developing world, traditional bonesetting practices are popular and these often result in a host of preventable complications. The added socioeconomic costs of treating these complications present a considerable strain on the resources of these already fragile economies and households. Aim: To document the risk factors, treatment options and outcomes for diaphyseal non-unions and malunions in our environment. Patients and Methods: Fifty-two consecutive patients comprising 37 non-unions and 15 malunions who presented in the orthopaedic unit of a tertiary hospital in Southern Nigeria were evaluated. Information sought included biodata, location of pathology, type of incident fracture, local risk factors including traditional bonesetting;treatment options and final outcomes. Information obtained was analyzed using SPSS version 20 (IBM, New York). Results are presented in simple frequency tables. Results: There were 34 males and 18 females (M:F = 1.9:1) with a mean age of 38.76 ± 14.55 years. There were 37 non-unions and 15 malunions. The femur was the commonest site of pathology in 21 (40.4%) cases, and among the non-unions, the atrophic variety was the commonest type (n = 26;70.3%). The mean fracture-to-surgery interval was 11.35 ± 7.95 months and traditional bonesetting was the commonest risk factor (n = 36;69.2%). Plate and screw Osteosynthesis with bonegraft augmentation was the commonest treatment modality and the overall union rate was 94%. Conclusion: Traditional bonesetting plays a major role in the health seeking behaviour of many African societies. The complications are varied and add to the overall socioeconomic burden of fracture care in these developing economies. Identification of traditional bonesetting practices as an important risk factor should translate into a focus on these practices in preventive public health decisions in fracture care. Continuing public health education backed by political will and can potentially drive a paradigm shift in health seeking attitudes in the developing word.
文摘BACKGROUND Traumatic radial head dislocation(RHD)is a well-described injury in the pediatric population.It is usually associated with an injury to the ulna in Monteggia fracture-dislocation,although it can occur as an isolated injury.Traumatic RHD with ipsilateral radial shaft fracture has rarely been reported.Delayed RHD secondary to the malunion of an isolated radial shaft fracture is extremely rare.CASE SUMMARY We report a 9-year-old boy with limited pronation of the right elbow.The patient was diagnosed with delayed RHD associated with the malunion of a distal radial fracture.Since the annular ligament was disrupted with forearm rotation causing subluxation of the radial head,a modified double-strip Bell Tawse procedure was performed to reconstruct the annular ligament without corrective osteotomy for the malunited site.Four years after surgery,the angulation deformity of the distal radius was corrected with the restoration of the normal curvature of the radius.There was no recurrence of RHD.CONCLUSION Annular ligament reconstruction without corrective osteotomy could reduce RHD and restore the normal curve of the radial shaft in children with delayed dislocation of the radial head associated with malunion of the radial shaft.Annular reconstruction using double triceps tendon strips might be useful for maintaining a more stable reduction by augmenting anterolateral parts.
文摘Intracapsular fracture of femoral neck is treated by anatomical reduction （preferably closed） and can- nulated cancellous lag screw fixation. Malunion of these fractures have been described in the coronal plane （coxa valga or coxa rata）. We reported a case of young adult patient with displaced intracapsular fracture of femoral neck that had malunited in sagittal plane with callus formation with excellent functional outcome. The radiographs revealed intracapsular fracture of femoral neck right side （Garden type 4 and Pauwel type 3）. The patient was operated and closed reduction and internal fixation with three cannulated cancellous screws was performed. The postoperative radiograph revealed a loss of reduction in the lateral view. Due to this technical error, the patient was counselled for revision fixation for which he refused. At 9 months we observed union of the fracture in the displaced position by callus formation. Harris hip score at 2 years was 96 that indicate excellent functional outcome and the ra- diographs did not reveal any evidence of avascular necrosis of femoral head. We advised revision surgery to our patient as he had increased chances of implant failure and nonunion. However he refused the revision surgery and was continued with the suboptimal reduction. However, the fracture united and that too with callus formation, which is not a described phenomenon in neck of femur fracture.
文摘目的探讨距骨骨折后发生骨不连或畸形愈合的原因及处理方法。方法回顾性分析2015年7月至2023年3月南方医科大学南方医院收治的距骨骨折后骨不连或畸形愈合病例10例,均存在后足疼痛及畸形情况,按照Zwipp距骨畸形分型,Ⅰ型1例、Ⅱ型6例、Ⅱ型2例、Ⅳ型1例。Ⅰ型采用截骨切开复位内固定,Ⅱ型采用植骨内固定重建术,Ⅲ采用型切开复位植骨重建术,Ⅳ采用型自体骨移植关节融合术相应处理,分析发生畸形的原因,并观察翻修重建术前后的疗效及并发症发生情况。结果距骨骨折后畸形发生的原因包括骨折漏诊、复位不良、切口选择不正确、内置物安放不合理及保守治疗等。10例患者均获得随访,随访时间6~24个月,所有病例均无伤口并发症。美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝-后足评分术前(36.7±14.3)分、术后(87.3±11.0)分(P<0.001),Maryland评分术前(36.7±14.3)分、术后(85.8±16.0)分(P<0.001),健康调查简表(the MOS item short from health survey,SF-36)评分术前(38.8±10.7)分、术后(87.8±6.7)分(P<0.001)。2例Ⅲ型患者中1例未发生距骨头缺血性坏死进展,1例距骨塌陷;Ⅳ型患者行后足融合术后取得了满意效果。结论距骨骨折术后发生骨不连或畸形愈合的原因多样,距骨解剖形态复杂,应防止漏诊。手术应注意解剖修复重建距骨形态及充分保护血运,根据生物力学需求合理放置内置物,对开放性损伤注重清创及分期治疗。距骨骨折术后畸形根据不同分型个性化处理后疗效满意。
文摘The choledochal cyst(CC)can be better termed as biliary tract malformation because of the close association of embryology and etiology in the causation of CC.Contrary to Babbitt's postulation of reflux,damage and dilatation,reflux was not demonstrable as the causative factor in all varieties of CC.High pressure in the biliary system,otherwise termed ductal hypertension,is put forth as an alternative to explain the evolution of CC.The forme fruste type,which does not find a place in the standard classification,typifies the ductal hypertension hypothesis.Hence a closer,in-depth review would be able to highlight this apt terminology of biliary tract malformation.
