Tension band wiring of simple transverse olecranon fractures results in a high reoperation rate due to hardware problems. A technique using high-strength braided polyester and polyethylene suture through a bone tunnel has been piloted. This technique is suitable for simple transverse olecranon fractures or olecranon osteotomy with stability of the ulnohumeral articulation. A transverse drill hole was made in the ulna with a 2.5-mm drill. Fracture fixation was achieved using 2 braided synthetic sutures passed through the bone tunnel and grasping the insertion of the triceps tendon. The outcome measures used were Oxford Elbow score and QuickDASH score. Ten consecutive patients with a mean age of 47 years (range, 18 to 88 y) were included. The mean follow-up was 19 months (range, 14 to 30 mo). All fractures were clinically and radiographically united by 6 weeks. One malunion occurred. The mean Oxford score was 41 (20 to 48). The mean QuickDASH Score was 9 (0 to 20). This technique provides a safe and reliable alternative to conventional tension band wiring with no reoperations required in a pilot series.
Posterior glenohumeral joint dislocation is an uncommon injury and is associated with bony and ligamentous disruption. It requires prompt diagnosis and early treatment to prevent acute or recurrent instability and subsequent dysfunction. Reverse Hill-Sachs lesions associated with this injury are challenging to treat, and optimal treatment is controversial. Treatment methods can be divided into those that achieve stability through muscle transfers, osteotomies, or posterior bone-block procedures (glenoid augmentation) and those that restore the sphericity of the humeral head. Joint replacement is often suggested for large head lesions (>50%) considered beyond reconstruction. Restoration of stability, preservation of the proximal humeral anatomy, and salvage of the humeral head sphericity should be the treatment goals in the younger population.This article describes the surgical technique of elevation of the impressed osteochondral fragment followed by filling the lesion with Allomatrix bone graft putty (Wright Medical Technology, Arlington, Tennessee) in 2 patients. The size of the head lesion was ≤35%. Underpinning raft screws were used to provide subchondral support and prevent the collapse of the elevated fragment. Postoperatively, the sphericity of the humeral head and glenohumeral stability were restored. No evidence of collapse, osteonecrosis, or osteoarthritis progression was seen at latest follow-up. Functional results were excellent, with a minimum follow-up of 2 years.This technique is an alternative method of restoring humeral head sphericity in patients with acute posterior glenohumeral joint dislocations with medium (20%-40%) reverse Hill-Sachs lesions.
Background:Various treatment modalities have been described for the treatment of extra-articular distal radius fractures each with its own merits and demerits. Most of the work done with percutaneous pinning has shown a significant residual stiffness of the hand and wrist. Our technique involves percutaneous pinning of the fracture and immobilization in neutral position of the wrist for three weeks. This study's aim was to examine the functional outcome of percutaneous K-wiring of these extra-articular distal radius fractures with immobilization in neutral position of the wrist.Materials and Methods:This is a prospective study of 32 patients aged between 18 and 70 years with extra-articular distal radius fracture. Patients were treated with closed reduction and percutaneous pinning using two or three K-wires. A below- elbow plaster of paris dorsoradial slab was applied in neutral position of the wrist for 3 weeks. At the end of 3 weeks, the slab was removed and wrist physiotherapy started. The radiographs were taken postoperatively, at 3 weeks, 6 weeks and 6 months. The functional evaluation of the patients was done at 6 months follow-up. We used Sarmiento's modification of Lindstrom criteria and Gartland and Werley's criteria for evaluation of results.Results:Excellent to good results were seen in 93.75% of the cases while 6.25% had fair results. The complications observed were pin loosening (n=13), pin tract infection (n=2), malunion (n=2), wrist joint stiffness (n=2), reduced grip strength (n=2) and injury to the superficial radial nerve (n=1).Conclusion:Percutaneous pinning followed by immobilization of the wrist in neutral position is a simple and effective method to maintain reduction and prevent stiffness of wrist and hand.
Septic arthritis of sterno-clavicular joint is a rare entity which is often associated with predisposing conditions like intravenous drug abuse and diabetes. Its prevalence in healthy subjects with absence of medical co-morbidities has been sporadically reported. Due to the rarity of the condition, diagnosis is often delayed predisposing the patients to serious complications. Clinical suspicion supported by haematological and radiological investigations is needed for early diagnosis. Dysphagia as a complication of sterno-clavicular joint infection has not been reported. In this study, we report a case of sterno-clavicular joint infection causing dysphagia and review the literature with regards to aetiology, predisposing factors and treatment options. The aim of this study is to highlight the importance of early diagnosis in suspected cases of septic arthritis of sterno-clavicular joint and institution of intravenous antibiotics.
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