SUMMARYTendon rupture as a complication of distal radius fractures has been documented; however, flexor tendon rupture associated with closed distal radius fractures is rare. We report a case of a 43-year-old man who suffered a closed distal radius fracture. Intraoperatively, it was discovered that the flexor carpi radialis tendon had ruptured. From the frayed ends of the tendon and review of the radiographs, it was determined that the sharp ends of the fractured radius had lacerated the tendon at the time of injury. After fixation of the fracture with locking plate, the severed tendon was repaired and the wrist immobilised with a splint. The patient has been pain free after 5 months of follow-up, with full range of motion. This outcome demonstrates that timely detection and treatment of concurrent flexor carpi radialis tendon rupture and a closed distal radius fracture can achieve good functional results and outcome. BACKGROUND
SUMMARYNon-union of a proximal clavicle fracture is rare. When it does occur, it poses a difficult problem causing severe pain and shoulder impairment that must be dealt with surgically. We report a 29-year-old woman who suffered a proximal clavicle fracture and received plate and screws fixation. Six months later, after constant pain and a diminished range of shoulder motion, she sought help at our clinic and was diagnosed with symptomatic nonunion. Reconstruction with bone graft and interosseous sutures was performed in vain as pain persisted and follow-up radiograph showed no healing. A salvage procedure with partial claviculectomy was then carried out. The patient has been pain free after 3.5 years of follow-up, a full range of motion and is quite satisfied with the cosmetics. This outcome demonstrates that claviculectomy can be used successfully in a clinical situation where restoration of clavicular non-union fails. BACKGROUND
DESCRIPTIONThe patient is a 16-year-old girl who visited the clinic and presented with a 3-month history of right foot pain. She described the pain as constant and dull, and exacerbated with walking. No traumatic history was noted. Physical examination revealed evident swelling and tenderness near the second metatarsophalangeal (MTP) joint. Radiograph of the right foot revealed flattening of the second metatarsal head with subchondral sclerosis and fragmentation within the joint (figure 1). In addition, MRI demonstrated hyperintense signals on T2-weighted images ( figure 2A,B). Based on clinical and radiological information, Freiberg's infraction was diagnosed and the patient was treated conservatively with rest and activity modification. After 2 months of follow-up, she was walking pain-free.Freiberg's infraction is a rare disease characterised by osteonecrosis of the metatarsal head primarily affecting the second metatarsal.1 With its multifactorial aetiology, the condition predominantly occurs in teenagers with a 5 : 1 female predilection. 2Patients often present with pain and swelling around the MTP joint.1 The radiographic appearance is typical with flattening of the second metatarsal head, increased sclerosis and loose body formation within the joint. MRI is useful in its diagnosis, as T2-weighted images often show increased signal intensity in the metatarsal head.3 Since most cases are self-limited, conservative therapy in the form of rest, crutches or casting may be adequate. Surgery is rarely indicated and is reserved for patients who fail conservative management; it can range from metatarsal neck osteotomy and joint debridement to resection of the metatarsal head.
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