Nine patients with open fractures of the proximal humerus were treated using an external fixation device. All of them had grade III open fractures resulting from high-velocity missile and explosive injuries with massive foreign body contamination. Radial nerve injury was present in five and two multiply injured patients with thoracic wall and abdominal viscera were present. There were no major arterial injuries. Chronic osteitis with fistula and sequestra developed in one. There were no nonunions and no refractures. Minor painless limitation of shoulder and elbow motion presented in all patient. Upper-third humeral open fractures due to firearms are a unique type of open fractures. They are usually highly comminuted therefore, stable fixation is difficult or impossible to achieve. On the other hand, the risk of infection is high following plate fixation. External fixation allows adequate management of the soft tissue wounds, provides stable bone fixation and allows early mobilization of the shoulder and elbow.
It is rare for traumatic amputation of the big toe to occur as a single injury. This trauma is especially significant in children for influencing foot development and for possible psychological impact. Two cases of successful replantation of completely amputated big toes in two girls, 2 years 7 months and 5 years 2 months old, are presented. Follow-up was 10 years. In the younger child, the replanted big toe was 49.2 percent shorter compared to the contralateral side, because growth was limited by the affected growth zone in the proximal phalanx. In the older child, the growth zone of the bone was intact, with consequent bone growth unimpaired, and an initial shortage of 10.4 percent was reduced to 2 percent compared to the contralateral side.
The results confirmed that nonsurgical mode of treatment of mallet finger deformity was much more successful than surgical method of treating the same deformity.
In patients with symptomatic scaphoid nonunion there was an increased evidence of progessive osteoarthrosis expressed as instability of the wrist; it is defined as a scapholunate angle more than 70 degrees or a radiolunate angle of more than 10 degrees. We tried to determine the factors of risk and prognostic indicators of degenerative arthritis. In this study 40 patients with painfull nonunion of the scaphoid were analysed. Duration of nonunion was not in correlation with development of osteoarthritic changes (p=0,644; p>0,05). Progessive degenerative changes correlated well with radiolunate angle (p=0,398; p<0,05), kapitolunate angle (p=0,381; p<0,05) and carpal index (p=0,392; p<0,05). The average values of intercarpal angles increased with progression of osteoarthritic changes. There was a statistically strong corelation between location of fracture in proximal third and presence of degenerative changes (p=0,341; p<0,01). Intesity of arthritic changes showed no statistically significant correlation regarding untreated fractures (p=0,665; p>0,05). We recommend that a scaphoid nonunion associated with carpal instability should be operated before degenerative changes develop.
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