Within the context of elbow-level trauma, fractures with a coronal line at the distal extremity of the humerus are rare and result from indirect axial trauma with the arm extended. These are difficult-to-treat intra-articular fractures, since they require stable anatomical reduction in order to maintain joint congruence and diminish complications such as stiffness. This paper reports a case that occurred in a young man who suffered a fall from a ladder that resulted in a Bryan and Morrey type IV intra-articular fracture of the humerus. The injury was treated surgically by means of an anterior access, using osteosynthesis with two Herbert screws that were inserted from anterior to posterior.
Objective: To define and quantify the degree of change of the spinal canal diameter in patients with degenerative and spondylolytic spondylolisthesis. Methods: We studied CT scans of 54 patients. Of this total, 37 (29 women and 8 men) had degenerative type and 17 (7 women and 10 men) had spondylolytic type. Results: In the degenerative spondylolisthesis group, the average diameter of the spinal canal at the injured vertebra level was 17.35 mm and 17.64 mm for the upper vertebra level. The average diameter of the foramen at the level of the affected vertebra was 14.61 mm to left side and 15.00 mm to the right side. The average diameter of the foramen at the upper vertebra level was 16.82 mm to the left side and 16.51 mm to the right side. In the spondylolytic group, the average diameter of the spinal canal at the level of the affected vertebra was 23.25 mm and at the upper vertebra level was 18.66 mm. The average diameter of the foramen at the level of the affected vertebra was 11.98 mm to the left side and 12.34 mm to the right side. The average diameter of the foramen at the level of the upper vertebra was 16.97 mm to the left side and 15.58 mm to the right side. Conclusion: The diameter of the spinal canal in the sagittal plane showed no statistically significant increase in the spondylolytic spondylolisthesis group, in contrast to what is found in the degenerative spondylolisthesis group. It was also observed a reduction in vertebral foramina of the injured level in both groups.
Ankle fractures are common and represent approximately a quarter of all lower limb fractures. The general concepts for osteosynthesis techniques for deviated and unstable fractures have undergone little change since the 1960s. The presence of comorbidities and poor soft tissue conditions, especially in elderly patients, is associated with a higher rate of postoperative complications. Intramedullary implants have the advantage of using smaller incisions, which minimizes skin damage allowing for early loading. The present technical note describes the use of the fibular intramedullary nail with a minimally invasive approach to deviated and unstable ankle fractures.
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