Total dislocation of the talus has been reported as 0.06% of all dislocations and 2% of all talar fractures. It usually occurs from considerable violence. Total dislocation of the talus is frequently an open injury, or the skin may be tented over the dislocated talus leading to skin slough. Closed total dislocation of talus with posterior process injury is rare. The functional prognosis is poor due to osteonecrosis of the talus which develops in the majority of cases. Review of literature reported successful closed reduction in cases of closed pan-talar dislocation under anesthesia. However, there were few cases where there was difficulty in closed reduction. Operative technique has also been described in different reports of similar cases. Case report We present a case of pan-talar dislocation of the left talus in a 25-year-old road accident victim, with posterior talar process fracture. Reduction of dislocation was attempted in emergency department by external manipulation. Reduction process failed, and hence planned for reduction under anesthesia. It required a open reduction after a unsuccessful closed reduction attempt. The talus after reduction was found to be unstable hence, stabilized with trans-calcaneotalar Steinmann pin. At 1-year follow-up, the right ankle was pain free and stable. Motion was satisfactory. The talus after a follow-up of 1 year did not show any signs of subluxation or avascular necrosis. Conclusion The main obstacle to closed reduction appeared to be talus had button holed through dorsal fascia. The talus after reduction was found to be unstable hence stabilized with trans-calcaneotalar Steinmann pin. The management of the associated fracture will depend on many factors, particularly displacement of the fracture fragments. How to cite this article Kumar MP, Gopinath KM, Kumar BNR, Balaji GAG. Closed Pan-talar Dislocation with Posterior Talar Process Fracture. J Med Sci 2015;1(2):32-35.
INTRODUCTION Femoral neck fractures occur most commonly in elderly females. The incidence of fracture neck femur occurs in two different patient populations. Very small groups (3% to 5%) are young patients subjected to high energy trauma. The reminder occurs in elderly population and approximately 90% of these injuries are the result of simple fall from standing position. OBJECTIVE To assess the functional outcome of uncemented hemiarthroplasty (AMP and Bipolar) in patients under 55 years of age with intracapsular neck of femur fracture. PATIENTS AND METHODS 16 patients under 55 years of age with the mean age of 35.5 years (range 16-55 years) with intracapsular fracture neck of femur operated between September 2010-September 2012 were undertaken for the study. The functional follow-up was done for a minimum period of 6 months. The results were assessed using Harris hip evaluation. RESULTS Out of 16 patients, 10 were female and 6 were male with an average age of 35.5 years. After one year of follow up 5 patients had Excellent, 8 had a good result, 1 had a fair result and 2 had a poor result. In our study all our patient had satisfactory functional result. CONCLUSION Patients who lead mainly a sedentary life with limited daily activities are suitable candidates for hemiarthroplasty.
BACKGROUND Malunion occurs more often after Colles fracture than any other and can result in considerable disability. Multiple techniques for corrective osteotomy have been developed in recent years with objective of restoring the normal anatomy of distal end of radius and also to evaluate the results with respect to pain, restoration of function of wrist and forearm. MATERIALS AND METHODS A prospective randomized controlled study was conducted in 20 cases of malunited Colles fracture who underwent Corrective osteotomy with a Dorsal Ellis T plate and bone graft. Post operatively all patients were immobilized on a Sugar-Tong splint and followed up at 4, 6 and 12 weeks. RESULTS All measurements of Pain, final range of motion and grip strength significantly improved compared with preoperative measurements. Based on Fernandez et al scoring system we obtained Excellent results in 8 cases, Good in 7 cases, Fair in 3 cases and Poor in 2 cases which was attributed to infection in 1 case and RSD in the other case. Radiologically a mean radial length of 6.14mm (N:10mm), Radial Angle of 21.25⁰ (N:22⁰) and Volar angle of-3.4⁰ (N: +4⁰) was achieved. CONCLUSION Corrective Osteotomy with Bone graft is a preferred and an Ideal procedure if performed after Proper selection of patients i.e in young adults and extra articular malunions with good range of movements.
BACKGROUNDAmong the various methods of treating the long bone fractures in children less than 5yrs (POP cast) and adolescents 16yrs (IMN), flexible intramedullary nail has gained importance because of its stability, not violating the physis and less complications and early rehabilitation. Irrespective of mode of treatment, goal shall be to achieve union at fracture site, control length and alignment, minimize the morbidity and complications for patient and their family.
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