Introduction: Late diagnoses of orthopaedic injuries after epileptic crisis are a matter of concern. The rarity of correlation between seizure and specific trauma incidences such as bilateral anterior shoulder dislocation, may lead to improper estimation of the patient's clinical state, wrong treatment and unpleasant complications.
Description
Delbet Classifi cationPaediatric hip fractures can be divided into four types as fi rst described by Delbet ( Fig. 72.1 ). This classifi cation, along with other factors, helps determine operative versus non-operative therapy and predicts the risk of avascular necrosis of the femoral head [ 1 ].Type I : Trans -epiphyseal separation . These are fractures through the proximal femoral physis, and represent Salter-Harris type I fractures of the proximal femur (<10 %). Subtypes are IA (without dislocation) and IB (with dislocation). Type II : Trans -cervical fracture . This is the most common type of paediatric hip fracture (40-50 %). It extends through the mid-portion of the femoral neck. Type III : Cervico -trochanteric fracture . This fracture occurs through the base of the femoral neck (25-35 %). Type IV : Intertrochanteric fracture . This fracture between the greater and lesser trochanters accounts for 6-15% of all paediatric hip fractures and has the best outcome
Lisfranc fracture dislocations are complex lesions which, when combined with additional trauma of the ankle and foot region, create a difficult to treat injury pattern. This article presents a case of a patient with Lisfranc fracture dislocation combined with metatarsophalangeal dislocation of the second toe and ankle fracture-dislocation. The sequence of medical acts and complications included: reduction of dislocations, cast immobilization, compartment syndrome and fasciotomies, external fixator application, fasciotomies closure, and final internal fixations. The following examinations were performed: radiography, computed tomography (CT), and intracompartmental pressure measurement. Despite the compartment syndrome incidence, which was effectively managed, the patient regained an ankle- and foot-pain-free full range of motion. Although this is an isolated case of a rare injury, several recommendations can be made. Early CT scan should be used for injuries of the Lisfranc joints to fully assess the distorted anatomy of the midfoot and forefoot, which is essential for preoperative planning, medicolegal issues, and prognosis of the injury. The use of a spanning external fixator, especially in complex injuries as the one described, should be preferred to cast immobilization and should be performed as a priority surgical procedure early on in the patient's admission. The development of compartment syndrome should be monitored and intracompartmental pressures measured especially in unconscious patients. There should be a high degree of suspicion for early complications in complex fracture patterns, even if the initial clinical assessment is reassuring.
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