In this study, we evaluate the differences, in the treatment of sacral fractures, between the two techniques, revising the literature and our experience.
Background: The trapeziometacarpal joint is the second joint affected by osteoarthritis in the hand. The symptoms and clinical presentation are characterized by pain, limited range of motion, muscle weakness with loss of strength, bone deformities and disability. The symptomatology often is not related to the radiographic grade of osteoarthrosis. Therefore, in addition to the radiographic stage of the disease, the treatment is influenced by multiple variables such as age, functional requirement, symptoms and stability of the joint.
Objective: There are several options of surgical treatments. Although trapeziectomy and its technical variation is the gold standard for treatment, prosthesis replacement can be used with good results. This case report discusses the case of a 70-year-old male who presents bilateral trapeziometacarpal osteoarthrosis treated with two different techniques with different timelines.
Methods: The patient underwent a trapeziectomy on the right hand and arthroplasty with implant on the left. In both TMC the stage of the disease was grade III according to the Eaton Litter classification and the results were evaluated according to clinical and radiographic criteria. The NPRS pain scale and the Quick Dash functional scale were used in subsequent checks. The mean follow-up was 12 months.
Conclusion: There were no significantly different results with respect to pain, activities of daily living, mobility or strength. No complications were observed. The patient is satisfied with the treatment having found a better and earlier resumption of daily activity of the left hand treated with prosthesis replacement.
Bilateral fracture-dislocation of the talus is a rare occurrence. It represents 0.06% of the dislocations and 2% of the traumas of the talus. We report the case of a 29-year-old patient with an exposed bilateral fracture of the talus following a plane accident. On the right ankle, the patient had a fracture-dislocation Hawkin 3 Gustilo II, on the left ankle presented a Hawkin 4 Gustilo IIIB. The patient was treated within six hours from the trauma. We reduced the dislocation and performed an osteotomy of the tibial malleolus and osteosynthesis of the fracture with screws. The definitive stabilisation has been achieved in both limbs with an external fixator. We evaluated the patient at 1, 3, 6, 8, 12 and 18 months from treatment, with a radiograph and with SF-36 and Foot and Ankle Disability Index questionnaires. No infection was reported, radiographs showed a successful consolidation of the fracture in both limbs. At the one year follow-up, the patient was able to walk without aids and there were no signs of osteonecrosis on the MRI. The treatment of these lesions requires timely treatment, an anatomical reduction of the fracture and patient's collaboration. The use of external fixator with internal osteosynthesis represents a good therapeutic option in Hawkins 3 and 4 type fractures.
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