- Email: [email protected]
Fixation of terrible triad with ulnohumeral dislocation using two incisions
j o u r n a l o f c l i n i c a l o r t h o p a e d i c s a n d t r a u m a 6 ( 2 0 1 5 ) 7 4 e8 3
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/jcot
Conference Proceedings - Annual conference of Delhi Orthopaedic Association, Year 2014, at Maulana Azad Medical College, Delhi, 1st & 2nd November 2014 Posters AP1. Lateral swivel talo-navicular joint dislocation: An unusual case G. Dhaked, N. Rana Sir Gangaram Hospital, Old Rajinder Nagar, New Delhi, India Introduction: Lateral swivel dislocation is a rare entity. It occurs as a result of laterally directed force applied to the foot which causes dislocation of the talo-navicular joint but not the dislocation of the subtalar joint. Case report: A 17 years old male injured his left foot after road traffic accident while foot got stuck under the front seat and twisted. There was a lacerated wound (5 3 cm) over dorsolateral aspect with diffuse swelling and tenderness over midfoot region without neurovascular deficit. Radiographs (AP and Lateral views) showed lateral swivel dislocation of left talonavicular joint. Open reduction and internal fixation with 2 kwires was done under general anaesthesia after failed attempt at close reduction with skin grafting for lacerated wound after meticulous debridement. At 6 weeks, k-wires were removed, partial weight bearing started and full weight bearing allowed at 12 weeks. At 6 months follow up, patient has functional, painless, stable foot with normal range of motion at subtalar and ankle joint except restricted inversion. Discussion: Swivel dislocation is a variant of midtarsal dislocation in which calcaneus rotates on an intact interosseous talocalcaneal ligament without tearing it. To our knowledge only one case of lateral swivel talo-navicular joint dislocation has been reported to date. This case is important because of its rare occurrence, unusual mode of injury; treatment and prognosis are different from a subtalar dislocation and excellent outcomes after close/open reduction with k wire fixation.
AP2. Fixation of terrible triad with ulnohumeral dislocation using two incisions T. Manideep, T. Simon, A. Jain Background: Terrible triad with posterior Ulnohumeral dislocation is rare but a devastating injury. It consists of posterior dislocation of Ulna, Radial head/neck and Coronoid fracture. Most of the times it is associated with medial collateral ligament injury
also. There are several approaches mentioned in literature for fixation of these complex injuries. Materials and methods: We report here a case of 63 yr old lady presented in casuality following fall with dislocation of right elbow without distal neuro vascular injury. Antero-posterior and lateral radiographs showed Terrible triad with posterior Ulnohumeral dislocation. Provisional reduction was found to be unstable. Above elbow splintage was done. In view of the substantial lateral migration of Ulna, medial collateral ligament was anticipated to be injured and thus two incisions were planned. From medial incision coronoid was fixed by pull through sutures and augmentation of medial collateral ligament was done. From lateral incision Radial head was fixed, Annular ligament and Radial Collateral Ligament repaired. Elbow was immobilized for 3 weeks. Results: At last follow up her range of movement was 200-1100 and MayoElbow Performance Score(MEPS) is 90 which is considered as excellent result. Conclusion: Medial approach is useful whenever medial collateral ligament injury is suspected as it gives direct visualization of medial epicondyle and minimum soft tissue dissection.
AP3. Sacral stress fracture: An unusual cause of low back pain in post-partum females V. Anand, A. Yadav, R. Singh, V. Sidhu, J. Sikdar, S. Saini MMIMSR, Mullana, Ambala, India Background: In the post-partum females, low back pain is the common finding. Here we describe an atypical cause of prolonged back pain: insufficiency type sacral stress fracture using plain roentgogram, DEXA scan, CT, MRI studies obtained in the postpartum females. Most significant risk factor was an increase postpartum strenuous activity. Potential risk factors such as abnormal menstrual history, dietary deficiency and low mineral density was examined. Methods: 5 females in post-partum period in the age group of 1732 years old were initially evaluated with thorough history and physical examination and were categorized in to heavy (3) moderate (1) and mild (1) exertional activity. Quantitative ct density measurements of 110 mg/ml and bone density by DEXA of 0.800 gm/cm2 is referred to as fracture threshold below which
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/jcot
Conference Proceedings - Annual conference of Delhi Orthopaedic Association, Year 2014, at Maulana Azad Medical College, Delhi, 1st & 2nd November 2014 Posters AP1. Lateral swivel talo-navicular joint dislocation: An unusual case G. Dhaked, N. Rana Sir Gangaram Hospital, Old Rajinder Nagar, New Delhi, India Introduction: Lateral swivel dislocation is a rare entity. It occurs as a result of laterally directed force applied to the foot which causes dislocation of the talo-navicular joint but not the dislocation of the subtalar joint. Case report: A 17 years old male injured his left foot after road traffic accident while foot got stuck under the front seat and twisted. There was a lacerated wound (5 3 cm) over dorsolateral aspect with diffuse swelling and tenderness over midfoot region without neurovascular deficit. Radiographs (AP and Lateral views) showed lateral swivel dislocation of left talonavicular joint. Open reduction and internal fixation with 2 kwires was done under general anaesthesia after failed attempt at close reduction with skin grafting for lacerated wound after meticulous debridement. At 6 weeks, k-wires were removed, partial weight bearing started and full weight bearing allowed at 12 weeks. At 6 months follow up, patient has functional, painless, stable foot with normal range of motion at subtalar and ankle joint except restricted inversion. Discussion: Swivel dislocation is a variant of midtarsal dislocation in which calcaneus rotates on an intact interosseous talocalcaneal ligament without tearing it. To our knowledge only one case of lateral swivel talo-navicular joint dislocation has been reported to date. This case is important because of its rare occurrence, unusual mode of injury; treatment and prognosis are different from a subtalar dislocation and excellent outcomes after close/open reduction with k wire fixation.
AP2. Fixation of terrible triad with ulnohumeral dislocation using two incisions T. Manideep, T. Simon, A. Jain Background: Terrible triad with posterior Ulnohumeral dislocation is rare but a devastating injury. It consists of posterior dislocation of Ulna, Radial head/neck and Coronoid fracture. Most of the times it is associated with medial collateral ligament injury
also. There are several approaches mentioned in literature for fixation of these complex injuries. Materials and methods: We report here a case of 63 yr old lady presented in casuality following fall with dislocation of right elbow without distal neuro vascular injury. Antero-posterior and lateral radiographs showed Terrible triad with posterior Ulnohumeral dislocation. Provisional reduction was found to be unstable. Above elbow splintage was done. In view of the substantial lateral migration of Ulna, medial collateral ligament was anticipated to be injured and thus two incisions were planned. From medial incision coronoid was fixed by pull through sutures and augmentation of medial collateral ligament was done. From lateral incision Radial head was fixed, Annular ligament and Radial Collateral Ligament repaired. Elbow was immobilized for 3 weeks. Results: At last follow up her range of movement was 200-1100 and MayoElbow Performance Score(MEPS) is 90 which is considered as excellent result. Conclusion: Medial approach is useful whenever medial collateral ligament injury is suspected as it gives direct visualization of medial epicondyle and minimum soft tissue dissection.
AP3. Sacral stress fracture: An unusual cause of low back pain in post-partum females V. Anand, A. Yadav, R. Singh, V. Sidhu, J. Sikdar, S. Saini MMIMSR, Mullana, Ambala, India Background: In the post-partum females, low back pain is the common finding. Here we describe an atypical cause of prolonged back pain: insufficiency type sacral stress fracture using plain roentgogram, DEXA scan, CT, MRI studies obtained in the postpartum females. Most significant risk factor was an increase postpartum strenuous activity. Potential risk factors such as abnormal menstrual history, dietary deficiency and low mineral density was examined. Methods: 5 females in post-partum period in the age group of 1732 years old were initially evaluated with thorough history and physical examination and were categorized in to heavy (3) moderate (1) and mild (1) exertional activity. Quantitative ct density measurements of 110 mg/ml and bone density by DEXA of 0.800 gm/cm2 is referred to as fracture threshold below which