PURPOSE To evaluate the results of treatment in 6 cases of coronal split fractures of the femoral condyle MATERIALS AND METHODS: Six cases of coronal split fractures of the femoral condyle were treated and followed up 16 to 36 months. Five cases were treated operatively. We used anteromedial approach for 3 cases, posteromedial approach for 1 case and posterolateral approach for other 1 case. Non-displaced case was treated conservatively with cast. We compared the results of each case using Letenneur assessment system. RESULTS All 3 cases approached anteromedially and the case approached posterolaterally showed good results. But the case approached posteromedially showed fair result with mild limitation of motion and pain. Non-displaced case treated with cast resulted in poor result with nonunion. CONCLUSION We propose operative treatment for coronal split fracture of the femoral condyle even though there is no displacement. Anteromedial approach and headless screw fixation could be the best method for reduction and fixation of fracture.
Isolated plantar midtarsal dislocation is extremely rare injury. Only few cases have been reported previously in the literature. We experienced 1 case, a 16-year-old man. And we report a case with review of the literatue.
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Combined Ipsilateral Fracture and Dislocation of Hip, Knee and Foot Joints - A Case Report - Hyoung-Soo Kim, Ju-Hak Kim, Sang-Joon Park, Jae-Won Hyung Journal of the Korean Fracture Society.2012; 25(1): 73. CrossRef
Bone bruise or occult osseous lesion on magnetic resonance imaging was focused on the indirect sign of acute anterior cruciate ligament injury. But there were few reports which compared the location of bone bruise with the injured structure. The purposes of this study were to identify the common pattern of location of bone bruise, and to analyze the relationship between the location and injured structure or mechanism of injury. The authors reviewed 76 magnetic resonance imaging studies of the knee from March 1993 to May 1994 which show the sign of bone bruise in acute knee injury within six weeks. The mean age of the patient was 26.3 years and the main cause of injury was traffic accident. The final diagnosis was 20 cases of isolated medial collateral ligament injury, 17 cases of isolated anterior cruciate ligament injury, 16 cases of combined anterior cruciate and medial collateral ligament injury, 7 cases of meniscus injury, 6 cases of combined posterior cruciate and medial collateral ligament injury, 5 cases of isolated posterior cruciate ligament injury, 2 cases of patella dislocation, 1 case of lateral collateral ligment injury, and 2 cases of undiagnosed knee injury. In isolated MCL injuries, bone bruises were all confined to the lateral compartment. In isolated injury of ACL, the most common pattern of location of bone bruises were lateral tibial plateau and lateral femoral condyle(47.1%). In combined ACL and MCL injury, the most common pattern of location was lateral tibial plateau, only(43.8%). Bone bruise on MRI may be easy to detect during interpretation and we can obtain much information to decide the diagnosis and prognosis.
The lnate dislocation and perilunte dislocation with or without fracture, occupying about 10% of carpal injury, might b classified as a same category of injury resulted from similar mechanim. Initial diagnosis was missed often. In case of failure of closed reduction, open reduction and internal fixation will be necessary. The authors analyzed retrospectively 15 patients with lunate dislocation and perilunate dislication without fracture(Group A)and perlunate dislication with scaphoid fracture(Group B) who were treated from 1989 to 1994 at our hespital. The follow-up periods were 7 months to 60 months with mean of 23.2 months. The results were as follows.
1.Group A were 2 cases of anterior dislication of lunate and 8 cases of perilunate dislocation Group B were 5 cases of transscaphoid perilunate fracture-dislocation. The direction of perilunar dislocation with or without scaphoid fracture was posterior in all cases.
2.The causes of injury were fall from height in 7 cases, slip in 3 cases, traffic accident in 3 cases and crushing injury in 2 cases.
3.The overall clinical results by modified Green and OBriens clinical score were excellent in 4 cases(26.7%), good in 4 cases (26.7%),fair in 4 cases(26.7)and poor in 3 cases(20%).
4.9 out of 10 cases (90%) in Group A and 3 out of 5 cases(60%) in Group B were superior to fair.
Early treatment within 3 days injury was performed in 11 cases (7 in Group A,4 in Group B), The average point was 85 and 70, respectively and there was no statisticat significance between two groups(P>0.05). Treatment was delayed beyond two weeks after injury due to missed initial diagnosis and open wound in 4 cases(3 in Group A,1 in Grdup B). The final tesults were 1 case of good, 1 case of fair, 1 case of poor in Group a, and 1 case of poor in Group B. There was no statistical significance between the early treatment cases and delayed treatment cases(P>0.05). In conclusion, ounate and perilunate dislocation without scaphoid fracture can be treated by early operation to get and maintain the anatomical reduction. The authors thought that the presence of scaphoid fracture, nonanatomic reduction and delay in treatment are poor prognostic factors.