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Comminuted trapezium fracture is very rare. As the trapezium is necessary for thumb movements, delayed diagnosis and treatment can result in thumb carpometacarpal (CM) joint osteoarthritis and restricted mobility. The K-wire or screw fixation is recommended for repairing displaced fractures. However, there is currently no established treatment protocol for this rare fracture. In trapezium fracture, a technique with K-wire fixation in addition to open reduction and internal fixation (ORIF) has been reported with favorable clinical outcomes. In this report, we present a case of comminuted trapezium fracture successfully treated with surgery. The present case involved a 26-year-old woman who was injured while driving her car, which led to a comminuted trapezium fracture. ORIF was conducted with headless screws and a locking plate, and the first and second metacarpals were temporarily fixed by K-wire with the thumb in traction. Six months after surgery, bony union and favorable clinical outcomes were achieved. This technique could be beneficial to prevent articular surface collapse in the comminuted trapezium fracture and to achieve favorable clinical outcomes., Competing Interests: The authors declare that there are no relevant conflicts of interest., (© 2022 The Authors.)

Ankylosing spondylitis is a common inflammatory rheumatic disease with a prevalence of 0.1 %-1.4 %. The most common vertebral fractures associated with ankylosing spondylitis are cervical spine injuries due to low-energy trauma, whereas pelvic fractures are rare. Conversely, fragility fracture of the pelvis is a fracture of the pelvic ring caused by low-energy trauma with a background of bone fragility. In recent years, minimally invasive surgery for early mobilization of displaced fragility fracture of the pelvis has been reported. We report herein a case of a 91-year-old male with ankylosing spondylitis who underwent internal fixation for fragility fracture of his pelvis. He was brought to the emergency room with a complaint of pain in the right hip after a fall from a standing position at home. Computed tomography showed a fracture of the right pubis and a fracture, which crossed the sacrum from the ilium with a maximum dislocation. There was also extensive ossification of the anterior longitudinal ligament in the thoracolumbar spine and bony ankylosis of both sacroiliac joints. The diagnosis after the injury was fragility fracture of the pelvis, which complicated by ankylosing spondylitis. The fracture type did not match the Rommens and Hofmann classification criteria. Iliac intramedullary stabilization was performed in accordance with the treatment of Rommens and Hofmann classification type IIIa. The patient's pain reduced a day after the surgery, and he was able to use a wheelchair. He was able to walk with a cane two months after the surgery, and bone union was achieved four months postsurgery. Iliac intramedullary stabilization was useful in patients with atypical fractures a) that did not fit the Rommens and Hofmann classification criteria owing to the presence of ankylosing spondylitis, and b) in cases wherein strong fixation was considered necessary., Competing Interests: The authors declare that there is no conflict of interest regarding the publication of this article., (© 2022 The Authors.)

Scaphoid nonunion causes humpback deformity and dorsal intercalated segment instability (DISI) deformity due to dorsal rotation of the proximal scaphoid fragment. In the treatment of scaphoid nonunion, it is important to not only achieve bone union, but also to improve DISI deformity and carpal bone alignment in order to attenuate pain, increase the range of motion, and prevent the development of osteoarthritis. We encountered a case of DISI deformity caused by the long-term neglect of scaphoid nonunion that was treated in a two-stage operation with the Ilizarov mini fixator. A 28-year-old male had been injured during a soccer game 10 years ago. Although he had wrist pain, he did not visit a hospital. This led to chronic scaphoid nonunion with DISI deformity. Since 10 years had passed from the initial injury, DISI deformity was considered to be difficult to correct using a single stage procedure. Therefore, a two-stage operation was performed. The Ilizarov mini fixator was used to gradually correct DISI deformity in the first stage, and screw fixation with bone grafting was performed in the second stage. Difficulties are associated with achieving good clinical results in cases of long-term scaphoid nonunion. In cases of DISI deformity, it is important to correct the alignment of lunate dorsiflexion and the distal carpal row as well as achieve bone union. Although the Ilizarov external fixator has been used for scaphoid nonunion, it has not yet been applied to scaphoid nonunion with DISI deformity. The Ilizarov mini fixator may be useful to correct long-term deformities, and good results were obtained in the present case. It represents an option for the treatment of scaphoid nonunion with DISI deformity., Competing Interests: The authors declare that there are no relevant conflicts of interest., (© 2022 The Author(s).)

Intramedullary or cephalomedullary nail removal often is performed during nonunion reoperations. We have experienced a rare case in which it was difficult to remove the lag screw of the antegrade intramedullary nail, requiring a large amount of force to be applied over a long period. Removal of the lag screw is essential for removal of the nail and subsequent revision surgery. In our case, the lag screw could be removed only by cutting the screw with a carbide drill. For cases in which the nail and lag screw are firmly fixed, surgeons should prepare for the possibility of their separation using a carbide drill. Written informed consent was obtained from the patient for publication of this case report and accompanying images., (© 2021 The Authors.)

Total talar dislocation without a fracture is an extremely rare injury. It is often the result of high-energy trauma, such as that incurred after a fall, or owing to motor or vehicular accidents. Talar dislocations have poor outcomes owing to the frequent complications of infection, avascular necrosis and osteoarthritis attributed to open dislocations. We report herein a closed total talar dislocation without a fracture in a college athlete who was injured during sports activities. Specifically, a 20-year-old man was injured during a soccer game this led to a closed total talar dislocation. We performed closed reduction with image guidance subject to a popliteal sciatic nerve block, and placed a plaster cast below the knee. Radiographic studies after reduction revealed no associated fractures. After an eight week no-weight bearing period, we confirmed that there were no avascular necrosis signs on magnetic resonance images. Based on these findings, partial weight bearing was allowed. At 18 months post trauma, the athlete continues to play soccer despite the fact that he experiences a slight pain and limited range of motion. The blood supply to the talus is limited, and trauma, such as dislocation, can easily injure the blood supply, thus resulting in complications, such as avascular necrosis. The talus vascularity of the presented case was maintained by superior branches. We think that it is important to a) perform closed reduction early on, b) avoid any type of surgical operation that damages the limited talus blood supply, and c) allow weight bearing after the lack of avascular necrosis signs is confirmed. Although there is no standardized treatment, the talar dislocation treatment should be chosen to preserve the blood supply to the talus as much as possible., Competing Interests: The authors declare that there are no relevant conflicts of interest., (© 2021 The Authors.)