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This is a retrospective cohort study of type C distal humeral fractures (AO classification system) aimed at evaluating the effectiveness of current operative treatment options.Thirty-seven patients with type C distal humeral fractures, treated operatively from January 2002 to September 2016, were retrospectively studied. Thirty-two were eligible for inclusion. Patients were treated by open reduction using the posterior approach, olecranon osteotomy and parallel-plate two-column internal fixation. Patients were evaluated for fracture healing, functional outcomes and complications (infection, ulnar neuropathy, heterotopic ossification and need for implant removal). Restoration of the normal anatomy was defined by measuring carrying angle, posterior angulation and intercondylar distance of distal humerus.The mean follow-up time was 8.7 years [range 2-15.5 years, standard deviation (SD) = 3.96]. Mean time to fracture union was 8 weeks for 29 patients (90.6%) (range, 6-10 weeks). In nine cases, there was malunion of varied importance (28.1%). There was one case with postoperative ulnar neuropathy and one case with deep infection. The mean Disabilities of the Arm, Shoulder and Hand (DASH) score and mean Mayo Elbow Performance Score (MEPS) were 20 (range 0-49) and 83.3 (range 25-100), respectively.In complex distal humerus fractures, the posterior approach with olecranon osteotomy and parallel plating of two columns, after anatomic reconstruction of the articular segment, is a prerequisite for successful elbow function.Athanaselis ED, Komnos G, Deligeorgis D

A polytrauma patient with a life-threatening condition is a quite demanding situation due to special considerations regarding the time, the way, and the sequence of the necessary procedures. Elastic intramedullary nails (EIN) could be used under these conditions for adult patients with humeral fractures requiring fixation. Here we present a case of a multi-segmental closed humerus fracture in a polytrauma patient treated by EIN. The general condition of the patient and the need for multiple surgical procedures required the selection of a minimally invasive and time-saving fixation technique. The patient's follow-up was uneventful with complete healing of the humeral fracture; the functional scores results are excellent at five years post operatively. A review of the literature revealed limited published cases of humeral fractures (128 patients) treated by EIN, despite the fact that the results are quite encouraging. Based on our results and the current literature, we believe that EIN could become an effective treatment choice for multi-level humerus fractures, especially in damage control surgery.

Aim: Small soft tissue defects of the distal tibia and hindfoot resulting from traumatic, operative, or neoplastic conditions and chronic ulcers can be successfully dealt with the use of the reverse sural artery flap (RSAF). This study aims to describe a single center’s results and familiarity with this technique over a 15-year period of time. Material and methods: We retrospectively reviewed the clinical files of patients who were consecutively treated with RSAF and regularly followed up between January 1, 2004 and December 31, 2018, with a minimum postoperative follow-up period of two years. Patient demographics and comorbidities, location of the defect, performing surgeon, mean operation time, flap pedicle width, mean size of the defect, days of hospitalization following the operation, healing flap rate, and complications were recorded. Results: The sample consisted of 30 adult patients (25 men, 5 women), with a mean age of 51.07 years (16-80 years, SD 18.61). The mean operation time was 99.03 min (range 83-131, SD 10.57), and the mean size of the defect was 11.11 cm2 (range 6.1-19.4, SD 3.22). Successful flap rate (complete healing and coverage of the defect, with or without additional minor intervention) was 83.3% (25/30). Among successfully healed flaps, six patients with partial necrosis of the dermis were treated by an additional split-thickness skin graft. Five flaps failed to heal. Deep infection was present in two patients, leading to flap failure and reoperation. Serious venous congestion resulting in flap ischemia occurred in three cases. Circumferential keloid formation (not affecting successful outcome) was present in seven cases. Flap thickness approximated to normal within six months. All donor sites healed well (either by a split-thickness cutaneous flap or by immediate wound closure). Light paresthesia on the lateral border of the leg and foot disappeared within six months. Conclusions: A single-center experience with the RSAF has yielded satisfactory clinical outcomes, and the long-term tackle with the difficult reconstruction conditions around the ankle, has led to valuable advice on surgical technique and postoperative protocol, based on an anatomical basis.

Hip periprosthetic joint infections (PJIs) with concomitant retroperitoneal abscesses may not be common clinical situations but they can be easily misdiagnosed affecting the effectiveness of infection control and eradication interventions. We present the case of a 75-year-old female patient with a late hip PJI complicated with iliopsoas abscess that was barely discovered intraoperatively. Literature review supports our recommendation of a high index of suspicion in cases of hip PJI and even routinely imaging examination of pelvis and abdomen for retroperitoneal involvement exclusion.

Distal radius fractures are among the most common fractures. Though associated neurologic problems are not uncommon, ulnar nerve dysfunction is a rare complication. An interesting case of sensory impairment of the ulnar nerve in a female patient with distal radius malunion, 6 months after a conservatively treated fracture, in which surgical intervention revealed an anatomic variation of ulnar nerve route, is presented in conjunction with a review of relevant literature.

Case. An unusual case of a foreign body in the hand is described here. Excision of a tumor-like soft tissue mass revealed a 75-year-old World War II bullet fragment of which patient was unaware. Conclusion. Differential diagnosis of hand lumps and inflammatory reaction must always include retained foreign bodies even after a very long period of posttraumatic quiescence or patient’s inability to provide a relative injury case history.

The human hand is the most exposed part of the body to highest risk for injuries, loss of the skin integrity, and to the inoculation of bacteria, most commonly Staphylococcus aureus, Streptococcus β-haemolytic, and gram-negative. In case of an infection, the mobile anatomical structures and the synovial membranes in close proximity to each other may spread the pus towards deep spaces and compartments. Mild early infections without an abscess formation may respond to antibiotics, but at more advanced stage, erythema, swelling, stiffness, and severe pain may ensue. Abscess formation will cause debilitating pain, fever, systemic symptoms, and even sepsis. Necrotizing infections may threaten not only the limb, but also patient’s life. Therefore, an initially “trivial” hand injury should never be neglected, as it might turn into a deep space infection, which must be treated immediately with drainage, wound debridement, and i.v. antibiotics. Delay in diagnosis and inadequate initial management might rapidly lead to abscess formation, destruction of the gliding surfaces and the normal anatomy, and irreparable functional deterioration.

Wartenberg’s syndrome is a compression neuropathy of the superficial branch of the radial nerve. It is the result of pressure on the nerve by external or internal factors. The syndrome also includes iatrogenic causes of nerve injury. As a sensory nerve, it produces pain and dysesthesias in the area of its distribution on the dorsolateral site of the wrist and hand. Failed conservative treatment of rest and external pressure removal, is followed by surgical decompression.

To evaluate the functioning of 1,2 intercompartmental supraretinacular artery (ICSRA) in vascularized bone grafting (VBG) of scaphoid nonunions with avascular necrosis of proximal pole. Fourteen patients with scaphoid nonunion were treated operatively with 1,2 ICSRA VBG. Viability of the pedicle artery was evaluated by MR angiography with intravenous contrast agent. In 13 out of 14 patients, the 1,2 ICSR artery was found to be patent and functional. Revascularization of scaphoid proximal pole was revealed in all cases, and nonunion healing was confirmed as well. 1,2 ICSRA VBG in scaphoid nonunion is an effective surgical technique. It combines the advantages of bone grafting and vascular supply via the transferred pedicle artery which seems to be functional postoperatively if a meticulous operative technique is used.

Introduction A patient with a neglected, compound acutely ruptured false aneurysm of the brachial artery which developed after a periprosthetic fracture of the right humerus, is reported. Case presentation An 84-year-old Greek woman underwent right shoulder hemiarthroplasty 2 years before a periprosthetic fracture which was treated conservatively in another hospital. After removing the U-slab herself, she noticed the development of an ulcer on the mid-humerus, with continuous oozing but no fever. This led to above-elbow amputation in an attempt to save the patient's life. Conclusion It is hoped that by awareness of such a possibility coupled with an early diagnosis based on the clinical picture and imaging modalities, such unfortunate results can be avoided in the future. In case of increasing displacement at the fracture site and excessive local swelling, the possibility of the presence of a false brachial aneurysm should be ruled out despite the presence of normal perfusion of the hand and palpable radial and ulnar pulses.

Introduction A case of an osteolysis by Mitek anchor-suture is presented. Case presentation A case of index finger's flexor digitorum profundus tendon primary reconstruction with the use of Mitek anchor is presented here. Within a 14 month period, Mitek suture anchor caused local foreign body reaction with osteolysis and ulceration of the palmar skin of the finger while on the other hand tendon's healing was successfully completed. Conclusion Mitek anchor-sutures can cause an aseptic inflammatory reaction which represents a typical biologic response to a foreign body. Concomitant osteolysis can drive to loosening and migration of the implant.