No abstract

This case demonstrates that arthrodesis is a suitable salvage procedure for chronic, irreducible CMC dislocations of the thumb.

Background: The vast majority of pediatric distal-third tibial shaft fractures can be treated with closed reduction and casting. If conservative measures fail, then these fractures are usually treated with 2 antegrade flexible intramedullary nails. A postoperative cast is usually applied because of the tenuous fixation of the 2 nails. Recent studies have described the use of 4 nails to increase the stability of the fixation, a technique that may preclude the need for postoperative casting. The purpose of this biomechanical study is to quantify the relative increase in stiffness and load to failure when using 4 versus 2 nails to surgically stabilize these fractures. Methods: Short, oblique osteotomies were created in the distal third of small fourth-generation tibial sawbones and stabilized with 2 (double) or 4 (quadruple) flexible intramedullary nails. After pilot testing, 5 models per fixation method were tested cyclically in axial compression, torsion, and 4-point bending in valgus and recurvatum. At the end of the study, each model was loaded to failure in valgus. Stiffness values were calculated, and yield points were recorded. The data were compared using Student’s t tests. Results are presented as mean±SD. The level of significance was set at P≤0.05. Results: Stiffness in valgus 4-point bending was 624±231 and 336±162 N/mm in the quadruple-nail and double-nail groups, respectively (P=0.04). There were no statistically significant differences in any other mode of testing. Conclusions: The quadruple-nail construct was almost 2 times as stiff as the double-nail construct in resisting valgus deformation. This provides biomechanical support for a previously published study describing the clinical success of this fixation construct.

Case: Tibial plateau fractures can be associated with arterial injuries or dysvascular limbs, particularly in settings of trauma. Dysvascular limb in the setting of fracture is commonly due to dissection of the artery. Entrapment of the artery within the fracture is rare. We report a 48-year-old man who presented with left popliteal entrapment within a left tibial plateau fracture status-post external fixation and stent placement in the popliteal artery. Conclusion: Findings from this case highlight entrapment of an artery as a mechanism of a dysvascular limb in the setting of high-energy lower-extremity fractures and specifically for tibial plateau fractures.