Volume 14-3, Fall 2005

Compartment Syndrome: Time From Diagnosis to Fasciotomy -- Brett M. Cascio, MD; Dhruv B. Pateder, MD; John H. Wilckens, MD; Frank J. Frassica, MD

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A definitive safe time to fasciotomy for compartment syndrome has not been established. Therefore, the records of 28 patients who had a fasciotomy for compartment syndrome at two trauma centers (18 level I, 10 level II) were reviewed to determine time from diagnosis to fasciotomy and clinical outcome. Average times at the two trauma centers (level I: 160 minutes, range, 50–315 minutes; level II: 105 minutes, range, 51–185 minutes) were significantly different. Ten patients (5 level I, 5 level II) with an average time from diagnosis to fasciotomy of 122 minutes (range, 70–185 minutes) sustained residual deficits. There was no correlation between time from diagnosis to fasciotomy and residual deficits. A time from diagnosis to fasciotomy as short as 70 minutes was associated with residual deficit, but a time as long as 315 minutes (patient with deficits) was associated with no functional deficits. (Journal of Surgical Orthopaedic Advances 14(3):117–121, 2005) Key words: compartment syndrome, fasciotomy, residual deficit

Acetabular Dysplasia Following Closed Reduction of Developmental Dislocation of the Hip -- Brian T. Carney, MD

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The purpose of this study was to determine the incidence of acetabular dysplasia following closed reduction of developmental dislocation of the hip, particularly as it relates to the age at reduction and the presence of the ossific nucleus. Thirty-five children with unilateral developmental dislocation of the hip underwent closed reduction. Medical records were reviewed for gender, side, age at reduction, use of Pavlik harness, prereduction traction, presence/absence of the ossific nucleus, and whether adductor longus tenotomy was performed. Acetabular index was measured. The mean age at reduction was 10 months. The mean length of follow-up was 91 months. Following closed reduction, the incidence of acetabular dysplasia was 69% (24 hips). No statistically significant relationship between acetabular dysplasia and age at reduction or presence of the ossific nucleus was demonstrated. (Journal of Surgical Orthopaedic Advances 14(3):122–124, 2005) Key words: acetabular dysplasia, closed reduction, developmental dysplasia of the hip (DDH), ossific nucleus

Osteoblastoma of the Scaphoid: A Case Report -- Ricardo A. Meade, MD; Christian A. Allende, MD; Tsu-Min Tsai, MD

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Osteoblastoma is an uncommon primary bone tumor that rarely is found in the hand or wrist. Recurrent osteoblastomas often have a more aggressive appearance than the original tumor, and differential diagnosis from osteosarcoma is difficult. The pain that can accompany this tumor is debilitating. Therefore, successful treatment requires complete removal of the tumor. The purpose of this report is to present an unusual case of osteoblastoma of the carpal scaphoid. This tumor was treated successfully by curettage and bone grafting. At 1 year postoperatively, the patient presented with a stable, painless wrist with full range of motion. (Journal of Surgical Orthopaedic Advances 14(3):125–128, 2005) Key words: benign bone tumors, osteoblastoma, scaphoid tumors

Neurovascular Compression Following Isolated Popliteus Muscle Rupture: A Case Report -- Godard C. W. de Ruiter, MD; Michael E. Torchia, MD; Kimberly K. Amrami, MD; and Robert J. Spinner, MD

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This case report concerns an unusual complication of neurovascular compression following an isolated popliteus muscle rupture. A 59-year-old man, after a fall from a horse, gradually developed symptoms of a swollen leg, dysesthesias in the sole of his foot, and muscle weakness of his toe flexors. At presentation, he was found to have a complete tibial nerve injury at the level of the popliteal fossa and significant neuropathic pain. MRI demonstrated a rupture in the muscular portion of the popliteusmuscle with extensive edema and hemorrhage compressing the tibial nerve in the popliteal fossa. The edema extended up to the distal part of sciatic nerve where there was evidence of intraneural hemorrhage. In the course of recovery, the patient additionally developed deep venous thrombosis in the ipsilateral popliteal vein. Spontaneous recovery was documented on serial clinical and electrodiagnostic examinations. The patient’s neuropathic pain improved significantly within 6 months and his neurologic function recovered nearly fully by 2 years. (Journal of Surgical Orthopaedic Advances 14(3):129–132, 2005) Key words: deep venous thrombosis, isolated popliteus muscle rupture, sciatic nerve compression, tibial nerve compression

Trans-scaphoid, Transcapitate, Transhamate Injury: A Case Report -- Julian E. Kuz, MD

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Traumatic axial dislocation of the carpus in a 20-year-old man is described. This injury was accompanied by a crushing injury to the hand. The disruption pattern was different from those of previously reported cases. Despite the restoration of painless wrist motion postoperatively, grip strength remained below normal. Early accurate reduction, fixation, and range of motion exercise are the treatments of choice in such complex injuries. (Journal of Surgical Orthopaedic Advances 14(3):133–135, 2005) Key words: carpal arc, scaphocapitate syndrome, transcapitate, trans-scaphoid

Intrapartum Coccygeal Fracture, A Cause for Postpartum Coccydynia: A Case Report -- Rishi Kaushal, MD; Arun Bhanot, MD; Shalini Luthra, MD; P.N. Gupta, MD; Raj Bahadur Sharma, MD

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Coccydynia can result from a varying number of causes, parturition being one of them. Although strains and sprains of the ligaments attached to the coccyx have been thought to be the usual cause for coccydynia occurring after childbirth, an intrapartum coccygeal fracture dislocation can result in the same. A 28-year-old female presented to the orthopaedic department 4 weeks after the birth of her first child with the complaint of coccygeal pain. Examination revealed marked local tenderness over the coccyx but no crepitus was felt. Radiographs established the diagnosis of fracture and posterior dislocation between the second and third coccygeal fragments. Conservative treatment in the form of rest, doughnut ring, local heat, and avoidance of direct pressure over the area resulted in considerable improvement over the next 4 weeks. Coccygeal fracture dislocation may result in introital dyspareunia and tension myalgia of the pelvic floor. Pain from this lesion may become recurrently symptomatic. The diagnosis must be established at the outset and appropriate treatment instituted to avoid these complications. (Journal of Surgical Orthopaedic Advances 14(3):136–137, 2005) Key words: coccydynia, coccyx, fracture dislocation, parturition complications

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