Acute syndesmotic injuries in ankle fractures: From diagnosis to treatment and current concepts.

A stable and precise articulation of the distal tibiofibular syndesmosis maintains the tibiofibular relationship, and it is essential for normal motion of the ankle joint. The disruption of this joint is frequently accompanied by rotational ankle fracture, such as pronation-external rotation, and rarely occurs without ankle fracture. The diagnosis is not simple, and ideal management of the various presentations of syndesmotic injury remains controversial to this day.

Pectoralis major tendon rupture in a weight lifter: a rare case.

Pectoralis major tendon (PMT) rupture is a rare event, and it was originally described by Patisser in 1822. The PMT is a thick lamina, which has two origins, one from the clavicle and the other from the ribcage sternum. PMT lesions are classified according to 3 levels of severity: Type 1 is contusions and strains, Type 2 is a partial tear and Type 3 is a complete tear.

Fifth metacarpal neck fractures: fixation with antegrade locked flexible intramedullary nailing.

Background: Fifth metacarpal neck fractures (commonly named "boxer's fractures") are the most common metacarpal injuries and usually affect young active people. These lesions are mainly treated conservatively. Their surgical management, if indicated, is still a matter of debate.

A rare case of bilateral complex wrist injury in a professional motocross rider.

We describe the treatment of a 29 year-old professional motocross rider, who sustained a perilunate dislocation in his right wrist and a distal radius fracture and dorsal dislocation of his left wrist during a race. Both wrists were treated acutely during a single operating session. Surgery consisted in open reduction, k-wire fixation and mini-anchor repair of the scapho-lunate and luno-triquetrium ligaments on the right wrist, while closed reduction and percutaneous k-wire fixation was used in the left wrist.

Clinical approach in PIPj flexion contracture conservative treatment: our experience.

Proximal interphalangeal joint (PIPj) flexion contractures are a common clinical problem seen by hand therapists and orthopaedic surgeons after various types of injury to the finger. Conservative treatment is preferable over surgery but a variety of pre-fabricated and custom-made orthoses have been proposed in the literature. The aim of the present paper is to share our 15 year experience in treating PIPj flexion contractures using 2 different custom-fabricated orthoses and the exercise regimen used to preserve maximal PIPj passive and active extension obtained through the orthotic intervention.

Thermal balneotherapy in Antsirabe-Madagascar: water analysis and its applications in an African context.

The Orthopaedic Rehabilitation Centre of Madagascar can be found in the city of Antsirabe. The health care facility is equipped with 2 thermal sources of bicarbonate water used for post-operative rehabilitation and for the ailment of chronic degenerative illnesses. The aim of this study, which derives from the cooperation between the School of Specialization in Thermal Therapy of the University of Parma and Antsirabe Orthopaedic Hospital, is to analyze the real properties of thermal waters utilized in this centre and to do an overview of its possible applications in this particular African context.

Trapeziectomy With Ligament Reconstruction and Tendon Interposition Arthroplasty With the Entire Width of the Flexor Carpi Radialis Tendon.

The original Burton-Pellegrini technique used to treat trapeziometacarpal joint osteoarthritis suggests the use of half of the flexor carpi radialis (FCR) width to reconstruct the ligament and perform the tendon interposition arthroplasty. In our study, unlike the original technique, we used the full thickness of the FCR and evaluated a sample of 100 thumbs (95 patients) preoperatively and postoperatively, with a mean follow-up of 36 months. According to the Eaton classification, 1 thumb was grade II, 81 were grade III, and 18 were grade IV.

Triphalangeal thumb: case report and literature review.

Triphalangeal thumb (TPT) is a relatively rare congenital anomaly of the hand with evidence for autosomal dominant transmission. Surgical treatment is not always required, but according to Wood's classification it is related to the shape of the extra phalange. In this article, we present a case of  a 32 year old woman with isolated bilateral TPT.

Modified Mason type III and IV radial head fractures: results of different surgical treatments.

Background And Aim: Fractures of the radial head account for 4% of all fractures and 33 % of all elbow fractures. Their treatment is somewhat challenging and diversified, especially in more complex fractures (type III and IV of modified Mason's classification). The aim of this study was to identify the best surgical treatment for patients having sustained these latter lesions and outline possible predictive factors of worse outcomes.

Niccolò Paganini: the hands of a genius.

Niccolò Paganini was a man stricken by many diseases and according to Myron Schonenfield and Renzo Mantero, he may have also suffered from Marfan Syndrome. The following paper is based on actual physical examinations reports made by his contemporary physicians, documented in personal letters In addition, the current investigation presents a comparison between a post-mortem mold of Paganini's right hand and several paintings of the Maestro drawn by Lyser, his personal portraitist, and the images of the hand of a well-known musician affected by Marfan Syndrome which was treated by the authors. (www.

Complex transradial carpal dislocation in a Professional Pianist: Case Report.

Carpal fracture-dislocation associated to distal radius fractures is an uncommon injury of the wrist. Clinical assessment, instrumental diagnosis and treatment are all challenges for the surgeon. In addition, the prognosis in high-functioning patients is nearly always poor.

Effectiveness of cast immobilization in comparison to the gold-standard self-removal orthotic intervention for closed mallet fingers: a randomized clinical trial.

Study Design: Randomized clinical trial.

Introduction: Although orthotic immobilization has become the preferable treatment choice for closed mallet injuries, it is unclear whether orthosis self-removal has an impact on the final outcome.

Purpose: To evaluate the treatment efficacy of cast immobilization of closed mallet fingers using Quickcast(®) (QC) compared to a removable, lever-type thermoplastic orthosis (LTTP).

Mid-term results of complex distal humeral fractures.

The aim of this study was to assess outcomes following open reduction and internal fixation in complex fractures of the distal humerus. Between 2000 and 2006, 34 patients were operated for complex fractures of the distal humerus. Bone fixation was obtained with a reverse Y-shaped reconstruction plate in 13 cases and with double plating in 21 cases.

The four-strand staggered suture for flexor tendon repair: in vitro biomechanical study.

Purpose: To assess in vitro biomechanical properties of a 4-strand flexor tendon suture compared to 3 established suture techniques. This technique, which is made of 2 alternating and staggered sutures, one external to the tendon and the other internal, must be sufficiently resistant to withstand loads applied by modern, early active mobilization protocols.

Methods: Forty flexor hallucis longus tendons were harvested from fresh cadavers, cut, and repaired using 4 different suture techniques (Strickland, Wolfe, modified Savage, and a new technique called 4-strand staggered).

Linked semi-constrained total elbow prosthesis in chronic arthritis: results of 18 cases.

During the second half of the 1900s, total elbow joint replacement began its ascent. Since then, many prosthetic models have been used. The main objective of elbow joint replacement in arthritic diseases is to decrease pain, increase joint stability and improve overall range of motion.

Complex fractures of the distal radius treated with angular stability plates.

Complex fractures of the distal radius are articular lesions and comminuted at the level of the epiphysis and metaphysis. Their treatment is difficult and in most cases surgical. Of all the different osteosynthesis methods available, internal fixation with plate and screws is the most commonly used.

Alternative splinting approach for proximal interphalangeal joint flexion contractures: no-profile static-progressive splinting and cylinder splint combo.

Proximal interphalangeal joint (PIPj) flexion contractures can be challenging contractures to resolve. Through the years, numerous splints have been designed to treat such contractures. However, despite the abundance of available splints, therapists are always modifying splinting designs and incorporating new concepts into these designs to treat this challenging problem.