Babacar Thiam

Open Anterior Transverse (Divergent) Dislocation of the Elbow Joint

A divergent dislocation of the elbow joint is an unusual injury1. To the best of our knowledge, only sixty-nine cases have been reported in the literature since Warmont first described a case in 18542; these dislocations most commonly occurred in children. The upper ends of the radius and ulna dislocate from each other and from the humerus, and therefore diverge posteriorly and laterally (transverse divergence)1 or anteroposteriorly, with the radius diverging anteriorly and the ulna diverging posteriorly (anteroposterior divergence)3, or they converge with the radius posteromedially and the ulna posterolaterally (crossed divergence, radioulnar translocation)4. We report the case of a nine-year-old boy who sustained an open anterior divergent dislocation of the right elbow after a traffic accident. Open reduction and repair of the soft tissue was performed, and complete functional recovery had occurred at six months postinjury. To our knowledge, no other case of an anterior transverse dislocation of the elbow previously has been reported. The patient and his parents were informed that data concerning the case would be submitted for publication, and they provided consent. A nine-year-old right-hand-dominant boy presented to our Emergency Department with an open elbow injury following a traffic accident. He had been crossing the road when a truck struck his right upper limb. The exact mechanism remained undefined. On admission, the elbow joint was flexed and supinated. There was a large posterior wound with loss of soft tissue from the distal part of the arm to the wrist. The olecranon process and radial head were not palpable in their normal positions, and the distal part of the humerus had herniated through the triceps muscle (Fig. 1-A). Active motion of the elbow was not possible. Distally, the radial and ulnar pulses were palpable; the fingers were sensitive …

Fracture-décollement de l’épiphyse médiale de la clavicule: à propos de 6 cas et revue de la littérature

This study aims to describe the epidemiological characteristics and the different anatomo-clinical entities of the fracture-separation of the medial clavicular epiphysis but also to relate the morphological and functional results of bloody reduction followed by osteosuture using non absorbable thread. Five boys and one girl (mean age 14 years) showed a closed and isolated shoulder girdle trauma. Clinical examination and medical imaging, especially CT scan, allowed the diagnosis of epiphyseal separation and to classify the degree of medial clavicular epiphysiseal ossification indicating the direction of displacement as well as the nature of displacement according to the Salter-Harris classification. Bloody reduction followed by osteosuture using non absorbable thread (No. 1 decimal) was performed in 3 patients. One patient underwent cross-pinning the two younger patients were treated orthopedically. The displacement of the clavicle stump was anterior in 3 patients and retro-sternal in 3 patients. Posterior forms were complicated by odynophagia (n = 2) and asymptomatic compression of the subclavian vein (n = 1). One of the posterior forms was associated with an ipsilateral fracture of the medial one third of the clavicle. Consolidation was achieved in all patients with preservation of shoulder mobility. The fracture-separation of the medial end of the clavicle mimes clinically and radiologically the sternoclavicular dislocation. It can be serious because of the risk of visceral and vascular compression in its posterior form. Tomdensitometry is irreplaceable for an accurate diagnosis. Our preference is for bloody reduction followed by osteosuture using non metallic thread.Le but de ce travail est de décrire les caractéristiques épidémiologiques et les différentes entités anatomo-cliniques de la fracture-séparation de l’épiphyse claviculaire médiale mais également de rapporter les résultats morphologiques et fonctionnelsde de la réduction sanglante suivie de l’ostéo-suture au fil non résorbable. Cinq garçons et 1 fille âgés en moyenne de 14 ans ont présenté un traumatisme fermé et isolé de la ceinture scapulaire. L’examen clinique et l’imagerie médicale surtout la TDM ont permis de poser le diagnostic de décollement épiphysaire, de classer le degré d’ossification de l’épiphyse claviculaire médiale en précisant le sens du déplacement, ainsi que la nature du décollement selon Salter-Harris. Une réduction sanglante suivie d’une ostéo-suture au fil non résorbable décimale n°1 a été réalisées chez 3 patients. Un patient a bénéficié d’un embrochage croisé. Les deux plus jeunes ont été traités orthopédiquement. Le déplacement du moignon claviculaire était antérieur chez 3 patients et rétro-sternal chez les 3 autres. Les formes postérieures ont été compliquées d’une odynophagie (n=2) et d’une compression asymptomatique de la veine sous Clavière (n=1). L’une des formes postérieuresétait associée a une fracture ipsilatérale du 1 / 3 médial de la clavicule. La consolidation a été obtenue chez tous les malades avec une mobilité de l’épaule conservée. La fracture-décollement de l’extrémité médiale de la clavicule mime au plan clinico-radiologique la luxation sterno-claviculaire. Elle peut être grave en raison du risque de compression viscérale et vasculaire dans sa forme postérieure. La tomodensitométrie reste irremplaçable pour un diagnostic précis. Notre préférence va à la réduction sanglante suivie d’une ostéo-suture au fil non métallique.

Threatened Aortic Injury by Thoracic Pedicle Screw: A Case Report

Iatrogenic vascular injury during posterior spinal surgery is a rare but potentially serious complication with treatment challenges. We report the case of threatened aortic injury by pedicle screw impingement during posterior fixation of thoracic spine T7 - T8 fracture dislocation. The removal of the conflicting screws was done posteriorly after a visual control of the absence of adventitious break-in by a thoracotomy.