Ben Shamian

Chronic scaphoid nonunion of 28-year duration treated with nonvascularized iliac crest bone graft.

Scaphoid nonunions present a challenging clinical problem, particularly if the diagnosis of nonunion is missed or delayed. The optimal management technique can vary from free vascularized bone grafts to scaphoid excision and limited wrist fusion. The classic method of open reduction, nonvascularized corticocancellous bone grafting and internal fixation is still an effective technique. In this report, we describe a case of a 28-year-old chronic scaphoid nonunion treated with nonvascular iliac crest bone graft and internal fixation.

Treatment of a segmental defect in open radial and ulnar shaft fractures using rhBMP-2 and iliac crest bone graft: a case report

Segmental defects and delayed healing of long bone fracture remains a major problem among orthopedic surgeons. Nonunion of the forearm as a result of complex open fracture can result in imbalance in the main anatomical structures, leading to impaired function [17]. Therefore, the treatment of these defects must include the restoration of length and alignment in order to restore functional forearm motion [21]. Current treatment options for segmental long bone defects includes autogenous bone grafting, bone shortening, plate fixation combined with either intercalary non-vascularized structural (corticocancellous) bone grafts, vascularized grafts, or amputation [9]. The identification of recombinant human bone morphogenetic protein-2 (rhBMP-2) has led to revolutionary treatment options in certain orthopedic procedures. Currently, rhBMP-2 is approved by the United States Food and Drug Administration (FDA) for spine fusion [7, 11, 13, 16], tibial fractures [12, 14], and oral maxillofacial [4–6] procedures. The reported use of BMP-2 in cases of forearm shaft fractures has been limited. In our case report, we describe an off-label use of rhBMP-2 used in combination with iliac crest bone graft to treat segmental defects in a man with open radius and ulna fractures.

CORRECTIVE OSTEOTOMY AND LOCAL BONE GRAFTING FOR EXTRA-ARTICULAR MALUNION OF THE PROXIMAL PHALANX

Corrective osteotomies are often utilised to treat finger deformities that may occur due to a phalangeal malunion. Rotational or angular malalignment, in addition to shortening of the digit may negatively affect hand function and be aesthetically displeasing. Thorough preoperative examination of the malunion and its associated deformities is crucial in determining the type of osteotomy technique to be used. Osteotomies can create bony defects that need to be filled with bone graft or some type of graft substitute. We describe an opening wedge osteotomy with local cancellous bone graft combined with dual plating to treat a dorsal angular deformity in a proximal phalangeal malunion.

Novel Use of Synthetic Acellular Dermal Matrix for Coverage of a Tibial Defect Following Resection of an Osteochondroma A Case Report

The application of an artificial dermal matrix (Integra Life Sciences, Plainsboro, NJ) in the management of substantial burn injuries has been extensively documented. Use of an artificial dermal matrix has resulted in excellent outcomes and is free of the morbidity associated with harvesting free-tissue flaps. However, coverage of bony defects where the periosteum has been removed is often challenging. In the current report, we present a case wherein the use of an acellular synthetic dermis combined with split-thickness skin grafting resulted in successful coverage of a tibial defect following resection of an osteochondroma.

Exposures of the humerus for fracture fixation.

The care of humeral shaft fractures is undergoing a transition to more aggressive treatment methods with more frequent operative fixation. The upper arm has an extensive network of nerves, arteries, and veins that must be protected during any operative exposure. The ultimate goal of fixation of a humerus fracture is rigid stabilization to allow early range of motion, protection of the neurovascular structures, and preservation of the triceps mechanism posteriorly and the anterior elbow flexor muscles.

Osteonecrosis of the Lunate Following Low-Energy Trauma

Osteonecrosis of the lunate was first described by Austrian radiologist Robert Kienbock in 19101. Presenting symptoms include pain, loss of carpal mobility, and prominence in the dorsal wrist. Theories about the pathogenesis of Kienbock disease include repetitive trauma, attritional rupture of the surrounding ligaments, and vascular compromise of the lunate. This causes osteonecrosis and progressive collapse of the lunate. It usually presents as idiopathic osteonecrosis or, alternatively, after high-energy trauma that may cause dislocation of the lunate. In this case report we describe a case of osteonecrosis following a low-energy fracture of the distal part of the radius. The patient was informed that data concerning the case would be submitted for publication, and she provided consent. A fifty-four-year-old woman sustained a fracture of the distal part of the right radius after falling on some ice (Figs. 1-A and 1-B). She was treated with closed reduction and splinting at an outside institution. Six days after the incident, she presented to us with persistent wrist pain. Repeat imaging showed a displaced fracture of the distal part of the right radius with unacceptable dorsal angulation. The lunate appeared normal with no fracture, collapse, or signs of osteonecrosis. The patient was taken to the operating room two days later for closed reduction; the arm was placed in a long-arm cast under intravenous sedation. Because of other medical problems, including severe hypertension, congestive heart failure, hepatitis C, and depression, a prolonged procedure under general anesthesia was contraindicated. Initial anteroposterior (Fig. 1-A) and lateral (Fig. 1-B) radiographs showing the fracture of the distal part of the radius. Fig. 1-A Fig. 1-B At the first follow-up visit twelve days later, radiographs showed acceptable alignment of the fracture with maintenance of the reduction. The lunate had a normal appearance (Figs. 2-A and 2-B). One month after reduction, the patient was evaluated, and she reported no wrist pain. Radiographs revealed interval healing with some settling of the fracture. The radiographic …

Hybrid compression plating for the treatment of complex distal radial fracture

BackgroundTo evaluate the radiographic and clinical outcome of hybrid compression plating for the treatment of combined fractures of the distal radius and radial shaft. MethodsThis is a retrospective review of 18 patients treated with open reduction and internal fixation of combined distal radial and radial shaft fractures using hybrid site-specific plating. Ten patients were men and eight were women with an average age of 46 years (range 19–90 years). The time from injury to surgery was an average of 5.8 days (range 1–16 days). Nine were open fractures and the remaining nine were closed fractures. ResultsEleven of the 18 patients were available for a minimum of 3 month follow-up. The average follow-up time of these patients was 6.5 months (range 3–15 months). All fractures healed with an average healing time of 4.5 months (range 2–7 months). One patient had an infection that presented 2 months postoperatively. All fractures had acceptable alignment with good restoration of the radial bow. The average range of motion was 138° elbow flexion, 2° elbow extension, 66° wrist flexion, 54° wrist extension, 69° pronation, and 72° supination. Radiographic evaluation showed an average ulnar variance of −2.1 mm, radial bow of 14.3 mm, and location of radial bow at 55%. ConclusionsThis study demonstrates that hybrid compression plating can be a useful technique for the treatment of complex diaphyseal-metaphyseal fractures of the radius, resulting in good clinical and radiographic outcomes.

Isolated radial shaft fracture with unreducable posterior dislocation of the radial head and rupture of the lateral collateral ligament: A case report

Combined injuries associated with forearm shaft fractures and elbow dislocations are well recognized. We describe an uncommon case of an isolated radial shaft fracture with an unreducable posterior dislocation of the radial head and associated rupture of the lateral collateral ligament of the elbow.