Chanyut Suphachatwong

Sensory abnormalities after the seventh cervical nerve root transfer

Twenty‐four patients with root avulsion of brachial plexus were treated with the contralateral C7 root transfer. The area of sensory abnormalities was found on the thumb in 20 cases (83.33%), index finger in 14 cases (58.33%), middle finger in 8 cases (33.33%), ring finger in 3 cases (12.5%), little finger in 11 cases (45.83%), on the radial side of forearm in 9 cases (37.5%), thenar area in 12 cases (50%), and hypothenar area in 8 cases (33.33%). No patient had normal sensation after the seventh cervical root transfer. Sensory abnormalities disappeared within 3 months in all except one patient, who still had sensory abnormalities on the tip of index finger for more than 20 months after the operation.

Transfer of one fascicle of ulnar nerve to functioning free gracilis muscle transplantation for elbow flexion

Background:  In brachial plexus injury, elbow flexion is the first priority in reconstruction. Neglected cases need functioning free muscle transplantation that requires the donor nerve to supply the transplanted muscle. The purpose of this study was to investigate the effects and results of transferring one fascicle of the ulnar nerve to the transplanted gracilis muscle.

Effect of early surgery in high surgical risk geriatric patients with femoral neck fracture and taking antiplatelet agents

AIM To investigate the effect of early surgical intervention on the high surgical risk elderly patients who sustained femoral neck fracture (FNF) and taking concomitant antiplatelet agents. METHODS Between 2010 and 2012, a prospective study was conducted on 49 geriatric patients, who took antiplatelet agents, sustained FNF and underwent surgery within 72 h [early surgery (ES) group], and these were compared with a retrospective consecutive case series of patients with similar characteristics (45 cases) who had delayed surgery (DS group) after 72 h during an earlier 3-year period. Postoperative outcomes were followed for one year and compared. RESULTS There were non-significant differences in perioperative blood loss, blood transfusion, intensive care unit requirement and postoperative mortality (P > 0.05 all). There were 2 patients (4%) in the DS group who died after surgery (P = 0.23). However, the ES group showed a significantly better postoperative outcome in terms of postoperative complications, length of hospital stay, and functional outcome (P < 0.05 all). CONCLUSION Early hip surgery in geriatric hip fracture patients with ongoing antiplatelet treatment was not associated with a significant increase of perioperative blood loss and postoperative mortality. Moreover, ES resulted in a better postoperative surgical outcome. In early hip surgery protocol, the antiplatelet agents are discontinued and the patient is operated on within 72 h after admission, which is safe and effective for the medically fit patients.

Using a reconstruction locking compression plate as external fixator in infected open clavicle fracture

Open clavicle fracture is an uncommon injury mostly caused by severe direct trauma. It is often associated with multiple organ injuries. Generally, surgical intervention with debridement and fracture repair is always indicated in order to prevent infection, non-union, and malalignment. In situations of bony exposure and significant contamination concomitant with severe soft tissue damage, the external fixation is the treatment of choice because of the possibility it offers of providing stable fixation with minimal local tissue damage resulting in excellent union rates and better soft tissue outcome. Nevertheless, traditional external fixation encountered some potential problems as its bulkiness and sharp edges caused discomfort to the patient. In this study, we present an interesting case of a polytraumatized patient with a gunshot injury with complex open clavicle fracture that was successfully treated with external fixation using reconstruction with a locking compression plate as definitive treatment.

Anteromedial marginal fracture of medial tibial plateau without significant knee ligamentous injury in hypermobility patient: a case report and review of literature

Anteromedial rim fracture of medial tibial plateau is a rare fracture pattern with only a small number of case reports in the literature. However, it is highly likely that is associated with specific significant soft tissue injuries, especially posterior and posterolateral corner structure, and medial meniscus injury. It is thought this fracture is caused by hyperextension and varus rotation mechanism. The previous reports highlight the typical pattern of severe concomitant knee ligament injury associated with this fracture that always require surgical repair to restore knee stability and function. In this report, we present an unusual case with a history of generalized joint laxity and acute anteromedial marginal fracture of medial tibial plateau without associated significant ligament damage, together with a literature review of this condition. We believe this case report introduces new insights into this unique fracture pattern.

The Use of Dual Reconstruction Plates for Failed Fixation of Patellar Fracture after Total Knee Replacement: A Case Report

Patellar fracture after total knee replacement (TKR) is one of the challenging problems in periprosthetic fracture. Open reduction with internal fixation (ORIF), as tension band wiring (TBW), usually required in cases with extensor mechanism disruption. However, many studies reported a high failure rate after using this technique. In this report, we presented an interesting case of periprosthetic patellar fracture after TKR with TBW failure that was successfully treated with double non-locking reconstruction plates fixation and TBW augmentation.

Case Report: Closed Posteromedial Dislocation of the Ankle without MedialMalleolar Fracture

Closed ankle dislocation without associated fractures of malleoli is a very rare condition and has been reported sparsely in literatures. We present two cases of this type of injury. All patients were treated conservatively with immediate closed reduction and immobilization in a short leg slab. Mechanism of injury, MRI findings, management, functional outcome and possible complications were discussed. Sufficient immobilization period with gradual ankle joint motion exercise with brace support resulted in good to excellent clinical outcomes. A review of the literature is also presented in this paper.

Demineralized Bone Matrix Add-On for Acceleration of Bone Healing in Atypical Subtrochanteric Femoral Fracture: A Consecutive Case-Control Study

Background. Delayed union and nonunion are common complications in atypical femoral fractures (AFFs) despite having good fracture fixation. Demineralized bone matrix (DBM) is a successfully proven method for enhancing fracture healing of the long bone fracture and nonunion and should be used in AFFs. This study aimed to compare the outcome after subtrochanteric AFFs (ST-AFFs) fixation with and without DBM. Materials and Methods. A prospective study was conducted on 9 ST-AFFs patients using DBM (DBM group) during 2013-2014 and compared with a retrospective consecutive case series of ST-AFFs patients treated without DBM (2010–2012) (NDBM group, 9 patients). All patients were treated with the same standard guideline and followed up until fractures completely united. Postoperative outcomes were then compared. Results. DBM group showed a significant shorter healing time than NDBM group (28.1 ± 14.4 versus 57.9 ± 36.8 weeks, p = 0.04). Delayed union was found in 4 patients (44%) in DBM group compared with 7 patients (78%) in NDBM group (p > 0.05). No statistical difference of nonunion was demonstrated between both groups (DBM = 1 and NDBM = 2, p > 0.05). Neither postoperative infection nor severe local tissue reaction was found. Conclusions. DBM is safe and effective for accelerating the fracture healing in ST-AFFx and possibly reduces nonunion after fracture fixation. Trial registration number is TCTR20151021001.

Modification of spinal pedicle screw-plate fixation for bilateral pediatric pelvic ring injury in 2-year-old girl

Unstable pelvic fractures in children are an uncommon injury and are typically associated with high-energy trauma, such as an automobile accident or motor vehiclepedestrian injury [1–3]. Results from recent studies concluded that these unstable injuries needed to be treated with operative management [4–9], to achieve as near anatomical reduction as possible, with stable fixation to prevent longterm poor outcomes following non-operative treatment, such as residual pain, limb length discrepancy and scoliosis [10, 11]. Nevertheless, to date, there is still no consensus treatment option for surgical management in pediatric pelvic fracture, especially in very young children with displaced sacroiliac (SI) fracture-dislocation or bilateral SI joint injury. Traditional surgical fixation methods of SI joint disruptions, such as SI screw and anterior retroperitoneal SI plate, have several limitations because of the small bony anatomy in children, which requires an experienced surgeon and advanced imaging techniques. Moreover, there are still possible catastrophic intraoperative complications such as extensive blood loss, neurovascular injury, and implant jam due to the small bony architecture [12]. Therefore, in this present study, the authors aimed to introduce a new alternative surgical fixation procedure by modifying a spinal pedicle screw-plate (PSP) system to treat a complex bilateral unstable SI joint fracture-dislocation in a very young pediatric patient with a minimally invasive technique, and to report the mid-term result.