Yuen-Fai Leung

Solitary dislocation of the scaphoid: From case report to literature review

Solitary dislocation of the scaphoid can be classified as simple, or complex if the distal carpal row is included. It may be total or partial. Partial dislocation of the proximal pole may occur in a radial, palmar or dorsal direction. Each type has a different significance in terms of surgical approaches, complications and prognosis.

The crisscross injury mechanism in forearm injuries

IntroductionA new mechanism of injury of the forearm bones, crisscross injury, is described. It is more common than the Essex-Lopresti fracture dislocation. The old concept of isolated injury of one side of the radioulnar joint may be challenged. It often occurs in Mason type II fracture dislocation of the radial head or dislocation of radioulnar joints.Materials and methodsThe first part was a cadaveric study of the crisscross injury of forearms. The second part was a clinical study of the crisscross injury in some cases of Mason type II fracture radial head and double dislocation of the radioulnar joint.ResultsThe cadaveric study confirmed a stable crisscross fracture dislocation injury with intact interosseous membrane. The clinical study echoed the presence of this injury by imaging techniques.ConclusionThe crisscross injury mechanism explains the mirror pathogenesis of the traumatic fracture dislocation of the distal and proximal radioulnar joints with intact shaft of the radius and ulna. Co-existing subluxation or dislocation of the other radioulnar articulation must not be overlooked in cases of fracture dislocation of one radioulnar joint. Two types of crisscross injury of forearm bones are proposed.

Isolated dislocation of the radial head, with simultaneous dislocation of proximal and distal radio-ulnar joints without fracture in an adult patient: case report and review of the literature.

A 36-year-old female saleswoman presented with left upper limb injury in a landslide in 1999. The falling stones and mud caught her left forearm with the elbow in semi-flexion and pronation position. The left wrist was hyperflexed passively by the rushing mud. The patient described a pronated twisting force on her left forearm associated with severe pain. She also had minor head injury but without loss of consciousness. The Glasgow Coma Scale was normal with no retrograde amnesia. On physical examination, her left elbow was held in flexion and hyperpronation with the wrist in flexion. A superficial abrasion was noted on the dorsal surface of the left forearm. The elbow and wrist were swollen. All movements of the elbow and wrist were limited by severe pain. There was no neurological or vascular injury. Radiography of the forearm (Fig. 1) included the left elbow and wrist joint was taken. It revealed antero-lateral dislocation of the radial head at the radio-capitellar joint, dislocation of the proximal and distal radio-ulnar joints without fracture of the left upper limb. The ulnar head was dislocated volar to the carpus and distal radius while the radial head was volar to the proximal ulna. The ulno-humeral articulation was intact. The forearm bones had a criss-cross appearance on the lateral radiograph. An elbow arthrogram showed some leakage of the contrast from the elbow joint and no intra-articular loose cartilage fragments. Closed reduction was performed under general anaesthesia. The distal radio-ulnar joint reduced with pronation of the forearm but the proximal radio-ulnar joint and dislocated radial head could only be reduced with supination of the forearm. Reduction of one end was repeatedly lost during the manipulation of the other end. Eventually, the distal radio-ulnar joint was reduced by pronation of the forearm and held by compression of the distal ulna against the distal radius with one hand. The forearm was then supinated, reducing the proximal radio-ulnar joint and radio-humeral articulation. Both reductions were stable in neutral rotation and no K-wire was required. There was no diastasis seen at the radio-ulnar joints, we presumed the interosseous membrane was intact. A long arm cast was applied for 5 weeks with the forearm in neutral rotation, 90° of elbow flexion, and the wrist in neutral deviation and 25° of dorsiflexion. A course of physiotherapy and occupational therapy was offered. The patient regained full function and range of movement of the elbow and wrist joints 2 months after the cast was removed. Minor degree of instability of the distal radio-ulnar joint was noticed on rocking the ulnar head against the radius on follow-up at 6 months, but this became stable at 1 year. The patient had full recovery of function.

Tuberculous osteomyelitis of the scapula.

Abstract Tuberculous osteomyelitis is an uncommon disease entity. We report two cases of tuberculous infection of the scapula, one involving the acromion and one involving the body of the scapula. Tuberculosis is still an important differential diagnosis in unusual or chronic bone conditions.Rèsumè Nous rapportons deux cas d’infection tuberculeuse de l’omoplate, l’un atteignant l’acromion, l’autre atteignant le corps de l’omoplate. La tuberculose est encore un diagnostic différentiel important des maladies rares ou chroniques des os.

Non-union of the triquetrum with pseudoarthrosis: a case report

We report a case of symptomatic non-union of the triquetrum with pseudoarthrosis in a 34-year-old man. Motion of the pseudoarthrosis was noted from radial to ulnar deviation. The patient was treated with bone grafting and screw fixation. The non-union healed and the symptoms subsided. The Mayo wrist score had improved from 65 (fair) to 90 (excellent).