Vol 8 | Issue 2 | July-December 2022 | page: 06-12 | Kenzie Kao, Mohammed Alsabri
DOI: https://doi.org/10.13107/ti.2022.v08i02.027
Authors: Kenzie Kao [1], Mohammed Alsabri [2]
[1] Saba University School of Medicine, Saba, Dutch Caribbean, Netherlands. [2] Department of Emergency Medicine, Al-Thawra Modern General Teaching Hospital, Sana’a City, Yemen.
Address of Correspondence
Dr. Mohammed Alsabri,
Department of Emergency Medicine, Al-Thawra Modern General Teaching Hospital, Sana’a City, Yemen.
E-mail: alsabri5000@gmail.com
Abstract
Hypothesis: Early administration of tranexamic acid (TXA) reduces mortality in patients suffering from acute traumatic brain injury (TBI).
Methods: A structured search of PubMed and CENTRAL from inception until July 1st, 2022 was carried out seeking RCTs comparing the effects of TXA administration to placebo in patients suffering from TBI. The primary outcome tested was 28-day all-cause mortality. Secondary outcomes included intracranial hemorrhage growth and thromboembolic events.
Results: Eight RCTs involving a total of 14,714 patients met the inclusion criteria; 7573 patients received TXA while 7141 patients received a placebo. There were 1415 patient deaths (18.7%) in the TXA group and 1410 patient deaths (19.7%) in the placebo group. None of the included studies reported a significant reduction in 28-day all-cause mortality, however, they all shared positive trends toward superior outcomes in the intervention arms. Two of the included studies reported significant reductions in intracranial hemorrhage expansion in those patients treated with TXA, with four more studies reporting trends toward superior outcomes in the TXA groups. There was no evidence of increased incidence of thromboembolic events in the TXA groups in four of the five studies that reported relevant data, with one study representing 1.2% of total patients reporting an increased incidence of pulmonary emboli in the intervention group.
Conclusions: In patients suffering from acute TBI, early administration of TXA reduces intracranial hemorrhage growth and may have positive effects on mortality with no corresponding increase in thromboembolic events. Given these results, early administration of TXA in patients experiencing TBI is recommended in initial care.
Keywords: Tranexamic acid, Traumatic brain injury, Intracranial hemorrhage, Mortality, Disability
References
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| How to Cite this article: Kao K, Alsabri M | Efficacy and Safety of Tranexamic Acid Administration in Patients with Acute Traumatic Brain Injury: A Review of Current Literature | July-December 2022; 8(2): 06-12. https://doi.org/10.13107/ti.2022.v08i02.027 |
From The Editor’s Desk!!
/in Volume 4 | Issue 2 | Sep-Dec 2018Vol 4 | Issue 2 | Sep-Dec 2018 | page:1 | Ashok K. Shyam
doi- 10.13107/ti.2018.v04i02.066
Author: Ashok K. Shyam [1, 2].
[1] Indian Orthopaedic Research Group, Thane, Maharashtra, India.
[2] Sancheti Institute for Orthopaedics & Rehabilitation, Pune, Maharashtra, India.
Address of Correspondence
Dr. Ashok Shyam
Head of Academics, Sancheti Institute for Orthopaedics & Rehabilitation, Pune, Maharashtra, India.
Email: editor.trauma.international@gmail.com
We thank authors for their contribution in the September-December 2018 issue of Trauma International. This issue contains Original Articles on Bimalleolar Fractures with Various Modalities, Triage in Mass Casualty Incidents, Proximal Femoral Nail in Subtrochanteric Femur Fractures, and case reports on Lateral Elbow Dislocation, Rashless and Bilateral Symmetrical Lower Limb Gangrene, Combined
Rupture of Patellar Tendon, Anterior Cruciate Ligament, Medial Collateral ligament, and Lateral Meniscus. We appreciate efforts of the authors and hope for more contribution in the field of orthopaedic literature in the coming years.
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Fixation of Acromion Fracture by Distal Radius Plate: A Case Report
/in January-June 2023 | Volume 9 | Issue 1Vol 9 | Issue 1 | January-June 2023 | page: 00-00 | Mohd. Danish, Hemant Gupta, Ravi Kant, Vikas Singh
DOI: https://doi.org/10.13107/ti.2023.v09i01.000
Authors: Mohd. Danish [1], Hemant Gupta [1], Ravi Kant [1], Vikas Singh [1]
[1] Department of Orthopaedics, Max Super Specialty Hospital, Vaishali, Ghaziabad, Uttar Pradesh, India.
Address of Correspondence
Dr. Mohd Danish,
Department of Orthopaedics, Max Super Specialty Hospital, Vaishali, Ghaziabad, Uttar Pradesh, India.
E-mail: danish.shan@gmail.com
Abstract
Acromion process fractures are as rare to happen and even rare to be treated surgically. Acromion acts as a stabilizer of shoulder joint through a number of ligaments and muscles attached to it. Although most of the acromion fractures are treated conservatively which may either be due to surgeon preference or lack of sufficient training in surgically treating these fractures. Our case is of a 54 years old, Male who presented to us after being referred from other hospital with Type II acromion process fracture who was treated surgically after the fracture was fixed by the unconventional distal end radius plate in place of usually used clavicular or recon plates. The patient yielded excellent Oxford shoulder score in the subsequent follow ups. Although the acromion fractures are not fixed by most of the surgeons and if at all they are fixed they usually use the conventional plates as mentioned for its fixation, but our case shows that even the distal radius plates can be used as a fixation device in such fractures with excellent rehabilitation results and almost no complications.
Keywords: Acromion, Fracture, Plate
References
1. Bartonicek J. Rockwood and Green’s Fractures in Adults, 8th Edition. Vol. 1. Netherlands: Wolters Kluwer; 2015. Scapular fractures; p. 1478.
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Long-Term Outcomes Following Synthetic Patch Augmentation to Treat Rotator Cuff Tears
/in January-June 2023 | Volume 9 | Issue 1Vol 9 | Issue 1 | January-June 2023 | page: 01-04 | Florian Hess, JoEllen Welter, Laurenz Jaberg
DOI: https://doi.org/10.13107/ti.2023.v09i01.031
Authors: Florian Hess [1], JoEllen Welter [1], Laurenz Jaberg [2]
[1] Department of Orthopaedic Surgery and Traumatology, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland.
[2] Department of Orthopaedic Surgery, Clinica Ars Medica, Gravesano, Switzerland.
Address of Correspondence
Dr. Florian Hess,
Department of Orthopaedic Surgery and Traumatology Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland.
E-mail: florian.hess@stgag.ch
Abstract
Background: Treatment of massive rotator cuff (RC) tears can result in re-rupture rates up to 94%, and some studies have detected re-ruptures occurring 3.5 years postoperatively. This study aimed to compare long-term clinical outcomes, measured at two time points, after massive RC tears with patch augmentation.
Methods: We performed 58 arthroscopic RC reconstructions augmented with a synthetic polyester patch between 2012 and 2014. 50 patients were available for long-term follow-up one and five years after surgery. We compared clinical outcomes (Constant-Murley score (CS) and subjective shoulder value (SSV)) to assess if the results were sustained over time.
Results: 86% (50/58) of the patients were assessed at the one- and five-year follow-up visits. The median CS one year postoperative reached 84 (interquartile range 76.5-90), and SSV was 95 (IQR 82.5-100). The median CS five years after surgery was 85 (IQR 81.5-91.5) and SSV was 95 (IQR 85-100). The clinical improvement between postoperative years one and five was statistically significant for CS (p=0.0013) and SSV (p<0.0001).
Conclusions: Rotator cuff repair with polyester patch augmentation achieved good clinical outcomes over the long term. Clinical improvement continued over time, with slightly more favorable results measured at the five-year follow-up visits.
Keywords: Massive rotator cuff tears, Augmentation, Patch, Shoulder, Arthroscopy
References
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6. Davey MS, Hurley ET, Carroll PJ, Galbraith JG, Shannon F, Kaar K, Mullett H (2023) Arthroscopic Rotator Cuff Repair Results in Improved Clinical Outcomes and Low Revision Rates at 10-Year Follow-Up: A Systematic Review. Arthrosc – J Arthrosc Relat Surg 39 (2):452-458.
7. Meyer DC, Wieser K, Farshad M, Gerber C (2012) Retraction of supraspinatus muscle and tendon as predictors of success of rotator cuff repair. Am J Sports Med. 40 (10):2242-2247.
8. Shah NS, Suriel Peguero E, Umeda Y, Crawford ZT, Grawe BM (2022) Long-Term Outcomes of Massive Rotator Cuff Tear Repair: A Systematic Review. HSS J 18 (1):130-137.
9. Smolen D, Haffner N, Mittermayr R, Hess F, Sternberg C, Leuzinger J (2020) Application of a new polyester patch in arthroscopic massive rotator cuff repair-a prospective cohort study. J Shoulder Elbow Surg 29 (1):e11-e21.
10. Proctor CS (2014) Long-term successful arthroscopic repair of large and massive rotator cuff tears with a functional and degradable reinforcement device. J Shoulder Elbow Surg 23 (10):1508-1513.
11. Gerber C, Fuchs B, Hodler J (2000) The results of repair of massive tears of the rotator cuff. J Bone Joint Surg [Am] 82 (4):505-515.
12. Davidson J, Burkhart SS (2010) The geometric classification of rotator cuff tears: a system linking tear pattern to treatment and prognosis. Arthrosc – J Arthrosc Relat Surg 26 (3):417-424.
13. Bailey JR, Kim C, Alentorn-Geli E, Kirkendall DT, Ledbetter L, Taylor DC, Toth AP, Garrigues GE (2019) Rotator Cuff Matrix Augmentation and Interposition: A Systematic Review and Meta-analysis. Am J Sports Med 47 (6):1496-1506.
14. Ferguson DP, Lewington MR, Smith TD, Wong IH (2016) Graft Utilization in the Augmentation of Large-to-Massive Rotator Cuff Repairs: A Systematic Review. Am J Sports Med 44 (11):2984-2992.
15. Steinhaus ME, Makhni EC, Cole BJ, Romeo AA, Verma NN (2016) Outcomes After Patch Use in Rotator Cuff Repair. Arthroscopy 32 (8):1676-1690.
16. Smolen D, Haffner N, Mittermayr R, Hess F, Sternberg C, Leuzinger J (2019) Application of a new polyester patch in arthroscopic massive rotator cuff repair-a prospective cohort study. J Shoulder Elbow Surg.
17. Barber FA, Burns JP, Deutsch A, Labbe MR, Litchfield RB (2012) A prospective, randomized evaluation of acellular human dermal matrix augmentation for arthroscopic rotator cuff repair. Arthrosc – J Arthrosc Relat Surg 28 (1):8-15.
18. Gilot GJ, Alvarez-Pinzon AM, Barcksdale L, Westerdahl D, Krill M, Peck E (2015) Outcome of Large to Massive Rotator Cuff Tears Repaired With and Without Extracellular Matrix Augmentation: A Prospective Comparative Study. Arthroscopy 31 (8):1459-1465.
19. Mori D, Funakoshi N, Yamashita F (2013) Arthroscopic surgery of irreparable large or massive rotator cuff tears with low-grade fatty degeneration of the infraspinatus: patch autograft procedure versus partial repair procedure. Arthroscopy 29 (12):1911-1921.
20. Audenaert E, Van Nuffel J, Schepens A, Verhelst M, Verdonk R (2006) Reconstruction of massive rotator cuff lesions with a synthetic interposition graft: a prospective study of 41 patients. Knee Surg Sports Traumatol Arthrosc 14 (4):360-364.
21. Badhe SP, Lawrence TM, Smith FD, Lunn PG (2008) An assessment of porcine dermal xenograft as an augmentation graft in the treatment of extensive rotator cuff tears. J Shoulder Elbow Surg 17 (1 Suppl):35S-39S.
22. Giannotti S, Ghilardi M, Dell’osso G, Magistrelli L, Bugelli G, Di Rollo F, Ricci G, Calabrese R, Siciliano G, Guido G (2014) Study of the porcine dermal collagen repair patch in morpho-functional recovery of the rotator cuff after minimum follow-up of 2.5 years. Surg Technol Int 24:348-352.
23. Nada AN, Debnath UK, Robinson DA, Jordan C (2010) Treatment of massive rotator-cuff tears with a polyester ligament (Dacron) augmentation: clinical outcome. J Bone Joint Surg Br 92 (10):1397-1402.
24. Rotini R, Marinelli A, Guerra E, Bettelli G, Castagna A, Fini M, Bondioli E, Busacca M (2011) Human dermal matrix scaffold augmentation for large and massive rotator cuff repairs: preliminary clinical and MRI results at 1-year follow-up. Musculoskelet Surg 95 Suppl 1:S13-23.
25. Ciampi P, Scotti C, Nonis A, Vitali M, Di Serio C, Peretti GM, Fraschini G (2014) The benefit of synthetic versus biological patch augmentation in the repair of posterosuperior massive rotator cuff tears: a 3-year follow-up study. Am J Sports Med 42 (5):1169-1175.
26. Longo UG, Lamberti A, Maffulli N, Denaro V (2010) Tendon augmentation grafts: a systematic review. Br Med Bull 94:165-188.
27. Iannotti JP, Codsi MJ, Kwon YW, Derwin K, Ciccone J, Brems JJ (2006) Porcine small intestine submucosa augmentation of surgical repair of chronic two-tendon rotator cuff tears. A randomized, controlled trial. J Bone Joint Surg [Am] 88 (6):1238-1244.
28. Papalia R, Franceschi F, Zampogna B, D’Adamio S, Maffulli N, Denaro V (2013) Augmentation techniques for rotator cuff repair. Br Med Bull 105:107-138.
29. Phipatanakul WP, Petersen SA (2009) Porcine small intestine submucosa xenograft augmentation in repair of massive rotator cuff tears. Am J Orthop 38 (11):572-575.
30. Sclamberg SG, Tibone JE, Itamura JM, Kasraeian S (2004) Six-month magnetic resonance imaging follow-up of large and massive rotator cuff repairs reinforced with porcine small intestinal submucosa. J Shoulder Elbow Surg 13 (5):538-541.
31. Walton JR, Bowman NK, Khatib Y, Linklater J, Murrell GA (2007) Restore orthobiologic implant: not recommended for augmentation of rotator cuff repairs. J Bone Joint Surg [Am] 89 (4):786-791.
32. Henry P, Wasserstein D, Park S, Dwyer T, Chahal J, Slobogean G, Schemitsch E (2015) Arthroscopic Repair for Chronic Massive Rotator Cuff Tears: A Systematic Review. Arthroscopy 31 (12):2472-2480.
33. Shimokobe H, Gotoh M, Honda H, Nakamura H, Mitsui Y, Kakuma T, Okawa T, Shiba N (2017) Risk factors for retear of large/massive rotator cuff tears after arthroscopic surgery: an analysis of tearing patterns. J Orthop Surg Res 12 (1):140.
34. Miller BS, Downie BK, Kohen RB, Kijek T, Lesniak B, Jacobson JA, Hughes RE, Carpenter JE (2011) When do rotator cuff repairs fail? Serial ultrasound examination after arthroscopic repair of large and massive rotator cuff tears. Am J Sports Med 39 (10):2064-2070.
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Morphometric Comparison of Distal Hamate Articular Surface with the Proximal Articular Surface of Middle Phalanges of Index, Middle, Ring and Little Fingers for Hemi-Hamate Arthroplasty
/in July-December 2022 | Volume 8 | Issue 2Vol 8 | Issue 2 | July-December 2022 | page: 13-16 | B Jagannath Kamath, Manesh Jain, Monish N
DOI: https://doi.org/10.13107/ti.2022.v08i02.028
Authors: B Jagannath Kamath [1], Manesh Jain [1], Monish N [1]
[1] Department of Orthopedic, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Address of Correspondence
Dr. Monish N
Department of Orthopedic, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India.
E-mail: monish1994n@gmail.com
Abstract
PURPOSE: The study is focused to compare the Distal Hamate articular Surface to the morphology of the base of middle phalanges of Index, Middle, Ring & little fingers.
METHODOLOGY: A Observational Paired T study was conducted. Patients with fractures of forearm or hand excluding any fractures in hamate and middle phalanges of Index , Middle, Ring & Little finger of both the upper limbs are subjected to Computed Tomography (CT) of hand and a 3D reconstructed image is obtained. Once the scans are collected, the below parameters will be determined using Radiant software.
RESULTS: At the end of this study ,we found that Majority of the patients who underwent CT Scans were noted to be between 31 and 50 years of age. Gender wise, males considered for the study were 24 (52%) and females were 25 (49%). The average hamate axial ridge angle was 69.18 and that of the ring finger middle phalangeal base was 80.23 (P < .05) Out of 50 patients the axial ridge angle of hamate was comparable with ring finger middle phalangeal base. The average distal hamate surface area was 1.04 and that of the middle phalangeal base was 1.00 (P < .05) The distal hamate articular surface area was comparable with the middle finger’s middle phalangeal base. The average sagittal inclination of distal hamate surface was 48.64 and that of the ring finger middle phalangeal base was 49.08 (P < .05) . The sagittal inclination of hamate was comparable with ring finger middle phalangeal base .
CONCLUSION: In literature very few radiological studies comparing the hamate and middle phalanx articular surfaces are reported. This study helps us in understanding the digit which is similar to hamate for undergoing Hemi Hamate Arthroplasty and usefulness of pre operative CT scan in further management of chronic proximal interphalangeal joint fracture dislocations. According to the results obtained from our study, we conclude that the Axial ridge angle and sagittal inclination of Middle Phalanx of Ring finger is in close approximation with Hamate . Articular Surface Area of Middle Finger is in close approximation with Hamate distal articular surface area.
Keywords: PIPJ- Proximal Interphalangeal Joint, ORIF- Open Reduction, Interal Fixation, CT- Computed Tomography, HHA- Hemi Hamate Arthroplasty
References
1.Drain J, Mehta S, Goyal KS. An analysis of hamate morphology relevant to Hemi-hamate arthroplasty. J Hand Surg Am [Internet]. 2020;45(7):657.e1-657.e6
2. Sollaccio DR, Navo P, Ghiassi A, Orr CM, Patel BA, Lewton KL. Evaluation of articular surface similarity of Hemi-hamate grafts and proximal middle phalanx morphology: A 3D geometric morphometric approach. J Hand Surg Am [Internet]. 2019;44(2):121–8.
3. Calva, D., Calotta, N., Lopez, J., Christopher, A., Magid, D., Demehri, S., & Lifchez, S. D. (2016). A simple pre-operative imaging method to assess donor and recipient anatomy in hemi-hamate arthroplasty for proximal interphalangeal joint reconstruction. Surgical and Radiologic Anatomy, 38(6), 699-704.
4. Ten Berg P, Ring D. Quantitative 3D-CT anatomy of hamate osteoarticular autograft for reconstruction of the middle phalanx base. Clin Orthop Relat Res [Internet]. 2012;470(12):3492–8.
5. McAuliffe JA. Hemi-hamate autograft for the treatment of unstable dorsal fracture dislocation of the proximal interphalangeal joint. J Hand Surg Am [Internet]. 2009;34(10):1890–4.
6. Calfee, R. P., Kiefhaber, T. R., Sommerkamp, T. G., & Stern, P. J. (2009). Hemi-hamate arthroplasty provides functional reconstruction of acute and chronic proximal interphalangeal fracture–dislocations. The Journal of hand surgery, 34(7), 1232-1241.
7. Capo JT, Hastings H 2nd, Choung E, Kinchelow T, Rossy W, Steinberg B. Hemicondylar hamate replacement arthroplasty for proximal interphalangeal joint fracture dislocations: an assessment of graft suitability. J Hand Surg Am [Internet]. 2008;33(5):733–9.
8. Barksfield RC, Bowden B, Chojnowski AJ. Hemi-hamate arthroplasty versus transarticular Kirschner wire fixation for unstable dorsal fracture-dislocation of the proximal interphalangeal joint in the hand. Hand Surg [Internet]. 2015;20(1):115–9.
9. Korambayil PM, Francis A. Hemi-hamate arthroplasty for pilon fractures of finger. Indian J Plast Surg [Internet]. 2011;44(3):458–66.
10. Podolsky DJ, Mainprize J, McMillan C, Binhammer P. Suitability of using the hamate for reconstruction of the finger middle phalanx base: An assessment of cartilage thickness. Plast Surg (Oakv) [Internet]. 2019;27(3):211–6.
11. Williams RMM, Kiefhaber TR, Sommerkamp TG, Stern PJ. Treatment of unstable dorsal proximal interphalangeal fracture/dislocations using a hemi-hamate autograft. J Hand Surg Am [Internet]. 2003;28(5):856–65.
12. Janssen, S. J., Ter Meulen, D. P., Hageman, M. G., Earp, B. E., & Ring, D. (2015). Quantitative 3-dimensional CT analyses of fractures of the middle phalanx base. HAND, 10(2), 210-214.
How to Cite this article: Kamath BJ, Jain M, Monish N | Morphometric Comparison of Distal Hamate Articular Surface with the Proximal Articular Surface of Middle Phalanges of Index, Middle, Ring and Little Fingers for Hemi-Hamate Arthroplasty | July-December 2022; 8(2): 13-16. https://doi.org/10.13107/ti.2022.v08i02.028
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A Comparative Study showing Elbow Kinematics in Radial Head Replacement Versus Radial Head Excision Versus Radial Head Fixation
/in July-December 2022 | Volume 8 | Issue 2Vol 8 | Issue 2 | July-December 2022 | page: 01-05 | Amit Yadav, Sagar Bansal, Mrinal Kambli, Shaswat Mishra, Devenshu Gupta
DOI: https://doi.org/10.13107/ti.2022.v08i02.026
Authors: Amit Yadav [1], Sagar Bansal [1], Mrinal Kambli [1], Shaswat Mishra [1], Devenshu Gupta [1]
[1] Department of Orthopaedics, Grant Medical College and Sir J. J. Group of Hospitals, Byculla, Mumbai, Maharashtra, India.
Address of Correspondence
Dr Sagar Bansal,
Senior Resident, Department of Orthopaedics, Grant Medical College and Sir J. J. Group of Hospitals, Byculla, Mumbai, Maharashtra, India.
E-mail: sagarbansal59@gmail.com
Abstract
Background: Radial head fractures are quite common with incidence 1.5-4% of all adult fractures. The management of these fractures depends upon age and type of injury
Aim: To compare the outcome in comminuted radial head fractures(Mason type III) based on mayo elbow scoring and handgrip strength test when managed with radial head excision, radial head fixation or radial head replacement
Material and Methods: We did a prospective comparative study comprising 60 patients between age 20-60 years with Mason type III radial head fractures. The patients were randomised using the admission day of the week placing 20 patients each in arthroplasty , excision and in the fixation group. The patients were followed up for 18-24 months postoperatively. Results were evaluated by the Mayo’s elbow performance and Handgrip strength score at 6 months and 18 months and were statistically evaluated by one-way ANOVA test.
Results: As per Mayo’s score at 6 months follow up, mean and standard deviation (SD) of the scores in arthroplasty was 83.25 and 11.50, for excision it was 76.25 and 11.38 & for fixation, it was 68.75 and 17.83 respectively. At 18 months follow up, mean and standard deviation was 90 and 12.56 for arthroplasty, 83 and 9.92 for excision & 76.25 and 21.69 for fixation respectively. As per handgrip strength score at 6 months follow up, mean and standard deviation of the scores in arthroplasty was 31.1 and 4.37, for excision it was 28.75 and 4.27 & for fixation, it was 27.15 and 5.94 respectively. At 18 months follow up, mean and standard deviation was 32.95 and 4.006 for arthroplasty, 30.7 and 4.06 for excision & 28 and 6.75 for fixation respectively. The difference between the results according to both Mayo’s score as well as Handgrip strength test was statistically significant (p < 0.05).
Conclusion: Our study shows that long and short-term results of radial head replacement are better than radial head excision and radial head fixation in comminuted radial head fractures based on mayo elbow scoring and hand grip strength score.
Keywords: Radial head fracture, Radial head replacement, Mason classification
References
1. Duckworth AD, Clement ND, Jenkins PJ, Aitken SA, Court-Brown CM, McQueen MM (2012) The epidemiology of radial head and neck fractures. J Hand Surg Am 37(5):112–119.
2. Broberg MA, Morrey BF. Results of treatment of fracture-dislocations of the elbow. Clin Orthop. 1987;216:109-19.
3. Mason ML. Some observations on fractures of the head of the radius with a review of one hundred cases. Br J Surg. 1954;42:123-32.
4. Johnston GW. A follow-up of one hundred cases of fracture of the head of the radius with a review of the literature. Ulster Med J. 1962; 31:51-6.
5. Putz R, Milz S, Maier M, Boszczyk A. Functional morphology of the elbow joint. Orthopade. 2003; 32:684-90. 6. Kapandji IA. The Physiology of the Joints. Vol. 1. Edinburgh, London: E&S Livingstone, 1970:84.
7. Ring, David MD; Psychoyios, Vasilis N. MD; Chin, Kingsley R. MD; Jupiter, Jesse B. MD Nonunion of Nonoperatively Treated Fractures of the Radial Head, Clinical Orthopaedics and Related Research: May 2002 – Volume 398 – Issue – p 235-238.
8. Yamaguchi K, Sweet FA, Bindra R, Morrey BF, Gelberman RH: The extraosseous and intraosseous arterial anatomy of the adult elbow. J Bone Joint Surg 79A:1653–1662, 1997.
9. Singh AK, Jidge A, Ramteke U, Venkateswaran N, Rokade H, Mulje SM, Mukherjee S, Kotian A. Functional Outcome of Elbow Kinematics in Radial Head Excision Versus Radial Head Replacement: A Comparative Study. Open Access Maced J Med Sci. 2019 May 15;7(9):1505-1508.
10. Beingessner DM, Dunning CE, Gordon KD, Johnson JA, King GJ. The effect of radial head excision and arthroplasty on elbow kinematics and stability. J Bone Joint Surg Am. 2004 Aug;86(8):1730-9.
11. Ikeda M, Sugiyama K, Kang C, Takagaki T, Oka Y. Comminuted fractures of the radial head: comparison of resection and internal fixation. Surgical technique. J Bone Joint Surg Am. 2006 Mar;88 Suppl 1 Pt 1:11-23.
12. Swensen SJ, Tyagi V, Uquillas C, Shakked RJ, Yoon RS, Liporace FA. Maximizing outcomes in the treatment of radial head fractures. J Orthop Traumatol. 2019 Mar 23;20(1):15.
13. Sun H, Duan J, Li F. Comparison between radial head arthroplasty and open reduction and internal fixation in patients with radial head fractures (modified Mason type III and IV): a meta-analysis. Eur J Orthop Surg Traumatol. 2016 Apr;26(3):283-91.
14. Sinha S, Sarkar S, Singh A, Saraf SK, Rastogi A, Singh T. Radial Head Arthroplasty, Excision and Osteosynthesis in Complex Elbow Fracture-Dislocations in Young Adults: What is Preferred? Indian J Orthop. 2020 May 18;54(Suppl 2):260-269.
15. Heim U.[Combined fractures of the radius and the ulna at the elbow level in the adult. Analysis of 120 cases after more than 1 year]. Rev Chir Orthop Reparatrice Appar Mot. 1998 Apr;84(2):142-53.
16. Ring D, Quintero J, Jupiter JB. Open reduction and internal fixation of fractures of the radial head. J Bone Joint Surg Am. 2002 Oct;84(10):1811-5.
17. Herbertsson P, Josefsson PO, Hasserius R, Besjakov J, Nyqvist F, Karlsson MK. Fractures of the radial head and neck treated with radial head excision. J Bone Joint Surg Am. 2004 Sep;86(9):1925-30.
18. Shetty SK, Shetty A, Balan B, Ballal A, Rai HR, Hegde A. Excision Versus Fixation of the Radial Head: A Comparative Study of the Functional Outcomes of the Two Techniques. J Clin Diagn Res. 2017 Feb;11(2):RC01-RC03.
19. Bain GI, Ashwood N, Baird R, Unni R. Management of Mason type-III radial head fractures with a titanium prosthesis, ligament repair, and early mobilization. Surgical technique. J Bone Joint Surg Am. 2005 Mar;87 Suppl 1(Pt 1):136-47.
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Efficacy and Safety of Tranexamic Acid Administration in Patients with Acute Traumatic Brain Injury: A Review of Current Literature
/in July-December 2022 | Volume 8 | Issue 2Vol 8 | Issue 2 | July-December 2022 | page: 06-12 | Kenzie Kao, Mohammed Alsabri
DOI: https://doi.org/10.13107/ti.2022.v08i02.027
Authors: Kenzie Kao [1], Mohammed Alsabri [2]
[1] Saba University School of Medicine, Saba, Dutch Caribbean, Netherlands. [2] Department of Emergency Medicine, Al-Thawra Modern General Teaching Hospital, Sana’a City, Yemen.
Address of Correspondence
Dr. Mohammed Alsabri,
Department of Emergency Medicine, Al-Thawra Modern General Teaching Hospital, Sana’a City, Yemen.
E-mail: alsabri5000@gmail.com
Abstract
Hypothesis: Early administration of tranexamic acid (TXA) reduces mortality in patients suffering from acute traumatic brain injury (TBI).
Methods: A structured search of PubMed and CENTRAL from inception until July 1st, 2022 was carried out seeking RCTs comparing the effects of TXA administration to placebo in patients suffering from TBI. The primary outcome tested was 28-day all-cause mortality. Secondary outcomes included intracranial hemorrhage growth and thromboembolic events.
Results: Eight RCTs involving a total of 14,714 patients met the inclusion criteria; 7573 patients received TXA while 7141 patients received a placebo. There were 1415 patient deaths (18.7%) in the TXA group and 1410 patient deaths (19.7%) in the placebo group. None of the included studies reported a significant reduction in 28-day all-cause mortality, however, they all shared positive trends toward superior outcomes in the intervention arms. Two of the included studies reported significant reductions in intracranial hemorrhage expansion in those patients treated with TXA, with four more studies reporting trends toward superior outcomes in the TXA groups. There was no evidence of increased incidence of thromboembolic events in the TXA groups in four of the five studies that reported relevant data, with one study representing 1.2% of total patients reporting an increased incidence of pulmonary emboli in the intervention group.
Conclusions: In patients suffering from acute TBI, early administration of TXA reduces intracranial hemorrhage growth and may have positive effects on mortality with no corresponding increase in thromboembolic events. Given these results, early administration of TXA in patients experiencing TBI is recommended in initial care.
Keywords: Tranexamic acid, Traumatic brain injury, Intracranial hemorrhage, Mortality, Disability
References
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Management of a Polytrauma Case In a Resource-Constrained Hospital
/in July-December 2022 | Volume 8 | Issue 2Vol 8 | Issue 2 | July-December 2022 | page: 21-25 | Daniel Mossalbaye Adendjingue, S. Pascal Chigblo, Oswald Goukodadja, Adebola Padonou, Iréti Fiacre Tidjani, Aristote Hans-Moevi Akue
DOI: https://doi.org/10.13107/ti.2022.v08i02.0230
Authors: Daniel Mossalbaye Adendjingue [1], S. Pascal Chigblo [2], Oswald Goukodadja [2], Adebola Padonou [2], Iréti Fiacre Tidjani [2], Aristote Hans-Moevi Akue [2]
[1] Department of Orthopedic-Traumatology, National Teaching Hospital CHU-RN, N’Djamena-Chad. [2] Department of Orthopedic-Traumatology, National Teaching Hospital CNHU-HKM, Cotonou, Benin.
Address of Correspondence
Dr. Daniel Mossalbaye Adendjingue,
Department of Orthopedic-Traumatology, National Teaching Hospital CHU-RN, N’Djamena-Chad.
E-mail: dendjinguedaniel@gmail.com / adendjingue@yahoo.fr
Abstract
Introduction: The management of polytrauma patient should be beforehand and always in keeping in mind the damage control. the surgical treatment is secondary to the stabilization of the patient.
Clinical Case: we are reporting a 34 years old polytrauma patient from a motor vehicle accident. On physical examination, we noted : a severe brain injury, a closed articular fracture of right distal radius associated to a dislocation of distal radius and ulna distal joint, a closed bilateral fracture of both trochanters, an open communitive tibial fracture of proximal epiphysis methaphysis and diaphysis. The last one was classified as type IIIB of Gustilo and Anderson and associated to a closed fracture of the head and the neck of right fibula, a closed fracture of the right lateral malleolus. After patient stabilization, the head injury improves to normal Glasgow score on 8th day of admission. Necrosis of soft tissus and exposition of the tibia was noted. The surgical treatment was done on 2 stages due to financial issues. A bone synthesis of the trochanteric fracture was done only on the left and external frame as well as a muscle flap was done for the right tibial fracture on the 18th day. On the 42nd day a PAPINEAU technic associated to a proximal inter tibiofibular graft was done. The functional outcome of the orthopaedic treatment of the wrist was bad (malunion). That last complication was managed by a SAUVE KAPANDJI surgery (at 6 months) and the contracture (pronation and supination) at 12 months post trauma. The outcome was fair good despite patient financial issue and local complications that compromise an optimal surgical management and a delay. He resumes normal professional activities at about 2 years. At 5 years follow up, functional and anatomical results were satisfactory.
Conclusion: In a limited ressources’ setting, the management of lesions including a multiple fractures is a challenge for the practitioner and the injuried patient. A management taking into account social and economic ressources is mandatory to minimise sequelae. Keywords: Management, Polytrauma, Limited ressources.
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5. Mansat P. Traitement des fractures anciennes de l’extrémité distale des deux os de l’avant-bras. Technique chirurgicales Orthopédie-Traumatologie. 2017 ;44:346
6. Carter PB, Stuart PR. The Sauve-Kapandji procedure for post-traumatic disorders of the distal radio-ulnar joint. J Bone Joint Surg [Br]. 2000;82(B):1013-8.
7. Kacou AD1, Sié EJB1, Bamba I1, Lambin Y1. Résultats de la technique de Sauvé Kapandji dans les séquelles post-traumatiques du poignet. Afr J Orthop Trauma. 2016;1(1):57-63.
8. Baciu C. L’opération de Sauvé Kapandji dans le traitement des cals-vicieux de l’extrémité inférieure du radius. Ann Chir. 1997; 31 :323-9.
9. Pethapara Y, Singh V, Patel R. Radiological Assessment and Functional Outcomes of Hand and Wrist in Patients with Distal End Radius Fractures ; Trauma international. 2021; 7(2): 04-08.
10. Gartland JJ, Jr, Werley CW. Evaluation of healed Colles’ fracture. J Bone Joint Surg Am. 1951; 33(4) :895–907.
11. Jupiter JB. Fractures of the distal end of the radius. J Bone Joint Surg [Am]. 1991 ;73-A:461-9.
12. Jacobsen TW, Leicht P. The Sauvé-Kapandji procedure for posttraumatic disorders of the distal radioulnar joint. Acta Orthop Belg. 2004;70:226-30,
13. Zachee B, De Smet L, Roosen P, Fabry G. The Sauvé-Kapandji procedure for non rheumatic disorders of the distal radioulnar joint. Acta Orthop Belg. 1994;60:225-30.
14. Kasotya D, Bhatia N, Yadav R, Sabat D. Side Swipe Injury to the Leg. A Hefty Price for an Autorickshaw Ride: A Case Report. Trauma international. 2021; 7(2): 12-4.
15. Devender Kasotya , Nishant Bhatia , Rajeev Yadav , Dhananjay Sabat. Trauma International. 2021; 7(2): 12-4 .
16. Panda M, Ntungila N , Kalunda M, Hinsenkamp M. Treatment of chronic osteomyelitis using the Papineau technique. International Orthopaedics (SICOT). 1998 ;22: 37-40.
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Tens Nailing in Fracture Clavicle – A Case Series
/in July-December 2022 | Volume 8 | Issue 2Vol 8 | Issue 2 | July-December 2022 | page: 17-20 | Mohd Danish, Hemant Gupta, Ashish Sao, Ravi Kant
DOI: https://doi.org/10.13107/ti.2022.v08i02.029
Authors: Mohd Danish [1], Hemant Gupta [1], Ashish Sao [1], Ravi Kant [1]
[1] Department of Orthopaedics, Max Superspeciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh, India.
Address of Correspondence
Dr. Mohd Danish,
Department of Orthopaedics, Max Superspeciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh, India.
E-mail: danish.shan@gmail.com
Abstract
INTRODUCTION: Clavicle is one of the most commonly fractured bones accounting for 2.6 – 4 % of all the fractures. 69 – 82% of these occur in middle third of clavicle, 73 % of which are displaced midshaft clavicular fractures). Surgery has been indicated for displaced fractures of clavicle, one with NV compromise and skin tenting. Intramedullary fixation for clavicular fractures was first described by Peroni in 1950. The use of a TENS nail carries advantages of less soft tissue compromise, less operative time, better cosmetic results, load sharing fixation with relative stability that encourages copious callus formation.
MATERIAL AND METHOD: A prospective review of 20 patients who presented to our institute between January 2021 and June 2022 with displaced midshaft clavicle fractures and treated with TENS nailing was carried out. All the patients had Constant Murley score and DASH score, which were done at 6 and 12 weeks.
RESULTS: All the patients achieved clinical and radiological union at a mean of 19.6 ± 6.67.80% of the patient had excellent Constant Murley score on follow up. Based on the assessment parameters (Disability of Arm Shoulder and Hand) Score, the mean DASH score was 25.03 ± 3.36 (range 20-30), 18.56 ± 3.46 (range 14-25) at the end of 6 weeks and 12 weeks respectively.
CONCLUSION: The intramedullary fixation using TENS of midshaft clavicle fractures is a safe minimally invasive technique in indicated cases and in our hands, it provides good functional outcome and cosmetic results.
KEYWORDS: Tens, Clavicle, Fracture, Intramedullary
References
1. Postacchini F, Gumina S, De Santis P, Albo F. Epidemiology of clavicle fractures. J Shoulder Elbow Surg. 2002; 11(5):452–6.
2. Nordqvist A, Petersson C. The incidence of fractures of the clavicle. Clin Orthop Relat Res. 1994; (300: ):127–32.
3. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg Am. 2007; 89(1):1–10.
4. Houwert RM, Wijdicks FJ, Steins Bisschop C, Verleisdonk EJ, Kruyt M. Plate fixation versus intramedullary fixation for displaced mid-shaft clavicle fractures: a systematic review. Int Orthop. 2012; 36 (3):579–85.
5. Assobhi JE. Reconstruction plate versus minimal invasive retrograde titanium elastic nail fixation for displaced midclavicular fractures. J Orthop Traumatol. 2011; 12(4):185–92. doi: 10.1007/s10195-011- 0158-7 PMID: 21948051
6. Zlowodzki M, Zelle BA, Cole PA, Jeray K, McKee MD. Treatment of acute midshaft clavicle fractures: systematic review of 2144 fractures: on behalf of the Evidence-Based Orthopaedic Trauma Working Group. J Orthop Trauma. 2005; 19(7):504– 7.
7. Kontautas E, Pijadin A, Vilkauskas A, Domeika A. Biomechanical aspects of locking reconstruction plate positioning in osteosynthesis of transverse clavicle fracture. Medicina (Kaunas). 2012; 48(2):80– 3.
8. Zlowodzki M, Zelle BA, Cole PA, Jeray K, McKee MD, Evidence-Based Orthopaedic Trauma Working G. Treatment of acute midshaft clavicle fractures: systematic review of 2144 fractures: on behalf of the EvidenceBased Orthopaedic Trauma Working Group. J Orthop Trauma. 2005;19(7):504-507.
9. Grassi FA, Tajana MS, D’Angelo F. Management of midclavicular fractures: comparison between nonoperative treatment and open intramedullary fixation in 80 patients. J Trauma.2001;50(6):1096-100.
10. Leppilahti J, Jalovaara P. Migration of Kirschner wires following fixation of the clavicle–a report of 2 cases. Acta Orthop Scand. 1999;70(5):517-519.
11. Lyons FA, Rockwood CA, Jr. Migration of pins used in operations on the shoulder. J Bone Joint Surg Am. 1990;72(8):1262-1267.
12. Naidoo P. Migration of a Kirschner Wire from the clavicle into the abdominal aorta. Arch Emerg Med. 1991;8(4):292-295.
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Pure Obturator Dislocation of the Hip, a Rare Variety of Regular Dislocations, and Long-Term Clinical Outcomes
/in January-June 2022 | Volume 8 | Issue 1Vol 8 | Issue 1 | January-June 2022 | page: 19-21 | Walid Bouziane, Machmachi Amine, Soufiane Aharram, Omar Agoumi, Abdelkrim Daoudi
DOI: 10.13107/ti.2022.v08i01.025
Authors: Walid Bouziane [1], Machmachi Amine [2], Soufiane Aharram [1], Omar Agoumi [1], Abdelkrim Daoudi [1]
[1] Department of Orthopaedic Surgery and Traumatology, University Hospital Oujda, Morocco.
[2] Department of Medicine and Pharmacy, Mohammed First Oujda University, Oujda, Morocco.
Address of Correspondence
Dr Walid Bouziane,
Department of Orthopaedic Surgery and Traumatology, University Hospital Oujda, Morocco.
E-mail: walidbouziane93@gmail.com
Abstract
Introduction: Traumatic knee dislocation is considered an orthopedic emergency. Knee dislocations are relatively infrequent injuries. This injury frequently occurs from high-energy impact trauma. Neurovascular injuries can result in debilitating consequences if the diagnosis and treatment are delayed. Associated complications include degenerative arthritis, permanent neurovascular injury, and amputation. The poorest prognosis is seen in patients with knee dislocation longer than 6-8 hours before reduction.
History: The 25-year-old male patient presented with a history of a road traffic accident to the emergency department. The patient presented with swelling, pain, and deformity of the left knee and leg. Examination: On examination, the patient had tense swelling and tenderness of the left knee joint and leg. Visible deformity of the left knee joint is seen. The posterior tibial artery and dorsalispedis artery were not palpable. Active ankle and toe movements were absent.
Investigations: Plain radiograph was taken at the emergency department of the left knee and leg. X-rays showed anterior dislocation of the knee joint.
Treatment: After valid written informed consent, the dislocated left knee joint was reduced under sedation in the operation theatre and immobilized in the above knee plaster slab. Reduction of the knee joint was done within 4 hours of injury. Then the distal pulses were re-assessed. The posterior tibial and dorsalispedis artery was absent. Hence, MR Angiography of the left lower limb was done. It showed popliteal artery transection. So, the artery was explored and end-to-end vascular anastomosis was done. A knee-spanning external fixator was applied to the left lower limb. Fasciotomy was done for the tense leg compartments. After a week, the fasciotomy wounds were infected for which extensive debridement of the wounds was done and antibiotic beads were placed. Knee was mobilized with a gradual range of motion exercises and non-weight bearing mobilization with a foot drop splint. Gradually full weight-bearing ambulation was allowed.
Conclusion: Knee dislocation is rare, albeit a serious and potentially limb-threatening condition. The prognosis of knee dislocations is variable and is heavily dependent on the time interval between trauma and initiation of management. Immediate, timely, and proper management can salvage the limb, and amputation is not the only solution.
Keywords: Dislocation, Posterior tibial artery, Fasciotomy
References
[1] Phillips AM, Konchwalla A. The pathologic features and mechanism of traumatic dislocation of the hip. Clin Orthop 2000;377:7.
[2] Elouakili I, Ouchrif Y, Ouakrim R, Lamrani O, Kharmaz M, Ismael F, Lahlou A, El BardouniA,Mahfoud M, Berrada MS, El Yaacoubi M. Luxation obturatrice de la hanche: un traumatisme rare en pratique sportive. Pan AfricanMedical Journal. 201418 : 138.
[3] Epstein HC, Wiss DA. Traumatic anterior dislocation of the hip. Orthopedics 1985;8:130–2.
[4] Bouya A, et al. Luxation obturatrice de la hanche : survenue rare en milieu sportif. J Traumatol Sport (2017).
[5] Phillips AM, Konchwalla A. The pathologic features and mechanism of traumatic dislocation of the hip. Clin Orthop. 2000;377:7–1.
[6] Catonné Y, Meyer A, Sariali E, Biette G. Pathologie du complexe pelvi-fémoral du sportif. Pathologie du complexe pelvi-fémoral du sportif. 2009:88–99.
[7] Dellanh YY, et al. Luxation obturatrice de la hanche : à propos d’un cas. Pan African Med J 2015;22:195.
[8] Toms AD, Williams S, White SH. Obturator dislocation of the hip. J Bone Joint Surg (Br). 2001; 83(1): 113- 115.
[9] Brav EA. Traumatic anterior dislocation of the hip. J Bone Joint Surgery (Am). 1962; 44(A): 1115-1121.
[10] Polesky RE, Polesky FA. Intrapelvic dislocation of the femoral head following anterior dislocation of the hip: a case report. J Bone Joint Surg (Am). 1972;54(5):1097-8.
[11] Richards BS, Howe DJ. Anterior perineal dislocation of the hip with fracture of the femoral head: a case report. Clin Orthop. 1988;228: 194-201.
[12] Catonné Y, Meyer A, Sariali E, Biette G. Luxation de hanche sans fracture au cours d’activités sportives. In: Pathologie du complexe pelvi-fémoral du sportif; 2009. p. 88–99.
[13] Yang RS, Tsuang YH, Hang YS. Traumatic dislocation of the hip. Clin Orthop 1991;265:218.
[14] Hougaard K. Traumatic posterior dislocation of the hip: prognostic factors influencing the incidence of avascular necrosis of femoral head. Arch Orthop Trauma Surg. 1986;106(1):32–5.
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Acute Knee Dislocation with Neurovascular Injury- Salvage or Amputation? A Case Report
/in January-June 2022 | Volume 8 | Issue 1Vol 8 | Issue 1 | January-June 2022 | page: 15-18 | Ajay Kurahatti, Hariprasad S, Satyarup D
DOI: 10.13107/ti.2022.v08i01.024
Authors: Ajay Kurahatti [1], Hariprasad S [1], Satyarup D [1]
[1] Department of Orthopaedics, Sri Devaraj Urs Medical College, Kolar, Karnataka, India.
Address of Correspondence
Dr. Ajay Kurahatti,
Assistant Professor, Department of Orthopaedics, Sri Devaraj Urs Medical College, Kolar, Karnataka, India.
E-mail: ajaykurahatti@gmail.com
Abstract
Introduction: Traumatic knee dislocation is considered an orthopedic emergency. Knee dislocations are relatively infrequent injuries. This injury frequently occurs from high-energy impact trauma. Neurovascular injuries can result in debilitating consequences if the diagnosis and treatment are delayed. Associated complications include degenerative arthritis, permanent neurovascular injury, and amputation. The poorest prognosis is seen in patients with knee dislocation longer than 6-8 hours before reduction.
History: The 25-year-old male patient presented with a history of a road traffic accident to the emergency department. The patient presented with swelling, pain, and deformity of the left knee and leg. Examination: On examination, the patient had tense swelling and tenderness of the left knee joint and leg. Visible deformity of the left knee joint is seen. The posterior tibial artery and dorsalispedis artery were not palpable. Active ankle and toe movements were absent.
Investigations: Plain radiograph was taken at the emergency department of the left knee and leg. X-rays showed anterior dislocation of the knee joint.
Treatment: After valid written informed consent, the dislocated left knee joint was reduced under sedation in the operation theatre and immobilized in the above knee plaster slab. Reduction of the knee joint was done within 4 hours of injury. Then the distal pulses were re-assessed. The posterior tibial and dorsalispedis artery was absent. Hence, MR Angiography of the left lower limb was done. It showed popliteal artery transection. So, the artery was explored and end-to-end vascular anastomosis was done. A knee-spanning external fixator was applied to the left lower limb. Fasciotomy was done for the tense leg compartments. After a week, the fasciotomy wounds were infected for which extensive debridement of the wounds was done and antibiotic beads were placed. Knee was mobilized with a gradual range of motion exercises and non-weight bearing mobilization with a foot drop splint. Gradually full weight-bearing ambulation was allowed.
Conclusion: Knee dislocation is rare, albeit a serious and potentially limb-threatening condition. The prognosis of knee dislocations is variable and is heavily dependent on the time interval between trauma and initiation of management. Immediate, timely, and proper management can salvage the limb, and amputation is not the only solution.
Keywords: Dislocation, Posterior tibial artery, Fasciotomy
References
1. Jacodzinski M, Petri M. (2014). Knee dislocations and soft tissue injuries. Skeletal Trauma: Basic Science, Management and reconstruction, Philadelphia, Saunders, 1907-36.
2. Whelan AB, Levy BA. Knee dislocations. Rockwood and Green’s Fractures in Adults, Lippincott Williams & Wilkins, 2369-414.
3. Miller HH, Welch CS. (1949) Quantitative studies on the time factor in arterial injuries. Ann Surg, 130, 428-30.
4. Green NE, Allen BL. Vascular injuries associated with dislocation of the knee. J Bone Joint Surg Am 1977; 59(2): 236-9.
5. Merrill KD. Knee dislocations with vascular injuries. Orthop Clin North Am 1994; 25(4): 707-13.
6. Howells NR, Brunton LR, Robinson J, Porteus AJ, Eldridge JD, Murray JR. Acute knee dislocation: an evidence-based approach to the management of the multiligament injured knee. Injury 2011; 42(11): 1198-204.
7. Mills WJ, Barei DP, McNair P. The value of the ankle-brachial index for diagnosing arterial injury after knee dislocation: a prospective study. J Trauma 2004; 56(6): 1261-5.
8. Sisto DJ, Warren RF. Complete knee dislocation. A follow-up study of operative treatment. Clin Orthop Relat Res 1985(198): 94- 101.
9. Harner CD, Waltrip RL, Bennett CH, Francis KA, Cole B, Irrgang JJ. Surgical management of knee dislocations. J Bone Joint Surg Am 2004; 86-A(2): 262-73.
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