Introduction: Fracture dislocations of the carpo-metacarpal joints are high energy injuries which may occur with or without fracture. Carpo-metacarpal fracture dislocations of the hand are uncommon injuries accounting for less than 1% of hand injuries. Case report: We report a 55 year old man presented who to the emergency room, with history of self-fall following which his left hand was run over by a bullock cart. Clinical examination of his hand revealed an abrasion 3x4 cm over the dorsum of his third metacarpal. There was diffuse swelling and tenderness over the dorsum of his hand. Radiographs showed that there was radial and volar dislocations of the second, third and fourth carpometacarpal joints with fracture of the trapezium, trapezoid and and chip fracture of the proximal phalynx of the thumb. Computerised topography of the hand revealed that there was also chip fracture of the hamate, chip fracture of the base of the fifth metacarpal in addition to the above mentioned injuries. The patient was surgically managed by open reduction and K-wire fixation. Conclusion: Volar carpo-metacarpal joint dislocations are unique in their presentation. They are serious injuries and need to be reduced at the earliest. The articulation of third metacarpal and capitate is more proximal than the carpal articulations of other CMC joints. This produces a keystone relationship with other CMC joints. When these injuries are detected early, closed reduction can be easily performed. If reduction fails, surgical reduction is mandatory. The disability of the hand is more severe if treatment is delayed.

Bucket handle meniscal tears could be degenerative or traumatic. Most traumatic bucket handle tear of the meniscus is unilateral, either medial or lateral, and often associated with various degree injury of anterior cruciate ligament (ACL). However, traumatic bucket handle tear of both medial and lateral menisci on the same knee is very rare, and only cases were reported. We reported a case of traumatic bucket handle meniscal tears of both menisci with ACL partial tear on the same knee. Arthroscopic partial menisectomy for both medial and lateral menisci was successfully performed.

difficulties regarding treatment cost, psychological and emotional factors, and the fact that the treatment may continue for the rest of the patient’s life. The current paper reports the case of an 8-year-old girl who sought the pediatric dentistry clinic at the Catholic University of Brasilia with coronal fracture in tooth 11. During the interview, the patient reported that she had fallen during a leisure activity, fact that caused the fracture. She was firstly assisted in a private practice, where she received emergency care. Clinical and radiographic examination found that the patient had a fracture involving enamel and dentin, but not the pulpal. Class IV composite resin restoration was the proposed treatment. After selecting the colors, the cavity preparation was completed according to parameters in recent conservative guidelines. Rubber dam restoration was used to avoid contamination. The dentin and enamel surfaces were then treated according to the protocol of the chosen adhesive agent. The composite resin was inserted by incremental technique and light curing. The smoothest surfaces were obtained using the complete sequence of Sof-Lex discs. Systematic follow-ups were performed to check the periapical conditions, restoration integrity, as well as the color stability. Thus, the patient aesthetic, phonetic and mastication functions were restored, and she resumed her social activities.

Purpose: To determine the number of complications and plate removal surgeries after performing volar locking plate fixation of unstable distal radius fractures. Methods: In 2008, there were 100 patients (101 unstable fractures of the distal radius) who were treated with volar locking plates at our hospital. Thirteen patients were lost to follow-up; thus, 87 patients with 88 fractures were reviewed (65 women and 22 men). The mean age was 51 years (range, 17-86 years). In 2010, all the patients were clinically and radiologically assessed. In 2014, the number of hardware removals and complications was retrospectively assessed based on patient records. There were 9 A2, 14 A3, 6 B1, 1 B2, 11 B3, 29 C1, and 18 C2 fractures, according to the AO/ OTA classification. The complications, plate removal surgeries, and clinical and radiological outcomes were recorded. In 2010 the patients were clinically assessed using the visual analog scale (0–100 points) pain score at rest and at activity, Mayo Wrist Score (0–100 points), Quick-Disabilities of the Arm, Shoulder, and Hand (0–100 points), and range of motion. Plain radiographs of the wrist were also obtained. Results: Twenty-nine patients had complications (33%), which led to worse clinical results during the follow-up in 2010. Until 2014, hardware removal had been performed in 17 (19%) patients, and this was beneficial in 62%. The main reasons for plate removal were extensor tendon synovitis and pain, and screw penetration into the radiocarpal joint. Conclusion: The use of volar locking plates in unstable distal radius fractures is associated with several surgicalrelated complications, which has to be considered when using this method. Information about the complications may alter the patient outcomes more positively.

Background: Most fractures of femoral neck typically heal, but a significant proportion of fractures fail to heal, resulting in aseptic bone necrosis, delayed union or persistent nonunion. Specially, nonunion of fractured neck of femur in young adults is a serious problem. Some preclinical evidences show the therapeutic potential of autologous bone marrow for bone fracture healing; however, clinical outcome following of transplantation of bone marrow cells in patients with femoral neck nonunion has never been reported.

Case description: We describe a 57-year-old male who had a femoral neck nonunion and received autologous bone marrow transplantation, followed by growth factors injection. The primary endpoint of this study is to achieve radiological fracture healing (union) by evaluating anteroposterior images taken after and on 6th month, following bone marrow therapy and no serious adverse event occurred.

Literature review: To our knowledge, this is the first case in the literature of nonunion of femoral neck fracture treated with percutaneous autologous bone marrow transplantation.

Clinical relevance: This case suggests that autologous bone marrow transplantation, followed by plasma rich in growth factors (PRGF) could be considered as an exciting option to treat nonunion in femoral neck fracture.

Medial lag screw migration in Gamma nail system is an uncommon complication. In 92-year-old woman, the medial lag screw migration into the pelvic with nonunion of trochanteric fracture at 4 months after the osteosynthesis. The computed tomography scan did not reveal intestinal organs injury by the protruded screw and the removal of the implant eased her right hip pain. During the operation, the lag screw migration by the incorrect engagement of the set screw outside of the groove on the lag screw was observed, which was considered the reason. To avoid such a hazardous complication in Gamma nail system for trochanteric fracture, correct engagement of the set screw into the groove on the lag screw should be confirmed after tightening the set screw.

We report on the unusual finding of yellow-stained bone during an elective knee arthroscopy for a 52 year old female complaining of worsening pain on mobility. The magnetic resonance scan (MRI) confirmed medial and lateral meniscal tears. During the procedure, marked dark yellow stains were seen in the tibia, femur and the patella bones. Partial meniscectomies were performed in the usual fashion. Retrospective history from the patient confirmed that she was subjected to Tetracycline antibiotics use for a considerable time during her childhood. We believe this striking finding is directly related to childhood use of tetracycline and that her skeleton is permanently yellow-stained.

Acute compartment syndrome of the extremities is a serious and potentially limb and, life endangering condition. Compartment syndrome of the extremities is considered a medical emergency. Despite widely described classic clinical signs and profound physiologic understanding of its mechanism, most cases show only partial, often insidious clinical expression. In conjunction with lack of uniform, reliable and easily applicable diagnostic tools, the diagnosis of compartment syndrome is a challenge, as is the decision making tree of conservative versus surgical treatment. Unconscious patients present an especially difficult subgroup of patients. In this article we will try to compile and simplify the up-to-date knowledge about the etiology, pathophysiology, diagnosis and treatment of compartment syndrome of the extremities. We will present the rigid box model of acute compartment syndrome which can aid in medical personnel education as well as assist in diagnosis and treatment decision making. Early recognition, competency in practical application of intra compartmental pressure measurement techniques and a timely performed surgical decompression are the primary requisitions of successful treatment. A keen awareness by all medical personnel and a high grade of suspicion to this elusive but devastating entity is in place.

Background: The management of distal tibial fractures can be challenging because of scarcity of soft tissues, their subcutaneous nature and poor vascularity. Consequently, operative treatment can lead to complications. The surgical treatment of fractures has evolved a great deal since the development of the original “open reduction and internal fixation” technique by the AO group. A mechanically stable fracture-bridging osteosynthesis can be obtained without significant dissection and surgical trauma to the bone and surrounding soft tissues by minimally invasive percutaneous plate osteosynthesis (MIPPO). This technique utilizes indirect reduction and internal fixation with locking compression plates. Our aim was to observe the outcome of the distal tibial fracture fixation (extra-articular and intra-articular) with locking compression plate (LCP) using MIPPO technique. Material and Methods: 26 consecutive patients were prospectively underwent minimally invasive percutaneous plate osteosynthesis for distal tibial fractures between January 2010 and December 2011. Patients were aged between 20 to 65 years with seventeen males and nine females. Both open and closed AO types 43A, 43B and 43C fractures were included. Patients were managed with LCP using MIPPO technique. Postoperative regimen consisted of knee and ankle bending exercises starting on 1st postoperative day. Non weight bearing ambulation started on 3rd post-operative day, progressing to partial weight bearing at 6 to 8 weeks. Full weight bearing ambulation was allowed after clinico radiological union at 12 to 14 weeks. Observation and Results: RTA was the commonest cause of injury. All fractures healed with good functional outcome. Mean union time was 4.5 months (range 3.5–8 months). Mean follow-up was 14.3 months. For all fractures acceptable active range of ankle movement was achieved. Mean AOFAS score was 88. There were 2 cases of superficial infection, treated successfully with antibiotics. No deep infection, wound dehiscence and hardware failure was noted. Conclusion: MIPPO is a well-documented technique that offers biological advantages and appears to be a reasonable treatment option for complex unstable distal tibial or pilon fractures that are not suited for intramedullary nailing. The literature is full of studies from developed nations, but studies from developing nations are lacking. Nevertheless small numbers of patients were involved in our study to draw any definitive conclusions, but our encouraging results will motivate the trauma surgeons from the developing nations to use MIPPO technique in managing distal tibial fractures, in an endeavor to reduce morbidity and associated complications, especially of the soft tissues.