RESUMEN
INTRODUCTION: Differentiating supination external rotation (SER) type II and IV ankle injuries is challenging in the absence of a medial malleolar fracture or talar shift on radiographs. The accurate differentiation between a stable SER-II from an unstable SER-IV injury would allow implementation of the appropriate management plan from diagnosis. The aim of this study was to ascertain the practice of orthopaedic surgeons in dealing with these injuries. MATERIALS AND METHODS: A postal survey was undertaken on 216 orthopaedic consultants from three regions. RESULTS: In the presence of medial-sided clinical signs (tenderness, swelling, ecchymosis), 22% of consultants would perform surgical fixation. 53% would choose non-operative treatment and the majority would monitor these fractures through serial radiographs. The remaining 25% of consultants would perform an examination under anaesthesia (EUA; 15%), request stress radiographs (9%) or an MRI scan (1%). Without medial-sided signs, 85% would advocate non-operative treatment and, of these, 74% would perform weekly radiographs. Interestingly, 6% would perform immediate surgical fixation. Stress radiographs (6%) and EUAs (2%) were advocated in the remaining group of consultants. Foot and ankle surgeons utilised stress radiographs more frequently and were more likely to proceed to surgical fixation should talar shift be demonstrated. CONCLUSIONS: Clinical practice is varied amongst the orthopaedic community. This may lead to unnecessary surgery in SER-II injuries and delay in diagnosis and operative management of SER-IV injuries. We have highlighted the various investigative modalities available that may be used in conjunction with clinical signs to make a more accurate diagnosis.
Asunto(s)
Traumatismos del Tobillo/cirugía , Fracturas Óseas/cirugía , Práctica Profesional/estadística & datos numéricos , Traumatismos del Tobillo/diagnóstico , Inglaterra , Peroné/lesiones , Fijación de Fractura/métodos , Fijación de Fractura/estadística & datos numéricos , Fracturas Óseas/diagnóstico , Encuestas de Atención de la Salud , Humanos , Inestabilidad de la Articulación/diagnóstico , Inestabilidad de la Articulación/cirugía , Especialidades Quirúrgicas , SupinaciónRESUMEN
A rare case of a septic knee arthritis presenting as an infected ruptured popliteal cyst is described. Infection of a popliteal cyst is an uncommon complication of septic arthritis and presentation can mimic that of an acute deep vein thrombosis, leading to delay in diagnosis and treatment. Of interest, the typical hallmarks of infection and haematological markers of inflammation were all unremarkable in the current case. This case was of additional interest in that there have been no reports in the literature of Corynebacterium spp. being isolated from an infected popliteal cyst. Invasive infections caused by Corynebacterium spp. seem to have a predilection for patients who are immunocompromised. It is especially important in this subset of patients that delays in diagnosis are avoided by including it in the differential of an immunocompromised patient presenting with unilateral lower-extremity pain and swelling.
RESUMEN
Large osteoarthritic cysts can sometimes be difficult to distinguish from primary osseous and soft tissue tumours. We present such a case involving a cyst arising from the hip joint and eroding the acetabulum which presented as a soft tissue malignancy referred to a tertiary bone and soft tissue tumour centre. We discuss the diagnostic problems it may pose, and present a literature review of the subject.