Pure ligamentous ankle dislocation: A case report.

INTRODUCTION AND IMPORTANCE: Pure ankle dislocation is a rare injury, and this injury is an orthopedic emergency requiring immediate reduction. In more common circumstances, this injury is usually associated with malleolar fractures. The standardized treatment protocol is still deficient. CASE PRESENTATION: We report a case of a 33-year-old woman who presented with an open ankle dislocation without concomitant malleolar fractures. Early extensive wound debridement, immediate reduction, and immobilization of the ankle joint using an external fixator were performed during the first surgery. During the second surgery, which was performed 3 weeks later, the medial and lateral ankle ligaments were repaired, and a suture tape internal brace was added. A good functional outcome with the American Foot and Ankle Society score of 87 was achieved at 1-year follow-up. DISCUSSION: In an open dislocation with massive ligamentous injury, staged surgery could be performed to prevent deep infection, with extensive debridement and immobilization using an external fixator in the first stage and ligament repair in the second stage. An internal brace using a suture tape is an option for ligament repair if the remnant is not sufficient to be repaired, as in this case. Early range of motion exercises should be initiated after second-stage surgery to prevent stiffness. CONCLUSION: Staged surgery using an external fixator and ligament repair using a suture tape and internal brace augmentation can be an effective option for a pure ligamentous ankle dislocation with an open wound and a poor remnant of ankle ligaments.

The Use of Combination Paracetamol and Ibuprofen in Postoperative Pain after Total Knee Arthroplasty, a Randomized Controlled Trial.

BACKGROUND: Adequate pain management has an important role in supporting early ambulation after total knee arthroplasty (TKA). Multimodal analgesia is one of the modalities of overcoming postoperative pain. The use of a combination of paracetamol and ibuprofen is expected to reduce the total morphine requirement after TKA. OBJECTIVES: The use of a combination of paracetamol and ibuprofen to reduce morphine requirement after TKA, to provide adequate pain management and early ambulation. STUDY DESIGN: Patients scheduled for total knee arthroplasty who met the requirements for inclusion criteria were consented and randomized using randomizer.org in a 1:1:1 ratio to receive either combination paracetamol iv and ibuprofen iv (Group II), paracetamol iv only (Group II), or ibuprofen iv only (III). SETTING: Thirty-six patients aged 63-68 years who underwent TKA were included in this study. METHODS: All patients were divided into 3 groups. Group I received paracetamol 1 g and ibuprofen 800 mg, group II received 1 g paracetamol iv and 100 mL normal saline, group III received 800 mg ibuprofen iv and 100 mL normal saline, 10 minutes before the end of surgery and every 6 hours up to 24 hours. Total morphine consumption, pain score (resting, walking, knee flexion), and 2 minute-length walking tests were measured in hour 24 postoperative. Data were analyzed with SPSS 16.0. RESULTS: Median of total morphine consumption between 3 groups respectively was 7.5 (3.0-36.0) mg vs 15.0 (4.5-28.5) mg vs 9.0 (0.0-24.0) mg with no difference (P = 0.391). Mean of pain score at walking phase respectively was 4.8 ± 0.5 vs 7.3 ± 1.2 vs 5.6 ± 0.5 (hour 24, P < 0.01). Medians of 2-Minute Walking Test respectively were 6.0 (2-16) meters vs 0.0 (0-4) meters vs 0.0 (0-4) meters (hour 24, P  < 0.01). LIMITATIONS: The total morphine requirement measured in this study illustrates the consumption of morphine in resting phase. CONCLUSION: The combination of paracetamol and ibuprofen is better in reducing the total morphine requirement after TKA when compared with the administration of paracetamol injection alone or ibuprofen injection alone. Combination paracetamol injection and ibuprofen injection also provides adequate pain management in order to help early ambulation.

Parosteal Osteosarcoma: A Benign-Looking Tumour, Amenable to a Variety of Surgical Reconstruction.

Osteosarcoma arising from cortical surface is classified into parosteal, periosteal and high-grade surface osteosarcoma. Along the spectrum, parosteal osteosarcoma occupies the well-differentiated end. It is a relatively rare disease entity, comprised only 4% of all osteosarcomas and barely reported in the literature. The objective of this study is to describe cases of parosteal osteosarcoma as well as a variety of treatment options amenable to such entity. Six cases of parosteal osteosarcoma were identified based on histopathological reports in a tertiary referral hospital in Jakarta, Indonesia between January 2001 and December 2019. The mean age was 29.8 years old; four of them (66.7%) were male. Distal end of femur was the most commonly involved bone (five cases, 83.3%). The patients were treated with wide excision followed by several different reconstruction methods: replacement with endoprosthesis, extracorporeal irradiation, knee arthrodesis, or prophylactic fixation. One of our patients presented with dedifferentiated component, and therefore was treated by limb ablation. While two cases died of pulmonary metastasis, other patients reported fair to excellent functional outcome.