Treatment of Schatzker Type III Tibial Plateau Fractures: Report of an Alternative, Percutaneous Technique and Brief Review of the Literature.

Schatzker III tibial plateau fractures (TPF) reduction and stabilization still represents a challenging procedure. We present an alternative, percutaneous surgical technique. With an antero-medial transverse incision at the level of the tibial metaphysis, under fluoroscopic control, an osteotome is advanced from medial to lateral, under the depressed fragments, reducing the articular surface of the lateral TP anatomically, without creating a significant void and preserving the lateral wall. Final fixation is achieved with screws placed from lateral to medial in a percutaneous fashion, parallel to the articular surface to hold fragments in a rafting way. Open surgical techniques hide many pitfalls and several new reduction options have been described; some simple but invasive, using bone tamps and bone graft that increase surgical trauma; others reliable and safe, but demanding and difficult to reproduce, needing good arthroscopic skills or special and expensive instrumentation, therefore not always available in the operating theater. We prefer a medially based percutaneous metaphyseal bone access using two simple flat low profile instruments such as osteotomes, that preserve bone and vascularization during the reduction maneuvers, minimizing the above-mentioned risks, for the treatment of Schatzker type III TPF.

Unusual osteolitic intraosseous ganglion cyst of the medial tibial condyle in a patient affected by mild osteoarthritis of the knee.

Bone lesion of the proximal tibia are common findings; depending on the site, age of the patient and symptoms a carefull differential diagnosis must be carried out. We present the case of  a 60 years old active patient presenting at our clinic with atraumatic  knee pain. X-Rays performed revealed an osteolitic lesion of the medial tibial condyle; MRI  highlighted a lobulated cystic lesion of the medial tibial condyle without evidence of interruption of the suchondral bone. The cavity appeared with low signal intensity on T1 weighted images and with a high signal intensity on T2 images  The tissue obtained from the incisional biopsy macroscopically revealed a clear, yellowish gelatinous and mucinous material; the microscopical hystological exam confirmed a cystic area of the lesion; the lumen contained some dense, fibrous matherial with focal mucoid degeneration, while the wall  was composed of a fibrous tissue with rare ossification and calcification.  Clinical history, imaging and histhological findings lead to a certain diagnosis of an intraosseous ganglion cyst. We decided to surgically treat the lesion with courettage and bone grafting with allograft;the anterior part of the deep medial collateral ligament was used to avoid the leakage of the transplanted bone. With limitations concerning the short follow up, we obtained an optimal result in terms of patients satisfaction; this result is mainly related to the relief of the pain and the possibility for the patient to return to his activities. An accurate follow up must be carried out to verify the integration of the allograft.

Unusual case of hypotenar Hammer Syndrome and carpal tunnel syndrome association.

BACKGROUND AND AIM OF THE WORK: Hypothenar Hammer Syndrome is a relatively rare disease process caused by repetitive stress or injury to the hypothenar eminence leading to chronic injury to the ulnar artery. Our study reports an unusual case. METHODS: A 57 years old Plumber presented in April 2016 with a history of constant pain and recurrent paresthesia involving the fingers of the right hand for several months, over the previous 1 year, his hand had become more intolerant of exposure to cold temperatures. Angio-RNM and electromyography were performed and showed a severe double compression of ulnar and median nerve and an ulnar artery deformity without thrombosis. Surgery was performed under sedation and axillary anesthesia. RESULTS: After surgery patient' symptoms immediately improved, and within a few months, his hand had normalized. CONCLUSION: Hypothenar Hammer Syndrome is a rare disease process which manifests in certain occupations and activities that put undue stress on the hypothenar area. Furthermore, the carpal tunnel syndrome, a pressure damage of the median nerve, caused by repetitive manual tasks with flexion and extension of wrist has been added as well as hypothenar hammer syndrome which are vascular damages of hand caused by shock-type application of force.

Atraumatic acute bilateral quadriceps tendon rupture in a patient with bilateral patella spurs. A case report and review of literature.

BACKGROUND AND AIM OF THE WORK: the spontaneous and simultaneous rupture of both quadriceps tendons is uncommon and has rarely been reported in medical literature. The current case involves a 62-years old man with bilateral atraumatic complete quadriceps tendon rupture. Aim of this study is to provide a systematic review of this case and a literature review of similar cases. Methods: we reviewed and analyzed this patient's records. Initial x rays of both knees showed a bilateral patellar spur. Real time ultrasonography scan of both knees showed a complete tear of quadriceps. The repair has consisted on end to end Krackow sutures associated with bone suture to the proximal pole of the patella using patellar drill holes. We also researched the literature for bilateral simultaneous rupture of the quadriceps tendon. Results: The patient suffered only from seasonal asthma (receiving only inhaled corticosteroids) and he was overweight (BMI: 33,5), he did not do any type of sport, he was a biker. The patient was able to walk after 3 weeks with both knee cast. The patients had a 120° pain free range of motion in both knees 4 months after surgery. Conclusion: Simultaneous bilateral quadriceps tendon rupture is really very rare and these are generally reported as case presentation in the literature. This injury usually presents in middle aged people with a history of chronic illness. The general recommendation is to perform surgical intervention within 48-72 hours after injury.