Value of arthroscopy in the management of acute lesions of the distal tibiofibular joint.

PURPOSE: Managing the distal tibiofibular (DTF) joint remains a challenge despite recent developments. Ankle arthroscopy is emerging as a diagnostic and therapeutic means. Our study aimed to compare preoperative imaging data and arthroscopic data, with the hypothesis that imaging alone is insufficient to evaluate acute laxity, and with arthroscopy as the reference examination. METHODS: All patients treated in 2023 in our department for an acute isolated DTF lesion were included prospectively. Preoperative radiographic and MRI imaging were compared with arthroscopic data. RESULTS: Ten patients were treated. For five patients, the instability was doubtful after carrying out an appropriate imaging assessment (X-rays of both ankles, MRI). For four of these five patients, instability was confirmed by arthroscopy. Arthroscopy was useful for suturing the anterior bundle of the DTF joint for two patients and allowed for verifying the reduction in the sagittal and coronal planes for two patients. No complications were detected. CONCLUSIONS: Arthroscopy in isolated acute DTF lesions seems to provide a diagnostic and therapeutic advantage. Its use may allow for exhaustive assessment and complete repair of lesions. It must be offered as soon as possible; a delay in specialized imaging may delay therapeutic care.

First Case of Surgically Treated Chronic Exertional Compartment Syndrome of the Arm.

This paper reports the first case of chronic exertional compartment syndrome in the arm treated surgically. The diagnosis was made in a patient who is under 30 years old, military, and very athletic, with recurrent exertional pain in the anterior compartment of the arms associated with rhabdomyolysis. The high-pressure measurements in the arms' anterior compartment after exertional exercise confirmed the diagnosis. Given the patient's functional demands, a surgical treatment of fasciotomy of the anterior compartment by miniapproach was performed and allowed the resolution of symptomatology with a return to sport at the same level after 3 months.

Arthroscopic lateral ankle ligament reinsertion with reinforcement by a minimally invasive extensor retinaculum flap for chronic ankle instability.

The past decade has seen the development of numerous arthroscopic techniques for ankle ligament repair or reconstruction in the treatment of chronic lateral ankle instability. Arthroscopy allows the assessment and treatment of intra-articular pathologies and is associated with faster functional recovery. The open surgery technique described by Blanchet, combining reinsertion of the lateral collateral ligament with reinforcement by an extensor retinaculum flap, has long proven its effectiveness. The aim of this article is to describe this technique under arthroscopy.

Publication rate of studies presented at the French Arthroscopic Society Meeting in 2014.

INTRODUCTION: Publication rates for studies reported at French Arthroscopic Society (Société francophone d'arthroscopie, SFA) meetings are not known. A comprehensive search of podium presentations to the 2014 SFA meeting was performed, assessing: (1) publication rate for meeting abstracts, and (2) bibliometric parameters including journal Impact Factor. HYPOTHESIS: The full-text publication rate for abstracts accepted for the 2014 French Arthroscopic Society (SFA) meeting was around 47.1%: i.e., the rate reported for the 2013 meeting of the French Society of Orthopedic Surgery and Traumatology (SoFCOT). MATERIAL AND METHODS: Bibliometric analysis of all abstracts accepted for the 2014 SFA annual meeting was undertaken by the Junior French Arthroscopic Society (SFA Junior), who collated the podium presentations. Reported studies were retrospective in 43 cases (54%) and prospective in 36 (46%). They consisted in clinical studies in 52/79 cases (66%), experimental studies in 4 (5%), cadaver or animal studies in 13 (16.5%), epidemiological studies in 8 (10%), a case report in 1 (1.2%) and a literature review in 1 (1.2%). Thirty-two (40.5%) concerned the shoulder and 31 (39%) the knee. Publication was checked on systematic PubMed-Medline search of authors' names. Articles found on PubMed-Medline were downloaded into the SIGAPS scientific publication search, management and analysis system database. Journal impact factor and SIGAPS category (A to E) were obtained, as were number of citations and h-index. This was a descriptive study, assessing numbers; results were reported as number and percentage. RESULTS: Overall publication rate was 31/79 (39.2%): 20/31 clinical studies (64.5%), 6 cadaver studies (19.4%), 3 epidemiology studies (9.7%), 1 experimental study (3.2%) and 1 literature review (3.2%). Mean 2014 SFA meeting-to-publication time was 18.7 months [range, -2 to 60 months]. Journal SIGAPS categories were A for 4 articles (13.3%), B for 13 (43.3%), C for 3 (10%), D for 9 (30%), with no E category articles but 1 article (3.3%) without SIGAPS category. CONCLUSION: The publication rate for abstracts accepted for report to the 2014 SFA annual meeting was lower than for the 2013 SoFCOT meeting. The high level of the journals in question testified to the quality of the studies reported at the SFA meeting. LEVEL OF EVIDENCE: IV, retrospective study.

Bone reconstruction by the induced membrane technique. What differences between conventional and ballistic trauma?

BACKGROUND: The induced membrane technique (IMT) has been widely evaluated for reconstruction of post-traumatic bone defects. However, no specific evaluation was conducted in ballistic injuries. The objective of the present study was to compare IMT in conventional trauma (CT) versus ballistic trauma (BT) managed in a military trauma center. METHODS: A retrospective study was conducted between 2009 and 2018 in patients treated by IMT for post-traumatic bone defects, whatever the defect location. Endpoints comprised bone union, residual infection, additional bone grafting and lower-limb amputation. RESULTS: Thirty-six patients were included: 24 in the CT and 12 in the BT group. Demographics and injury pattern were similar in both groups, with open fracture and infected lesions predominating. The only significant difference was that tibial bone defects were larger in the BT group. Operative parameters and results were also similar. At a mean 24 months' follow-up, bone union rate was 83% in both groups, without significant differences in residual infection, complementary grafting or late amputation. CONCLUSION: IMT is appropriate to bone reconstruction in the aftermath of ballistic trauma, with similar results to those obtained in conventional trauma. LEVEL OF EVIDENCE: IV, retrospective study.

Masquelet technique for open tibia fractures in a military setting.

PURPOSE: The induced membrane technique (IMT) is a two-stage procedure dedicated to reconstruction of bone defects of the limbs. The objective of this report was to evaluate employment of the IMT for the treatment of open tibia fractures managed in a military trauma center treating both wartime and peacetime injuries. METHODS: A retrospective study was performed among the patients treated via IMT for tibial bone defects related to open fractures between 2009 and 2018. The outcomes recorded included bone union, residual infection, amputation and lower limb function. RESULTS: During this period, 15 patients with a mean age of 39 years were included for the treatment of Gustilo II (2 cases) or Gustilo IIIB (13 cases) injuries. A mean number of 2.9 debridements were required before stage 1. Flap coverage was associated in 14 cases. The mean interval between stages was 22 weeks. Five patients were re-operated on after stage 1 due to persistent infection. The mean follow-up was 33 months. Bone union was achieved in 13 of the 15 cases (87%) at a mean time of 10.1 months. However, seven additional bone healing procedures were required, including six inter-tibiofibular grafting. Only one late septic recurrence was found. Most patients returned to work in sedentary jobs. CONCLUSIONS: This series is the first to report IMT use in a military setting. The prior eradication of infection constitutes a major challenge in tibial bone defects, especially in high-energy, multi-tissue injuries. An inter-tibiofibular bone reconstruction approach is required when external fixation is chosen.