Popliteal artery thrombosis complicating posterior tibial exostosis in a 35-year-old male.

Chronic popliteal artery thrombosis complicating tibial exostosis has never been described as far as we know. Here, we report the case of a 35-year-old male patient complaining of intermittent claudication over the previous 4 months, without history of trauma or hereditary multiple exostoses. Clinical examination found no popliteal or distal pulses. The diagnosis was confirmed based on CT angiography showing distinct blockage of the contrast product over an exostosis on the posterior side of the proximal tibia. Treatment consisted of removing the exostosis and then bypassing the popliteal artery with a reversed autogenous venous graft.

[Morel-Lavallee syndrome of the lower leg]. / Syndrome de Morel-Lavallée du membre inférieur.

BACKGROUND: Morel-Lavallée syndrome, which appears after tangential trauma of highly vascularised tissues, is characterized by closed internal degloving injuries resulting in subcutaneous fluid collection. It can cause many complications. A 42-year-old man presented with open wounds after a violent right lower extremity trauma; the wounds were sutured. One month after the trauma, the patient complained of painful edema of the lower limb and fluid discharge from the previously sutured wounds. Local examination showed fluctuating fluid collection. Serum inflammatory markers were within the normal range. Ultrasound investigation of the right lower limb confirmed an extended fluid collection from the lower third of the thigh to the upper third of the leg, and CT scan delineated a surrounding capsule. The clinical and radiological data supported a diagnosis of post-traumatic Morel-Lavallée syndrome. Local surgical debridement and drainage associated with systemic antibiotic therapy (the fluid was found to be infected with oxacillin-resistant Staphylococcus epidermidis) resulted in rapid improvement. DISCUSSION: Morel-Lavallée syndrome commonly appear after tangential trauma of highly vascularised tissues. The skin and the subcutaneous fat tissue are abruptly torn from the underlying muscle fascia, shearing the lymphatic vessels, rendering lymphostasis impossible. The local inflammatory reaction can cause the formation of a fibrous capsule resulting in a fluid collection. The clinical signs are not specific. When examining a soft-tissue collection or slow-healing wounds, the dermatologist should always rule out previous soft-tissue trauma; simple imaging studies will confirm the diagnosis if Morel-Lavallée injuries are suspected. CONCLUSION: All dermatologists consulted by young patients without vascular disease for an unusual swelling and/or for slow-healing wounds should be mindful of this syndrome.

Do tantalum components provide adequate primary fixation in all acetabular revisions?

INTRODUCTION: A number of studies have reported favorable results of cementless fixation in acetabular revisions. Nevertheless, the implant bearing on more than 50% of the patient's bone and good primary stability are required. The objective of this study was to determine whether the use of tantalum implants could provide stable reconstruction for any type of acetabular revision. PATIENTS AND METHODS: This study investigated 72 hips (71 patients) implanted with tantalum cups, some with augments, and morselized graft material. The mean age was 60 years (range, 34-84 years). There were 30 males and 41 females. The mean weight was 71 kg (range, 52-102 kg), the mean height was 1.68 m (range, 1.52-1.84 m). Twenty-five revisions were bipolar. Six revisions were performed for infected acetabular loosening. The mean follow-up was 4 years (range, 2-6 years). RESULTS: The mean Merle d'Aubigné score at follow-up was 15.8 points (range, 9-18 points). According to the Paprosky classification of acetabular bone defects, there were 13 type 1 (18%), 14 type 2A (19.5%), 14 type 2B (19.4%), 23 type 3A (31.9%), and eight type 3B (11.2%) acetabular defects, four of which had pelvic discontinuity. Postoperatively, the position of the hip's center of rotation in relation to Köhler's teardrop was 22 mm (range, 5-41 mm) vertically (normal, < 25 mm) and 39 mm (range, 13-55 mm) horizontally (normal, < 35 mm). The mean acetabular inclination was 40 degrees (range, 20 degrees -63 degrees ). The radiographic analysis found no radiolucent line after 1 year and up to the last follow-up. None of the patients required revision for acetabular loosening. Three hips were revised for instability. Two retentive liners and a dual-mobility cup were cemented in the cups that were left in place. DISCUSSION AND CONCLUSION: Given their mechanical properties (coefficient of friction, porosity), tantalum implants provide a stable primary cementless fixation without compromising the center of rotation and without necessarily requiring a structural graft. A single implant range can therefore be used for any type and severity of bone loss and for all types of acetabular reconstruction. Longer follow-up is nevertheless necessary to confirm these encouraging results. LEVEL OF EVIDENCE: Level IV, historical series.

[Bone remodeling around cementless tantalum cups]. / Etude du remodelage osseux autour de cupules non cimentées en tantale.

PURPOSE OF THE STUDY: Most studies have reported a significant decrease in periacetabular bone stock one year after implantation of a cementless cup. The purpose of this work was to study the bone-implant interface of the tantalum cup using plain X-rays and dual-energy X-ray absorptiometry (DEXA). MATERIAL AND METHODS: This retrospective analysis concerned 42 patients with a tantalum cup, Trabecular Metaltrade mark (Zimmer, Warsaw, IN, USA). All hips had primary implantations, performed by one surgeon via the same approach and with the same postoperative rehabilitation protocol. Minimum follow-up was two years. The Harris clinical score, and radiographic (lucent lines and acetabular position) and densitometric (analysis of 3.3mm of periacetabular bone in the three DeLee and Charnley zones) were recorded. RESULTS: At follow-up, the mean Harris score was 81. There were no implant malpositions (horizontal, vertical, inclination). Lucent lines were noted for 14% of the cups. Bone mineral density (BMD) was higher than generally observed with cementless cups (1.290+/-0.309g/cm(2)). DISCUSSION: The clinical and radiographic results are similar to data in the literature regarding correct implant position. The higher rate of lucent lines around the tantalum cup is also reported in the literature and is the result of the pressfit, resolving at one year. The greater BMD in zone 1 might reflect better force transfer to the weight-bearing zone. CONCLUSION: As biomaterial recently introduced in orthopedic surgery, tantalum appears to provide a better force transfer to the central part of the iliac bone and thus possibly better preservation of pelvic bone stock.