Supramalleolar osteotomies for degenerative joint disease of the ankle joint: indication, technique and results.

Patients with varus or valgus hindfoot deformities usually present with asymmetric ankle osteoarthritis. In-vitro biomechanical studies have shown that varus or valgus hindfoot deformity may lead to altered load distribution in the tibiotalar joint which may result in medial (varus) or lateral (valgus) tibiotalar joint degeneration in the short or medium term. The treatment of asymmetric ankle osteoarthritis remains challenging, because more than half of the tibiotalar joint surface is usually preserved. Therefore, joint-sacrificing procedures like total ankle replacement or ankle arthrodesis may not be the most appropriate treatment options. The shortand midterm results following realignment surgery, are very promising with substantial pain relief and functional improvement observed post-operatively. In this review article we describe the indications, surgical techniques, and results from of realignment surgery of the ankle joint in the current literature.

Osteosynthesis of traumatic manubriosternal dislocations and sternal fractures with a 3.5/4.0 mm fixed-angle plate (LCP).

INTRODUCTION: We present a case series of three patients with manubriosternal dislocation and/or sternal fractures. METHOD: We describe our experiences of invasive surgical treatment with 3.5/4.0 mm fixed-angle plate (Locking compression plate, LCP) in this group of patients. Recommended nonoperative treatment options, e.g. correction tape or plaster bandage, symptomatic pain treatment, application of ice, and several weeks without sports are associated with a not inconsiderable rate of subluxations or reluxations with an increased risk of pseudarthrosis and chronic pain syndrome. RESULTS: Due to a small number of cases and the lack of controlled studies, a standardized operative procedure could, therefore, so far not been established. CONCLUSION: Our positive experiences with the operative treatment using 3.5/4.0 mm fixed-angle plate (LCP) may help to establish the operative procedure of first choice in this group of patients.

Successful removal of a 3.6-cm long metal band used as a penile constriction ring.

INTRODUCTION: Penile constriction rings are either used for autoerotic stimulus or to increase sexual performance. Potentially, they can become irremovable and cause urologic emergencies. AIM: We describe the successful removal of a 3.6-cm long piece of heavy metal tubing used as a penile constriction ring. METHODS: An angel grinder was used to open the metal tubing on both lateral sides. During the cutting procedure, the soft tissue parts were protected by two metal spatulas. Wet towels and cool running water prevented thermal injury. RESULTS: After removal of the band, no iatrogenic injury was visible and the further recovery of the patient remained uneventful. Postoperatively, one of the surgeons suffered from conjunctivitis of the left eye possibly due to metal sparks. CONCLUSION: Depending on the constricting object, heavy-duty technical equipment might become necessary for their removal. In such cases, special care should be taken to avoid injury to the patient and the medical crew.

Ankle osteoarthritis: etiology, diagnostics, and classification.

Osteoarthritis (OA) is defined as the syndrome of joint pain and dysfunction caused by substantial joint degeneration. In general, OA is the most common joint disease and is one of the most frequent and symptomatic health problems for middle-aged and older people: OA disables more than 10% of people who are older than 60 years. This article reviews the etiology of ankle OA, and describes the onset and development of posttraumatic ankle OA, the most common form of OA in the tibiotalar joint. Various methods of clinical and radiographic assessment are described in detail.

Thrombembolic complications after total ankle replacement.

The literature addressing functional outcome and survivorship of prosthesis components is constantly growing. However, the data on thromboprophylaxis and thrombembolic complications in patients who underwent TAR are scarce. A total of 31 studies were included in the systemic literature review. The incidence of thrombembolic complications varied between 0.0 % and 9.8 %. Most commonly, low molecular weight heparin was used as thromboprophylaxis for 6 weeks postoperatively. The incidence of thrombembolic complications was comparable with that of symptomatic deep vein thrombosis in patients with total knee or hip replacement.