Primary repair of complete Achilles tear augmented with amnion allograft wrap in college basketball player with a history of contralateral Achilles rupture: a case report.

Background: The Achilles tendon is the thickest tendon in the human body and is responsible for plantar flexion with muscle contraction. It is able to withstand tensile loads as large as ten times the body's weight or greater at times of peak stress on the tendon. Due to the repetitive and massive stress inflicted on the Achilles tendon, it is prone to injuries, especially in running and jumping athletes. Ruptures typically present after unsustainable stress placed on the tendon from rapid contraction with classic presentation of a sudden "pop". These injuries tend to occur in middle-aged men after atypical physical exertion with complaints of immense pain in the posterior lower leg. Case Description: This case examines a 20-year-old athlete presenting to the emergency department after sustaining a left calf injury while playing basketball. The patient suffered a full-thickness tear of the Achilles tendon with retraction and subsequent anterior and posterior tibiofibular ligament deficiency. This presentation is unique as he has a past medical history of an Achilles tear in the contralateral limb. Conclusions: This study concluded that the bilateral Achilles tears in such a young patient were caused by anatomical blood supply watershed area to the Achilles tendon and anatomical ankle alignment abnormalities. This study provided a viable option to successfully repair complex Achilles tears via close reduction internal fixation (CRIF) with allograft matrix.

A Tillaux Fracture and Concurrent Nondisplaced Salter-Harris Type III Fracture of the Distal Fibula: A Case Report.

The Salter-Harris classification system categorizes pediatric fractures in relation to the physis. A Salter-Harris type III fracture occurs from the physis extending to the epiphysis. Tillaux fractures are a type of Salter-Harris type III fracture that occurs due to incomplete fusion of the growth plate and includes the anterolateral tibial epiphysis. This specific fracture is unique to adolescents due to the anterior tibiofibular ligament's strength in relation to the growth plate, causing avulsion of the tibial fragment. The settings for a Tillaux fracture and a Salter-Harris type III fracture are uncommon due to the mechanism of injury, and it is incredibly rare to have two separate fractures of these classifications in the same ankle. In this case study, a 16-year-old male presented to the emergency department after sustaining trauma to the right ankle via a skateboarding accident. Initial radiographs showed no evidence of acute fracture, and CT imaging was performed. CT scan of the right lower leg found a Tillaux fracture of the distal right tibia with a 2 mm displacement and a nondisplaced Salter-Harris type III distal fibula fracture. Closed reduction and percutaneous screw fixation of the distal tibia fracture were performed. The repair of this fracture was complicated due to the presence of two distinct fractures. This case study aims to provide a viable option to successfully repair this complex presentation as well as explain imaging findings that differentiate this fracture from other pathologies that are not managed operatively.

Sliding Inguinal Bladder Hernia: An Open and Minimally Invasive Robotic-Assisted Repair.

Inguinal hernia repair, although a common procedure, can present in complicated ways such as a sliding inguinal bladder hernia (IBH). This rare type of hernia can alter a patient's quality of life by obstructing urination, requiring manual scrotal compression to fully empty the bladder, and lead to devastating complications such as hydronephrosis and kidney failure. Treatment is typically by open inguinal hernia repair with manual bladder reduction, but this method poses risks of iatrogenic injury to the bladder. Within this case series, IBH repairs via open and robotic-assisted laparoscopic procedures are compared, and the morbidity and mortality of each method are analyzed. Although risk of recurrence is similar for both procedures, robotic surgeries are linked to decreased postoperative pain and length of hospital stay. The ease of dissection of pelvic anatomy and detailed view of the associated structures that robotic surgery can provide during a complex hernia repair encourages its use for IBH.

Need for Increased Awareness of International Male Circumcision Variations and Associated Complications: A Contemporary Review.

Male circumcision is a prevalent, straightforward procedure. Cultural, religious, and/or social factors are the main determinants in the decision to undergo circumcision. The method of circumcision and age of the patient at the time of circumcision varies, dependent on the deciding determinant: cultural or religious tradition, personal hygiene, preventive health, or medical need. While circumcision is a relatively simple operation for a trained medical professional with low rates of adverse events, the safety of the operation varies when performed by non-medically trained (traditional) practitioners. This review aims to inform physicians of international circumcision variations and associated complications and to provide history-taking considerations during the review of the genitourinary system. The review revealed a wide variety in 1) training of practitioners performing circumcisions, 2) methods of circumcision, and 3) sterility during the procedure contributing to differing rates of complications. Findings suggest circumcisions should not be viewed equally, and greater emphasis should be placed on genitourinary history, especially circumcision, with patients from areas where traditional circumcisions are prevalent.