Patella fracture after medial patellofemoral ligament reconstruction using suture anchors.

The medial patellofemoral ligament (MPFL) acts as a soft tissue restraint to lateral subluxation of the patella, and is frequently damaged following patellar dislocation. A number of techniques for repair or reconstructions of the MPFL have been reported. We report two cases of patellar fracture following MPFL reconstruction utilizing suture anchors and bone tunnels that do not completely traverse the patella. The first case occurred seven months after surgery and the second case was at six weeks following surgery. There have been previous reports of patellar fracture following MPFL reconstruction, particularly when patellar tunnels completely traverse the patella. The authors decided to use suture anchors to reduce the risk of patellar fracture, and they feel that the fractures reported in this paper resulted from surgical error rather than system error. We feel that this is an important learning point when initially using this technique, and should be disseminated to other surgeons who undertake this surgery.

Medial tibial hemi-condylar elevation osteotomy as an operative technique to treat varus mal-united tibial plateau fracture.

Hemi-condylar tibial osteotomy was first reported as a corrective surgical option for neglected Blount's disease by Langenskiold in 1964. The indication for this procedure is largely reserved for the rare cases of excessive ligament laxity. To the best of our knowledge, literature search reveals only 6 cases, all of which were of Blount's disease and there has been no report of this procedure being used in Trauma. We present a case of failed osteosynthesis of Type V tibial plateau fracture, which resulted in genu varum deformity secondary to collapse of only the medial tibial condyle. We successfully realigned the mechanical axis by elevation osteotomy of the medial tibial hemicondyle.

External iliac vein compression and thrombosis by a migrated acetabular screw following total hip arthroplasty.

A fifty-nine year old gentleman underwent a right total hip replacement in another hospital for protrusio osteoarthritis of the right hip. Post-operatively he developed a large right-sided ilio-femoral deep venous thrombosis. A pelvic radiograph showed that the acetabular construct had migrated medially into the pelvis with a CT scan showing compression of the external iliac vessels by one of the acetabular screws. Revision surgery was carried out in collaboration with the vascular surgeons. This case report highlights the importance of pre-operative planning to avoid medial wall perforation in patients with protrusio osteoarthritis. It also illustrates an unusual complication of compression of the external iliac vessels causing massive ilio-femoral thrombosis. The management of this potentially limb threatening complication is described in this case report.

Benign self-limiting cystic lesion after lower end radius fracture in a child.

Post-traumatic cystic lesion is usually found adjacent to a healing torus fracture. It is typically asymptomatic and appears just proximal to the fracture line within the area of subperiosteal new bone formation. We report one such cyst in a 7 year old boy, with a brief review of literature to highlight the occurrence of such benign self limiting cystic lesions of lower end radius fracture.

Extractable substances from human hair: a discussion about the origin of the holes.

The existence of holes in the endocuticle, in the inter-macrofibrilar matrix and in the cell membrane complex of hair fibers is described. In this paper, we show that these holes are absent in the hair follicle. However, cell remnants found in young hair inside the follicle are located in the same regions and are of the same dimensions as the holes observed in mature fibers. Since holes in the endocuticle have been described to appear as a result of daily care actions, it is probable that the development of holes in the inter-macrofibrilar matrix and in the cell membrane complex is related to the removal of extractable substances. We discuss hole formation in terms of the nature of the extractable substances and the presence of cell remnants in the young fibers.