Failure of internal fixation for ankle joint Charcot neuroarthropathy with beta(2)-microglobulin amyloidosis: a case report.

Charcot neuroarthropathy (CN) is a serious diabetic complication with a poor prognosis and a high rate of misdiagnosis. Furthermore, beta(2)-microglobulin amyloidosis (Abeta2M) makes the diagnosis and therapy more difficult and complex. This case report highlights the pathophysiology, clinical evaluation, treatment, and prevention of the major diabetic complications associated with CN and Abeta2M that cause poor quality of life, limit the patient's ability to walk independently, and are directly or indirectly linked with a high risk for lower limb amputation. Ankle CN was discovered in a 36-year-old single female with a history of type 1 diabetes mellitus and diabetic nephropathy. We performed early internal fixation. However, because she lived alone and needed hemodialysis three times a week, wearing a brace and non-weight-bearing were extremely inconvenient. Furthermore, she did not experience any pain and only some edema; thus, she proceeded to bear weight ahead of schedule without authorization. Due to the premature weight-bearing and poor compliance, the patient suffered severe bone resorption and infection and eventually had to undergo amputation. Abeta2M was suggested by bone pathological sections. We present a case of failed internal fixation of ankle CN with Abeta2M, emphasizing the importance of social factors and postoperative management.

Surgical Outcomes of Articular Surface Crush Injury of Hawkins â ¢ Talus Neck and Medial Malleolus Fracture.

The present study was performed to evaluate the effects of the medial and anterolateral approach combined with internal fixation by double head compression screws and countersunk K-wires for Hawkins Ⅲ talus neck and medial malleolus fracture. Eleven patients with articular surface crush injury resulting in Hawkins Ⅲ talus neck fractures accompanied by medial malleolus fractures were reviewed. All patients underwent emergency operations. The fractures were fixed using double head compression screws and countersunk K-wires through combined medial and anterolateral approaches. FAOS, AOFAS ankle-hindfoot scale, and VAS questionnaire scores were recorded. In addition, ROM of the ankle and postoperative complications were assessed. All patients were followed up for a median of 52.45 ±â€…5.15 months. The multiple scales data of FAOS on the affected side were: pain score 89.14 ±â€…7.08; activities of daily living score 89.57 ±â€…8.88; quality-of-life score 89.20 ±â€…7.44; sports score 75.00 ±â€…15.49; and other symptoms score 84.74 ±â€…7.51. The mean overall AOFAS ankle-hindfoot score was 88.36 ±â€…6.39. The VAS score was 0.72 ±â€…0.65. Ankle motion included dorsiflexion (13.18°â€…±â€…9.02°) and plantar flexion (32.27°â€…±â€…12.34°). Subtalar joint motion included eversion (10.91°â€…±â€…7.01°) and inversion (11.36°â€…±â€…7.45°). All scores of the healthy side were higher than those of the affected side (p < .05). In addition to ROM of the ankle and subtalar joint and sports score, various indicators of recovery rate had scores > 80%. One patient developed skin necrosis, which healed after debridement and wound dressing. Late complications included subtalar and/or ankle traumatic arthritis in six patients, four of whom showed no obvious clinical symptoms. In conclusion, the method of emergency surgery and medial and anterolateral approach combined with countersunk K-wires to fix small bone fragments to restore the integrity of the articular surface is acceptable for Hawkins Ⅲ talus neck with medial malleolus fracture.

"Out-in" position in the surgical treatment of three-column tibial plateau fractures: A technical note.

Three-column classification of tibial plateau fractures is based on computerized tomography (CT) images, and the patients with three-column fractures can be treated with posteromedial combined with anterolateral approach in the floating position. However, there are certain disadvantages to operating in a "floating position". Therefore, we proposed an "out-in" position for those fractures. The patient is placed in supine position on the operating table, and the healthy hip is elevated. For the posteromedial approach, the affected limb should be placed on a rectangular fluoroscopy table and kept in abduction and external rotation (out); for the anterolateral approach, the affected limb is retracted into the operating bed and kept in neutral position (in).This position has been shown to be highly effective for easy operation as well as intraoperative image monitoring. Furthermore, it highlights the advantage of anterior-posterior joint fracture reduction.

A Modified 2-Stage Treatment for AO/OTA 43-C1 Pilon Fractures Accompanied by Distal Fibular and Posterior Lip of the Distal Tibia Fracture.

The management of pilon fractures remains challenging owing to the high-energy axial loading mechanism that produces comminution of the articular surface, displacement of tibia metaphysis, and severe soft tissue injury. How to preserve the vitality of soft tissue and achieve anatomic reduction has become a timely issue. We report and evaluate the effect of a modified staging treatment for AO Foundation/Orthopaedic Trauma Association (AO/OTA) 43C1 pilon fracture accompanied by distal fibular and posterior lip of the distal tibia fracture. We performed a modified 2-stage treatment of type C1 pilon fracture with distal fibular and posterior malleolar fractures. In the first stage, the posterolateral incision was used for simultaneous reduction of fibula and posterior malleolus, and the tibia was fixed with an external fixator. In the second stage, the external fixator was removed, and the medial malleolus and tibia were fixed after the edema of soft tissue had subsided. The following data were collected: Foot and Ankle Outcome Score (FAOS), American Orthopaedic Foot & Ankle Society (AOFAS) score, Short Form 36 (SF-36) score, Burwell-Charnley fracture reduction score, and postoperative complications. Twenty-seven patients were monitored for an average of 31.70 ± 7.38 months. The Burwell-Charnley fracture reduction scores had anatomic and fair ratings of 92.59%. SF-36 physical component score was 42.94 ± 12.47 and mental component score was 48.73 ± 9.79. Score data from the multiple scales of FAOS included pain, 88.79 ± 8.59; activities of daily living, 91.89 ± 7.50; quality of life, 90.26 ± 10.52; sports, 87.93 ± 11.64; and symptoms, 85.32 ± 8.65. The AOFAS ankle-hindfoot scores were 87.30 ± 13.45. Complications were reported in 5 patients (18.52%). Our study provides a good alternative to the existing protocol for type C1 pilon fractures with distal fibular and posterior lip of the distal tibia fracture and effectively reduces soft tissue complications.