Arthroscopic Microfracture for Traumatic Arthritis of Lateral Tarsometatarsal Joints A Case Report.

Conservative treatment is generally successful in treating early tarsometatarsal joint arthritis. However, if such treatment fails, invasive arthrodesis or arthroplasty may be needed. Arthroscopy is a less invasive alternative and can provide a precise diagnosis of early osteoarthritis or cartilage injury. Furthermore, arthroscopic treatments such as microfracture, chondroplasty, or loose-body removal are expected to delay progression of the osteoarthritis. We describe a 52-year-old man with early tarsometatarsal joint arthritis after calcaneal fracture healing who underwent a successful arthroscopic microfracture for cartilage defects. Arthroscopic findings show cartilage defects on the fourth and fifth tarsometatarsal joints. The patient underwent shaving and microfracture. The patient continues to experience effective symptom relief 3 months after surgery.

Extra-Articular Soft-Tissue Calcification After Burn Injury: A Case Study.

Soft-tissue calcifications after burn injury commonly develop in periarticular regions, especially in the elbow joint. They can be easily recognized in patients because calcification in the joint limits range of motion and brings about tingling sensation due to compression of ulnar nerve. However, the incidence of extra-articular soft-tissue calcification after burn injury has rarely been reported. We present a patient with massive soft-tissue calcification in extra-articular burn scar with nonhealing ulcer after a long latency period of 40 years. We recommended wide excision and skin grafting, for prevention of recalcification and recurrence of ulceration, which could transform into a malignant case, if left untreated. Furthermore, we propose that such patients with burn injury should undergo follow-up in outpatient clinic and x-ray evaluation.

Is retrograde drilling really useful for osteochondral lesion of talus with subchondral cyst?: A case report.

RATIONALE: Retrograde drilling is a well accepted procedure for osteochondral lesion of the talus and subchondral cyst with intact overlying cartilage. It has good results in most reports. Compared to anterograde drilling, retrograde drilling can protect the integrity of the articular cartilage. The purpose of this study was to evaluate the suitability of using retrograde drilling for osteochondral lesion with subchondral cyst and discuss the mechanism involved in the development of subchondral cyst. PATIENT CONCERNS: We report a 53-year-old man who had complained left ankle pain that lasted over 6 months which was exacerbated by walking. DIAGNOSES: We diagnosed it as osteochondral lesion of the talus with subchondral cyst. INTERVENTIONS: Plain X-ray, computed tomography, and magnetic resonance imaging (MRI) of the ankle. OUTCOMES: He undertook retrograde drilling without debridement of cartilage. After the surgery, the pain had been subsided for 1 year, although arthritic change had progressed. However, after 5 years of retrograde drilling, he revisited our hospital due to severe ankle pain. Plain X-ray and MRI showed arthritic change of the ankle and multiple cystic formation of talus. LESSONS: Retrograde drilling has some problem because this procedure is not theoretically correct when the development of a subchondral cyst in osteochondral lesion of the talus is considered. In addition, retrograde drilling may impair uninjured bone marrow of the talus, resulting in the development of multiple cystic formations.

Complications and outcomes of minimally invasive percutaneous plating for proximal humeral fractures.

BACKGROUND: The minimally invasive plate osteosynthesis (MIPO) technique using periarticular locking plates may be a good option for the repair of displaced proximal humeral fractures. However, axillary nerve complications related to this technique may be underestimated. The purpose of this study is to evaluate the outcomes of the minimally invasive plating, focusing on the complications. METHODS: The records of 21 consecutive patients treated for proximal humerus fractures using the MIPO technique with locking plates were retrospectively reviewed. These patients were treated between March 2009 and March 2011 with a minimum one-year follow-up. The clinical function, complications, and radiological bony union were evaluated. RESULTS: All of the patients, with one exception, showed at least 90 degrees of flexion and abduction at the shoulder joint six months postoperatively. The average Constant scores at three months, six months, and one year follow-ups were 74.0 (range, 62 to 90), 79.4 (range, 64 to 91), and 82.7 (range, 66 to 92), respectively. All of the patients achieved bony union within the average of 3.2 months (range, 2 to 6 months). There was one case of delayed union, one case of intra-articular screw penetration, and one case of axillary nerve paresis (incomplete injury), which did not completely recover during the one year of follow-up. CONCLUSIONS: The MIPO technique using periarticular locking plates is a useful option for the treatment of selected cases of displaced proximal humeral fractures. However, nerve complications such as axillary nerve paresis should be considered along with implant-related complications when choosing patients for minimally invasive plating.