Positional relationship between the Achilles tendon and sural nerve on ultrasound.

PURPOSE: This study sought to clarify the positional relationship between the Achilles tendon and sural nerve using ultrasound. METHODS: We studied 176 legs in 88 healthy volunteers. The positional relationship between the Achilles tendon and sural nerve at heights of 2, 4, 6, 8, 10, and 12 cm proximal from the calcaneus' proximal margin was investigated by distance and depth. Setting the X-axis (left/right) as the horizontal axis and Y-axis (depth) as the vertical axis against ultrasound images, we investigated the distance between the lateral margin of the Achilles tendon to the midpoint of the sural nerve on the X-axis. The Y-axis was split into four zones: the part behind the center of the Achilles tendon (AS), the part in front of the center of the Achilles tendon (AD), the part behind the Achilles tendon (S), and the part in front (D). We investigated the zones through which the sural nerve passed. We also studied any significant differences between the sexes and left/right legs. RESULTS: The mean distance on the X-axis was closest at 6 cm, with 1.1 ± 5.0 mm between them. The sural nerve's position on the Y-axis was such that at positions more proximal than 8 cm, the sural nerve ran through zone S in most legs and moved to zone AS through heights 2-6 cm. No parameters showed significant differences between the sexes or left/right legs. CONCLUSION: We presented the positional relationship between the Achilles tendon and sural nerve and suggested some measures to prevent nerve injury during surgery.

Treatment of a sacral fracture associated with an intrasacral meningocele: A case report.

We report a case of sacral fracture complicated by an intrasacral meningocele in a 37-year-old male. The patient had a left sacral fracture with bilateral fractures of the superior and inferior pubic rami. The sacrum was fixed with a posterior plate and both superior pubic rami were fixed with an intramedullary screw. However, computed tomography myelogram and magnetic resonance imaging showed the intrasacral meningocele with the leakage of the cerebrospinal fluid into the buttocks and developed delayed union. Reoperation utilizing a strong anterior and posterior internal fixation combined with posterior bone grafting was undertaken and bone union was obtained.

Age does not affect the clinical and radiological outcomes after open-wedge high tibial osteotomy.

PURPOSE: Open-wedge high tibial osteotomy (OWHTO) is a well-established procedure in the management of medial compartment osteoarthritis and osteonecrosis of the medial femoral condyle. Several studies have evaluated factors that negatively influence outcomes. However, few reports have investigated the effect of age on HTO outcome. We evaluated the influence of the age on the outcome after HTO. METHODS: The TomoFix® plate was used to perform 60 consecutive OWHTOs. Twenty-six knees in 23 patients >65 years old (mean age at surgery 68.7 ± 2.9 years; range 65-75 years, group A) were compared with 34 knees in 27 patients <65 years old (mean age at surgery 56.2 ± 7.5 years; range 38-64 years, group B) with respect to the clinical and radiological outcomes after HTO. The clinical evaluation included the Japanese Orthopedic Association Knee Score (JOA score), Oxford Knee Score (OKS) and complications after surgery. RESULTS: There were no statistical differences in the background factors between the two groups. Postoperatively, the mean JOA score showed a significant improvement in both groups. The mean OKS after surgery was 41.6 ± 5.9 in group A and 41.4 ± 5.9 in group B. There were no statistical differences in the postoperative knee alignment and clinical outcomes between the two groups. CONCLUSION: OWHTO using the rigid long plate was an effective procedure independent of patient's age. The results showed that age did not influence the clinical and radiological outcomes after OWHTO.

Polyneuropathy caused by cobalt-chromium metallosis after total hip replacement.

Although metal intoxication after arthroplasty causes various symptoms, polyneuropathy has never been the focus of clinical investigation. We report the case of a 56-year-old woman with metal neuropathy. She had metallosis after hip arthroplasty with a cobalt-chromium alloy prosthesis. She developed progressive sensory disturbance, hearing loss, and hypothyroidism. Sural nerve biopsy indicated axonopathy. After exchange arthroplasty, blood levels of cobalt and chromium decreased, and her symptoms improved. Cobalt or chromium can cause axonopathy.