Simultaneous use of lateral calcaneal ostectomy and subtalar arthroscopic debridement for residual pain after a calcaneal fracture.

Inadequate primary treatment of calcaneal fractures frequently results in persistent, residual pain. This can be caused by subtalar arthritis, an increased calcaneal width, and/or calcaneal fibular impingement of the peroneal tendons. Many patients experience multiple disorders simultaneously, requiring a combination of procedures to treat the injury. The purpose of the present study was to evaluate the clinical outcomes of arthroscopic debridement with lateral calcaneal ostectomy for residual pain after a calcaneal fracture. Four feet (4 patients) were treated with arthroscopic debridement and lateral calcaneal ostectomy. The patients were 3 males and 1 female, with a mean age of 55.3 ± 14.1 years. The mean follow-up duration was 33.5 ± 10.5 months postoperatively. Three patients received worker's compensation as a result of their condition. The patients were examined for improvement in pain levels using the numeric pain intensity scale and healing was assessed using the Japanese Society of Surgery of the Foot score. The mean Japanese Society of Surgery of the Foot score improved from 64.5 ± 13.8 preoperatively to 82.5 ± 7.1 postoperatively. The mean postoperative numeric pain intensity scale score was 2.3 ± 1.9. No complications, such as deep infection or problems with wound healing, were observed in any of the patients. The simultaneous use of arthroscopic subtalar debridement and lateral calcaneal ostectomy is a valuable intervention for the treatment of residual pain after a calcaneal fracture in patients who present with increased calcaneal width and mild or no degenerative changes in the subtalar joint.

A periacetabular osteotomy for the treatment of severe dysplastic hips.

BACKGROUND: We believe a curved periacetabular osteotomy is indicated for treatment of severe dysplastic hips with center-edge angles less than 0°, classified as Severin Group IV-b. However, the lower limit of the center-edge angle in hips classified as Severin Group IV-b is not clearly defined to determine which patients should receive periacetabular osteotomy alone. QUESTIONS/PURPOSES: We retrospectively compared the results of curved periacetabular osteotomies performed for the treatment of severe (Severin Group IV-b: center-edge angle < 0°) and moderate (Severin Groups III and IV-a: center-edge angle ≥ 0°) dysplastic hips. We investigated the lower limit of the center-edge angle, which was corrected by a curved periacetabular osteotomy alone in Severin Group IV-b hips. PATIENTS AND METHODS: We divided 191 hips in 163 patients into moderate (147 hips) and severe (44 hips) dysplastic hip groups. Minimum followup was 2 years (mean, 70.9 and 70.6 months, respectively). Clinical evaluations were performed using the Harris hip score. Radiographic measurements included the center-edge angle, acetabular head index, acetabular roof obliquity, and head lateralization index. Complications were compared between the two groups. RESULTS: All clinical and radiographic postoperative parameters showed satisfactory improvement over the preoperative parameters in both groups. The postoperative acetabular roof obliquity and head lateralization index were equivalent between the two groups. Eleven hips deteriorated to end-stage osteoarthritis. No complications were specifically associated with the severe dysplastic hips. CONCLUSIONS: Curved periacetabular osteotomy alone for treatment of severe dysplastic hips with preoperative center-edge angles as low as -20° and classified as Severin Group IV-b restored weightbearing area and medialization.

Arthroscopic treatment for an osteochondral defect of the talus after necrosis associated with acute lymphoblastic leukaemia: a case report.

Osteonecrosis is a serious complication of acute lymphoblastic leukemia (ALL) therapy. The spontaneous regression or healing of osteonecrosis is rare. An unusual case of an osteochondral defect of the talus secondary to osteonecrosis is herein presented. We treated a 26-year-old female who presented with an osteochondral defect of the talus after necrosis. ALL had previously been diagnosed in 1994 and the patients had been treated with chemotherapy included corticosteroid. She was thereafter diagnosed to have bilateral osteonecrosis of the talus in 1996, and thus had been treated with weight-bearing restriction using a patellar tendon bearing brace. She felt pain in her right ankle in 2006. Magnetic resonance imaging (MRI) showed an osteochondral defect in the lateral aspect of the talus and normal bone marrow signal in the right ankle. We performed arthroscopic treatment by means of a bone marrow stimulation technique. At second-look arthroscopy, the aspect of the talus was completely covered by fibrocartilage like tissue. This procedure is therefore considered to be one option for the treatment of an osteochondral defect of the talus after necrosis in young patients.