Extensor Retinaculum Syndrome of the Ankle: An Adult Case Series.

Background: Extensor retinaculum syndrome (ERS) is a relatively rarely diagnosed compartment syndrome-like entity caused by elevated pressures in the tissues deep to the superior extensor retinaculum (SER). ERS is identified as out-of-proportion anterior ankle pain, pain with passive toe plantarflexion, elevated SER pressures (>40 mm Hg), and ultimately toe extension weakness and first web space numbness. Although previously described in a pediatric population, this case series is the first to our knowledge in an adult population. Methods: Seven nonconsecutive cases over 18 years from 2 surgeons are reported who underwent complete SER release for ERS either through the direct lateral approach to the fibula or the anterolateral approach to the distal tibia. All were associated with traumatic injuries including 3 bimalleolar ankle fractures, 3 tibial pilon fractures, and 1 distal tibial/fibular shaft fracture. All patients developed writhing anterior ankle pain worsened with passive toe plantarflexion. SER compartment pressures ranged from 50 to >135 mm Hg. Five cases displayed decreased first web space sensation. Results: The diminished or absent first web space sensation uniformly improved post-release. Complications included 1 patient with complex regional pain syndrome type 1, 1 patient required hardware removal, and 2 had persistent but improved first web space sensation changes. Conclusion: Clinical suspicion for possible ERS should arise after distal tibial/fibular fractures when the excruciating pain localizes to the ankle instead of the classic anterior leg muscle bellies. If pain is worsened with passive toe plantarflexion, this diagnosis should be considered. Recommended treatment involves complete release of the SER anywhere on the anterior surface between the tibia and fibula depending on the approach needed for fixation of the associated fracture. Level of Evidence: Level IV, case series.

Anterior Hip Heterotopic Ossification after Traumatic Anterior Hip Dislocation in a Non-head Injured Pediatric Patient: A Case Report.

Introduction: Traumatic hip dislocation in pediatric patients is uncommon, with anterior dislocation being particularly rare. Heterotopic ossification (HO) is a rare complication, especially in the absence of concomitant head trauma. There are no reported cases of symptomatic anterior hip HO, after closed anterior dislocation, in the pediatric population. Case Report: We present a case of symptomatic anterior hip HO in a 14-year-old female after traumatic anterior hip dislocation without associated head trauma. After closed reduction, anterior hip HO matured over the course of 1 year and resulted in a near complete ankylosis of the hip joint. Surgical excision and prophylactic radiation therapy resulted in a satisfactory clinical outcome. Conclusion: Pediatric anterior hip dislocation, even in the absence of head trauma, can cause symptomatic HO to the extent of near ankylosis of the hip joint. This can be managed with surgical excision and prophylactic radiation, with satisfactory clinical results.

Oxidative Stress and Osteoporosis.

➤: Oxidative stress has been implicated as a causative factor in many disease states, possibly including the diminished bone mineral density in osteoporosis. ➤: Understanding the effects of oxidative stress on the development of osteoporosis may lead to further research improving preventative and therapeutic measures that can combat this important contributor to morbidity and mortality worldwide. ➤: A diet rich in whole plant foods with high antioxidant content along with antioxidant-preserving lifestyle changes may improve bone mineral density and reduce the risk of fragility-related fractures. While it is not explicitly clear if antioxidant activity is the effector of this change, the current evidence supports this possibility. ➤: Supplementation with isolated antioxidants may also provide some osteoprotective benefits, but whole plant food-derived antioxidants potentially have more overall benefits. Larger-scale clinical trials are needed to give credence to definitive clinical recommendations.

Morel-lavalée lesions treated with debridement and meticulous dead space closure: surgical technique.

Morel-Lavalée lesions (M-L lesion) can be successfully treated with debridement and meticulous dead space closure on an acute or delayed basis. The technique is simple, reproducible, and involves only one trip to the operating room in all but the open infected lesions. Our series of 24 Morel-Lavalée lesions in 22 patients resulted in no infections or recurrence of fluid collection. Two patients had superficial skin loss treated by local wound management.

Posterior bicondylar tibial plateau fractures.

OBJECTIVE: To present a case series of patients with posterior bicondylar tibial plateau fractures treated by direct fracture exposure and fixation through dual incisions. DESIGN: Retrospective clinical study. SETTING: Level 1 trauma centers. PATIENTS/PARTICIPANTS: Eight patients were identified that had posterior bicondylar tibial plateau fractures. Two patients had depressed posterolateral tibial plateau fractures with contained defects and did not have direct fracture exposure. One patient died of medical problems leaving 5 patients who underwent direct fracture exposure, reduction, and fixation. INTERVENTION: Posteromedial followed by posterolateral open reduction and internal fixation of posterior bicondylar tibial plateau fractures. RESULTS: At 6 to 24 months follow-up (mean 13 months), all patients returned to near full activities, each with aching after prolonged standing (8-hour shift). Range of motion averaged 2 degrees to 121 degrees of flexion. Three of 5 returned to manual labor jobs; the others were not employed at the time of injury. CONCLUSIONS: Posterior bicondylar tibial plateau fractures have a high association with lateral meniscal pathology and can be associated with anterior cruciate ligament injury. Reduction of the posterior plateau condyles is easiest with the knee in full extension. Flexion contractures can be a problem, and patients should be encouraged to regain/maintain knee extension. The dual-incision approach to these challenging fractures can result in good to excellent knee function for these patients.