ABSTRACT
INTRODUCTION AND IMPORTANCE: Septic arthritis (SA), an infection affecting joints, is primarily attributed to bacteria, viruses, or fungi, with the hip, knee, and ankle being common sites of involvement. However, SA of the proximal tibiofibular joint is exceptionally rare. We report a highly uncommon case of lateral knee pain with fever in an 11-year-old boy caused by SA of the proximal tibiofibular joint. CASE PRESENTATION: The case involves an 11-year-old male admitted with atraumatic knee pain, fever, and limping. Physical examinations revealed no pain or tenderness of the knee joint, but a painful swelling near the proximal tibiofibular region. The patient had a temperature of 38.6 °C and a petechiae-like rash. Initial bloodwork showed an inflammatory syndrome, and blood cultures were negative. Imaging, including X-rays, ultrasound, and MRI, revealed a fusiform collection near the fibula and a 40*10 mm mass. Surgery, performed through a posterolateral approach, identified purulence in the tibiofibular joint. Bacteriological samples confirmed methicillin-sensitive Staphylococcus aureus, with histopathological results confirming non-specific septic synovial involvement. The patient received a six-week course of dual empirical antibiotics and showed afebrile status postoperatively. At the two-year follow-up, the patient walked independently with no restrictions in joint mobility. CLINICAL DISCUSSION: SA of the tibiofibular joint is rare but should be considered in febrile knee pain, especially if lateralized. CONCLUSIONS: A favorable outcome require a prompt diagnosis and treatment, involving surgical debridement, appropriate antibiotics, and postoperative immobilization.
ABSTRACT
PURPOSE: Lateral tibial plateau fractures with depression are the most common. Their treatment is currently surgical. Many therapeutic procedures have been described. Our aim is to evaluate the results of open surgery and to compare the two internal fixation methods used: lag screw versus plates. MATERIALS AND METHODS: This is a retrospective comparative study of two series of tibial plateau fractures Schatzker types II and III treated surgically over a period of ten years with two different methods: Group A: Internal fixation using screws for 86 patients. Group B: Internal fixation using plates for 71 patients. Functional and anatomical results were assessed according to Rasmussen's clinical and radiological scores. RESULTS: The patients' average age was 44 years (range from 18 to 76). The male gender was predominant (104 males and 53 females). Road traffic accidents were the most common aetiology with over two thirds of the cases. The fractures were type Schatzker II in 61% of the cases. The mean follow-up was five years. Although the clinical and radiological Rasmussen scores were better in group A (internal fixation with lag screws), those differences were statistically insignificant (p = 0.6 and p = 0.8). Group A clinical and radiological scores were 26.06 and 16.57, respectively and those of group B were 25.72 and 16.45. We noticed more sepsis and skin complications and a longer operating time (95 min versus 70 min) in group B patients with a statistically significant difference. None of the patients of our series had bone grafting. CONCLUSION: For Schatzker II and III fractures, an internal fixation with lag screws would be preferable when possible especially in the case of a pure depression fracture. It yields satisfactory results with a shorter operating time and less complication rate.
