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Background: The internal and external rotation over 90° of flexion is restricted by posterior cruciate ligament (PCL). PCL also restricts posterior translation of tibia at all angles of flexion. The purpose of this study was to compare preoperative and postoperative functional outcomes (Lysholm scores and IKDC scores) in patients with PCL avulsion injuries managed with fixation by fiber wire suture tape. Methods: This was a prospective cohort study. The study group included 20 patients with PCL avulsion injuries with a mean age of 49.5 years (12 males and 8 females). All patients underwent treatment with high-strength 2-0 fiber tape tied around the PCL tibial insertion under arthroscopy for reduction and fixation. Results: There was increase in Lysholm score of 20 follow-up patients, from preoperative 36.9 ± 3.9 to a postoperative score of 96.1 ± 3.5. An increase in IKDC scores to 95.4 ± 3.1 from 52.9 ± 9.2 was also seen. Significant differences were found between preoperative and postoperative values. 19 patients regained function and one patient required manipulation under anesthesia. Satisfactory reduction was showed in X-ray and 3D CT scan for all 20 patients. Conclusion: If the PCL avulsion fracture injury is not identified and adequately treated, it can cause serious morbidity. Although newer studies demonstrate equivalent functional outcomes with arthroscopic treatment, open reduction with internal fixation (ORIF) with Cortico-Cancellous (CC) screw fixation is still a common treatment option. Improve postoperative functional outcome with minimal complications, author recommends PCL avulsion fracture fixation with arthroscopic fiber wire suture tape.
RESUMEN
Introduction: Syndesmotic injury in trimalleolar fracture is necessary to address intraoperatively by stability test, as it affects post-operative functional outcomes. Most of syndesmotic injuries are stable after fixation of the posterior malleolus, but in rare cases, syndesmosis is not stable after adequate fixation. In those rare conditions, we have to fix syndesmosis by corticocancellous (CC) screw throw lateral fibula plate. We emphasize this complex problem and offer solutions to overcome it. Case Report: Case 1: A 45-year-old male suffered significant trauma to his right ankle from a slip and fall, resulting in a trimalleolar fracture. The open reduction and internal fixation (ORIF) throw posterolateral approach was performed after wrinkles were seen on the ankle. A four-hole Ellis plate was used in antiglide mode to reduce posterior malleolar fragments. The lateral malleolus is fixed with a 7-hole, 1/3-locking tubular plate with a tricortical syndesmotic CC screw. The medial malleolus was internally fixed by a 6-hole LC-DCP. Case 2: A 49-year-old female suffered significant trauma to her right ankle from a domestic fall, resulting in a trimalleolar fracture. The ORIF throw posterolateral approach was performed after wrinkles were seen on the ankle. A four-hole Ellis plate was used in antiglide mode to reduce posterior malleolar fragments. The lateral malleolus is fixed with an 8-hole, 1/3-locking tubular plate with a tricortical syndesmotic CC screw. The medial malleolus was internally fixed by a 2 CC screw with an 8-hole LC-DCP. The anterior distal tibia fragment was fixed with a 16-mm anteroposterior CC screw. Conclusion: In a trimalleolar ankle fracture, fixation of the posterior malleolus is important for a better post-operative functional outcome, irrespective of the size of the posterior malleolus. The author recommends lateral fibula plate fixation by creating a window between the skin and the peroneus longus and brevis tendon, so we have a chance to put a syndesmotic screw into the lateral plate if syndesmosis is not stable.
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Introduction: Avulsion tuberosity fracture of the calcaneus is relatively unusual and occurs more frequently in elderly osteoporotic patients. Direct trauma to the heel is a rare cause in young individuals. Failure to perform early open reduction and internal fixation (ORIF) potentially leads to soft-tissue complications due to pressure necrosis of the overlying skin. Case Report: A 29-year-old male patient experienced left heel pain with swelling after the assault as he was hit by an iron rod 8 days prior. Radiographs revealed a Beavis Type 2 calcaneal avulsion fracture. An open reduction with two corticocancellous (CC) screw fixation was intended for the fracture. Conclusion: The avulsed bone fragment was small causing difficulty in reduction. The result of closed reduction in such a scenario is not promising and usually requires ORIF. We performed a modified surgical procedure of CC screw fixation in which one screw was passed perpendicular to the fracture plane for reduction of the fracture and another screw was passed obliquely to nullify Achilles forces. We believe that this technique of fracture management improves patient outcome and early mobilization.
RESUMEN
Introduction: An intertrochanteric fracture (IT) with below-knee (BK) amputation is challenging to manage since it is impossible to provide the ideal amount of traction to reduce the fracture due to the lack of a foot. We emphasize this complex problem and offer solutions to overcome it. Case Report: A 55-year-old man with a previous ipsilateral BK amputation presented to us after an episode of fall. The patient had been using a BK prosthesis for mobilization before the fall. Radiographs revealed a femoral IT fracture. A proximal femoral nail (PFN) fixation was intended for the fracture, but positioning the patient on the fracture table for surgery proved challenging. The patient had to be carefully positioned on the fracture table during surgery. Conclusion: The reverse boot technique is an effective method for treating an IT fracture in a patient with ipsilateral BK amputation. It involves the usual technique of applying traction, achieving reduction, and fixing the fracture with a PFN of the appropriate size. The patient was able to walk with support the next day after surgery and pre-injury mobility was regained within 3 days. We here emphasize a method of applying traction with this simple modification of the fracture table to apply an adequate amount of traction safely.