Alternative Treatment of Gonarthrosis: Proximal Fibular Osteotomy.

INTRODUCTION: Gonarthrosis is arthrosis of the knee joint, a chronic non-inflammatory disease manifested by progressive destruction of the intra-articular cartilage, accompanied by abnormal formation of the bones form the joint, changes in the synovial membrane and synovial fluid. Gonarthrosis is the most common type of arthrosis. Gonarthrosis can be treated conservatively and operatively. Among well-established surgical options for the treatment of medial gonarthrosis are high tibial osteotomy (HTO), unicompart-mental knee arthroplasty (UKA), and total knee arthroplasty (TKA). Proximal fibular osteotomy (PFO) or superior partial fibulectomy is a relatively recent procedure proposed to reduce knee pain in patients with medial compartment. AIM: Our study aims to demonstrate an alternative treatment for gonarthrosis with proximal fibular osteotomy and reduced knee pain in patients with medial compartment osteoarthritis of the knee. MATERIALS AND METHODS: At the Department of Orthopedics and Traumatology at J.Z.U "Borka Taleski" Prilep in the period from 2018 to 2021, 14 cases were treated, of which 11 were female and 3 were male. All patients were aged between 62 and 82 years with a mean age of 71.3 years. Patients had a severe degree of gonarthrosis (III/IV) according to Kellgren-Lawrence classification. Arthroscopy was performed in 2 patients. The fibula osteotomy was 7 cm away from the fibular head, with 1 cm resected bone fragment from the fibula. RESULTS: The average duration of the surgery was 30 minutes. Patients were followed up on the 7th day, first month, 3 months and 6 months after surgery. The final evaluation of function was done after 6 months by examining the active and passive movements of the knee joint. In all 14 patients we have excellent results with pain reduction, improvement of movement and quality of life. CONCLUSION: Proximal fibular osteotomy is an option for medial compartment osteoarthritis of the knee. Current literature is limited to small case series which report good outcomes in pain reduction, including the correction of varus deformity in medial gonarthrosis. Further studies are needed to determine the place of the PFO in the medial gonarthrosis management algorithm before it can be recommended for routine clinical use.

Our Experience with Posterior Approach for Posterior Tibial Plateau Fractures.

Introduction: Posterior tibial plateau fractures are a rare type of fractures. Most surgeons are accustomed to operate in the supine position, however, surgery in the posterior knee region and operating in prone position can be challenging because of the presence of neurovascular structures including the tibial nerve, popliteal artery and vein, common peroneal nerve and, also challenging to achieve effective reduction and fixation, thus, it is less commonly performed. Materials and methods: Between February and September 2022 four posterior tibial plateau fractures were diagnosed and operated in our clinic within a six months follow-up (2 female and 2 male with mean age of 48.5 years). All were diagnosed with X-rays and CT scans. All of the fractures were on the right leg. Posterior "S shape" approach in prone position was used to reduce the tibial condyle and fix it with a plate. In fracture patterns that include lateral plateau impressions, the posterior "S shape" approach may not be sufficient to perform open reduction and internal fixation of the lateral condyle, so an additional anterolateral approach was made and additional locking plate was placed. Radiographic evaluation included reduction quality and satisfactory alignment of the bone axis. Results: All fractures healed within 6 months, without secondary displacement. Throughout the follow-up period, there were no incidences of post-traumatic osteoarthritis of the knee. No patient complained of knee instability. Conclusion: The direct dorsal approach allowed for adequate open reduction and internal fixation, and early clinical results are promising. However, in fracture patterns that include lateral plateau impressions, the posterior "S shape" approach may not be sufficient to perform open reduction and internal fixation of the lateral condyle, so an additional anterolateral approach should be made and additional locking plate to be placed.

Surgical Treatment of Traumatic Posterior Sternoclavicular Joint Dislocation: А Case Report.

Posterior sternoclavicular joint dislocation is a rare condition. In this paper, we present a 51-year-old male patient who was admitted to the emergency department in our hospital after he was hit by a mining railway wagon in the chest. A diagnosis of posterior sternoclavicular dislocation was confirmed after performing a CT scan. Following necessary preparations, the sternoclavicular joint was stabilized with two wire cerclage techniques during open reduction. During control at the postoperative 4th week, the range of motion at the shoulder was satisfactory, but the patient had mild pain at the joint level and was sent to physical therapy to improve the range of motion and to minimize the pain.