Traumatic tibialis anterior tendon rupture: treatment with a two-stage silicone tube and an interposition hamstring tendons graft protocol.

A novel technique for managing ruptured tibialis anterior tendon complicated by infection and tendon substance loss in a young adult is described. A two-stage reconstruction technique with a silicon tube and tendon autograft was performed. At first, after local control of the infection, scar excision and placement of a silicone tube was performed. Ten weeks later, ipsilateral hamstrings tendons were harvested and bridged the 7 cm tendon gap. Eighteen months later, the patient has excellent clinical and functional outcome.

Treatment of full-thickness chondral defects of the knee with autologous chondrocyte implantation: a functional evaluation with long-term follow-up.

BACKGROUND: Autologous chondrocyte implantation (ACI) has been proven an effective method in treating large articular cartilage defects in short- or medium-term follow-up clinical studies. HYPOTHESIS: First generation ACI of patients with large full-thickness chondral defects of the knee could yield reliable functional outcomes after a minimum follow-up of 5 years. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Between 1997 and 2005, 42 patients (45 knees) underwent first generation ACI for symptomatic chondral defects of the knee. All patients had moderate to large (mean, 5.33 cm(2)) full-thickness chondral defects. Patients were evaluated using the International Cartilage Repair Society (ICRS) score, the International Knee Documentation Committee (IKDC) Knee Examination Form, the Tegner activity score, the Lysholm score, the Stanmore functional rating score, and a visual analog scale (VAS) for pain. RESULTS: The mean follow-up was 96 months (range, 62-144 months). At the final follow-up, a significant increase in all scores was recorded. Compared with preoperative findings, the median Lysholm score significantly improved, increasing from 56.0 to 89.0 (P < .05). The IKDC and the Tegner activity score showed significant improvement postoperatively, increasing from 45 and 5.5 to 69 and 6.5, respectively (P < .05). The mean ICRS improved from grade 3.8 preoperatively to grade 2.8 postoperatively (P < .05). The Stanmore functional rating score and the VAS pain score were decreased from 3.06 and 7.33 to 0.94 and 2, respectively (P < .05). Reoperation was required in 5 patients. In 2 of them graft failure was recorded due to degeneration or partial detachment, respectively. CONCLUSION: The long-term outcomes of our series support the effectiveness of first generation ACI in both pain relief and functional rehabilitation of patients with large full-thickness osteochondral defects of the knee.

Proximal screws placement in intertrochanteric fractures treated with external fixation: comparison of two different techniques.

BACKGROUND: To compare two different techniques of proximal pin placement for the treatment of intertrochanteric fractures in elderly patients utilizing the Orthofix Pertrochanteric Fixator. METHODS: Seventy elderly high-risk patients with an average age of 81 years were treated surgically for intertrochanteric fracture, resulting from a low energy trauma. Patients were randomly divided in two groups regarding to the proximal pin placement technique. In Group A the proximal pins were inserted in a convergent way, while in Group B were inserted in parallel. RESULTS: All fractures healed uneventfully after a mean time of 98 days. The fixator was well accepted and no patient had significant difficulties while sitting or lying. The mean VAS score was 5.4 in group A and 5.7 in group B. At 12 months after surgery, in group A the average Harris Hip Score and the Palmer and Parker mobility score was 67 and 5.8, respectively. In group B, the average Harris Hip Score and the Palmer and Parker mobility score was 62 and 5.6, respectively. No statistically significant difference was found regarding the functional outcome. The mean radiographic exposure during pin insertion in Group A and Group B was 15 and 6 seconds, respectively. The difference between the two groups, regarding the radiographic exposure, was found to be significant. CONCLUSION: Proximal screw placement in a parallel way is simple, with significant less radiation exposure and shorter intraoperative duration. In addition, fixation stability is equal compared to convergent pin placement.

Pyomyositis in children: early diagnosis and treatment.

PURPOSE: This study was conducted to evaluate early diagnosis, clinical course, and treatment outcome in children with pyomyositis. METHODS: Between 2001 and 2006, 6 children with a mean age of 7.2 years were diagnosed and treated for pyomyositis in our clinic. The most common site of involvement was the hip and thigh region. All patients underwent early magnetic resonance imaging (MRI) examination that played a significant role in the early diagnosis and management of the disease. RESULTS: Staphylococcus aureus was the most common pathogen and was identified in 3 cases. Intravenous antibiotics were administered and were followed by oral agents for an additional period. The duration of therapy ranged from 3 to 6 weeks. No surgical intervention was needed. Magnetic resonance imaging was used to evaluate response to the therapy. CONCLUSIONS: Although pyomyositis is a rare disease, it should be considered in the differential diagnosis of immediate onset of musculoskeletal pain in children. Early diagnosis and antibiotic treatment are important as major complications such as abscess formation and sepsis can be avoided. Having a high sensitivity to reactive inflammatory changes, MRI is a valuable tool in the armamentarium of the clinician in early diagnosis of pyomyositis.

Misdiagnosed bilateral C5-C6 dislocation causing cervical spine instability: a case report.

INTRODUCTION: The diagnosis of cervical spine injuries remains a significant problem in many blunt trauma patients. Correct and early diagnosis of these injuries is imperative as delayed or missed diagnoses result in increased morbidity and mortality. CASE PRESENTATION: A 57-year-old Caucasian woman presented with a misdiagnosed bilateral C5-C6 dislocation one month after a fall and head injury, without clearance of the cervical spine in her previous visits to two physicians and having already started physiotherapy sessions, despite the presence of pain in the clinical examination. Dislocation was treated with open reduction and spinal fusion with posterior instrumentation 4 weeks post-trauma. CONCLUSIONS: Every physician should be highly suspicious of cervical spine injury in blunt trauma patients with positive clinical examination and include radiologic studies in his screening modality. Physiotherapy sessions should under no circumstances be started in the presence of underlying spine injury.