RESUMEN
A closed spontaneous rupture of the extensor hallucis longus (EHL) tendon is an infrequent yet challenging clinical occurrence, typically associated with systemic conditions (diabetes mellitus or rheumatoid arthritis). A closed EHL rupture, however, exists but is only reported as scattered cases in the literature. This article presents a unique case of a traumatic EHL tendon rupture in a patient without underlying predisposing factors. A 66-year-old woman, previously healthy, presented with an inability to dorsiflex her big toe following trauma, showcasing the clinical triad of pain, edema, and deficit in big toe extension. Magnetic resonance imaging confirmed a 5.9 cm EHL tendon gap that was treated by primary end-to-end repair of the ruptured tendon. The aim of this case report is to provide an overview of the literature available concerning the classification and treatment of EHL rupture and to assist in the early diagnosis and treatment of this rare condition.
RESUMEN
Dorsal dislocation of the toes is an infrequent injury that can result in severe pain and deformity. Timely diagnosis and appropriate management are paramount for optimizing patient outcomes. This case report illustrates a 53-year-old male patient who suffered dorsal dislocation of the first and second metatarsophalangeal (MTP) joints due to a crush injury. We present the clinical manifestation, radiographic findings, and management approach for this unique isolated first and second ray MTP joint dorsal dislocation, without any associated fractures. This case report underscores several critical observations: firstly, hallux dorsal dislocation can potentially coincide with other injuries; secondly, it can stem from crushing trauma to the big toe; and thirdly, successful closed reduction, when followed by effective immobilization and early rehabilitation, can yield outstanding outcomes. Additionally, the report emphasizes the importance of pursuing another closed reduction attempt under general anesthesia, if the initial attempt in the emergency room proves unsuccessful, before contemplating open reduction.
RESUMEN
Isolated trapezio-metacarpal joint dislocation is a rare injury. Despite being simple to reduce, there is not yet a consensus regarding how to secure the reduction, the type of immobilization, and the postoperative protocol. Herein, we present a rare case of pure trapezio-metacarpal joint dislocation without any associated fractures that was treated with closed reduction and intermetacarpal fixation, six weeks of immobilization, and an early rehabilitation protocol.
RESUMEN
Traumatic osteochondral fractures of metatarsal heads are rare injuries and are scarcely reported in the literature. Their classification and modalities of treatment remain unclear. Herein, we report two cases of traumatic fractures of the articular surfaces of the metatarsal heads in two young patients in which two different modalities of surgical treatment were used to achieve anatomic reduction and congruity of the metatarsophalangeal joints. The postoperative period was uneventful, and good functional and radiological outcomes were achieved in both patients. In this report, we review the literature for similar cases and discuss the available treatment options and their associated complications.
RESUMEN
AIM: The aim of this retrospective study is to report the results of minimally invasive osteosynthesis when used for the treatment of intraarticular calcaneus fracture. This old technique is regaining popularity recently with the multiple advances added by different institutes when it is used in the management of intraarticular calcaneus fracture. METHODS: Twenty-four patients who suffered from intraarticular calcaneus fractures between 2014 and 2019 were included. Twelve of them had Sanders II fractures (group A) and 12 had Sanders III + IV fractures (group B). The mean follow-up duration was 37.5 months. The mean age at presentation was 54.23 ± 12.48 years. The skin condition at presentation was poor (blood-filled blisters) in 25% of patients equally distributed between the two groups. The mean time to surgery was 5.6 days where patients with poor skin conditions were treated lately. The technique involved percutaneous ascending proximal-to-distal pinning of the calcaneus after reduction using a 2 cm mini-incision below the lateral malleolus and augmenting the fixation with femoral head cancellous allograft. The primary outcomes variables analyzed in this study are post-operative Bohler angle, post-operative Gissane angle, American Orthopedic Foot and Ankle Society (AOFAS) ankle/hindfoot score at long-term follow-up (Excellent>95, Good 75-94, Fair 51-74, poor 0-50), and the delta angle benefit score. The secondary outcomes included post-operative complications such as infection and osteoarthritis. RESULTS: The radiological results showed significant improvement of Bohler angle from 6.09° ± 21.6 pre-operatively, to 31.79° ± 14.1 postoperatively with a p-value <0.001. An adequate reduction was achieved in 54.16% to 70.8% of patients. There is a trend to normalization of overcorrected fracture especially Sanders II with a mean reduction of 12,71° ± 11,88 at one year post-operatively (p=0.05). AOFAS score at the last follow-up shows 20.83% poor results (AOFAS<50), 50% fair results (AOFAS between 51-74), 16.67% good results (AOFAS 75-94), and 12.5% excellent results (AOFAS>95. The satisfaction rate was 83.3% (45.8% partially satisfied, and 37.5% fully satisfied). The incidence of superficial infection (wound inflammation and pin tract infection) was more prevalent in higher group B (40%) compared to group A (0%) with p=0.014. Other complications including osteoarthritis and varus deformity were found in 95.8% and 58.3% of patients respectively at three-year follow-up. CONCLUSION: The combination of minimally invasive osteosynthesis and femoral head allograft for the treatment of intraarticular calcaneus fractures seems to give fair to good functional results. Radiological data demonstrated that when the Bohler angle is over-reduced >40°, there was a tendency to autocorrection over time. This may be due to progressive depression of the angle over time as weight bearing is authorized; however, this must be analyzed carefully due to the low number of patients who were overreduced (seven patients). Our study demonstrates that this technique has a low early complication rate (especially low infection and soft tissue problems) but carries high long-term complications such as osteoarthritis and hindfoot varus.
