Minimally Invasive Sinus Tarsi Approach for Open Reduction and Internal Fixation of Calcaneal Fractures: Complications, Risk Factors, and Outcome Predictors.

Open reduction and internal fixation of displaced intraarticular calcaneal fractures remain the gold standard of treatment, but the traditional extensile approach has been associated with relatively frequent complications. The current study aims to evaluate the less invasive sinus tarsi approach and to elaborate on the associated complications, risk factors, and outcome predictors. A retrospective observational study was carried out among 39 patients diagnosed with calcaneal fractures that were operatively treated between January 2019 and January 2020 at a level-one trauma center in Riyadh, Saudi Arabia. Patients were assessed regarding the complications, pre- and postoperative Bohler's angle, Gissane's angle, calcaneal height, and return to baseline function. Patients older than 60 years show significantly more complications compared to younger patients (p < 0.05). Type IV calcaneal fracture, according to Sander's classification, showed significantly more complications than other types (p < 0.05). There were significant variations in pre- and postoperative Bohler's angle and calcaneal height (p < 0.05). These variations apply to the Gissane's angle but do not rise to significant results (p > 0.05). Furthermore, the current study reports a significant moderate direct correlation between delay time and complication incidence (p < 0.05). In conclusion, the minimally invasive sinus tarsi approach has relatively low complications and excellent clinical and radiological outcomes. Older patients and those who are diagnosed with type IV calcaneal factures, besides those presented with more delay, are more associated with unfavorable complications.

Necrotizing Fasciitis Following Wet Cupping: A Case Report.

Cupping therapy is a widely practiced form of adjunctive medicine and it has been used since ancient times. It involves using cups over the skin to create negative pressure. The exact mechanism by which cupping therapy exerts its effects is unknown, but it is thought to act as an artificial kidney. In this report, we present a case of a 35-year-old male who developed Pseudomonas-positive necrotizing fasciitis following wet cupping therapy. He refused surgical intervention and subsequently died. Necrotizing fasciitis is a severe soft tissue infection that has a high mortality rate. The only proven intervention to improve survival is aggressive surgical debridement. There have been a few reports of infectious complications following wet cupping, including lumbar abscess and septic arthritis; however, to the best of our knowledge, this is the first report of a necrotizing soft tissue infection following cupping therapy.

Galeazzi Fracture Dislocations: An Illustrated Review.

Galeazzi fracture dislocations are a fracture of the distal one third of the radius shaft with a concomitant dislocation of the distal radioulnar joint (DRUJ). These injuries usually occur by axial loading on an outstretched arm with pronation or supination of the wrist which determines the angulation of the fracture. Surgical treatment has been historically by the anterior (volar) approach to the forearm with plate fixation with or without pinning of the distal radioulnar joint. Failed or inadequate treatment may lead to complications including chronic pain, malunion or instability of the DRUJ that may warrant salvage procedures.

Chronic Galeazzi Fracture-Dislocation: A Case Report.

INTRODUCTION: Galeazzi fracture-dislocation is a unique entity of forearm fractures since they involve a fracture of the radius shaft, along with the dislocation of the distal radioulnar joint, the gold standard of treatment for adults is open reduction and internal fixation with or without repair or pinning of the DRUJ. CASE REPORT: We present a case of a 27-year-old male with a neglected Galeazzi fracture for over 2 months, the patient was treated with open reduction and internal fixation without the need of a salvage procedure and achieved excellent outcomes. CONCLUSION: Galeazzi fractures are not uncommon, and any forearm fracture requires complete radiographic and clinical assessment to avoid dreadful complications of delayed management.

Neglected Monteggia Fracture Dislocations in Children: A Case Series.

INTRODUCTION: Monteggia fracture dislocations are a relatively rare entity and they represent less than 2% of forearm fractures, the diagnosis can be missed in up to 50% of the time. The gold standard of treatment in adults has been open reduction and internal fixation, and closed reduction and cast immobilization in pediatrics. CASE REPORT: We present three cases series of neglected Monteggia fractures in a 5-, 4-, and 9-year-old patients. The patients presented 10, 20, and 25 days post-injury, respectively. Each case was treated differently with the last case requiring open reduction and annular ligament reconstruction. All the three cases showed excellent results on follow-up. CONCLUSION: To avoid missing these injuries, each patient should undergo a comprehensive clinical approach and adequate radiological imaging. Various treatment methods exist for neglected Monteggia fracture and each option should be exhausted to salvage the radial head starting with the less invasive approaches.

Efficacy of tranexamic acid in reducing blood loss and blood transfusion in idiopathic scoliosis: a systematic review and meta-analysis.

BACKGROUND: Tranexamic acid is a synthetic lysine-analogue antifibrinolytic that competitively inhibits the activation of plasminogen to plasmin, it is a well-documented blood sparing agent. However, its routine use in idiopathic scoliosis surgery is poorly documented. The objective of this meta-analysis was to determine TXA's efficacy in reducing blood loss and blood transfusion in idiopathic scoliosis surgery. METHODS: Five databases (Medline, PubMed, Web of Science, Embase and The Cochrane Central Register of Controlled Trials) were searched to identify the relevant randomized controlled trials (RCTs), prospective cohort control (PCC), and retrospective controlled trails regarding the TXA efficacy in idiopathic scoliosis surgery. Mean differences (MDs) of blood loss and blood transfusions in TXA-treated group compared to control and/or placebo group were extracted and combined using random-effect meta-analysis model. RESULTS: A total of seven studies comprising 426 patients were included in the meta-analysis according to the pre-defined selection criteria. TXA-treated group had an overall significantly (P<0.005) less volume of blood loss [ES (MD) =727.71 mL; CI, 281.86-1,173.56 mL]. Six studies comprising 346 patients TXA-treated group had an overall significantly {P<0.001 less transfusion volume [ES (MD) =268.30 mL; CI, 105.19-431.44 mL]}. CONCLUSIONS: Patients treated with TXA had a significantly lower blood loss and lower rates of allogeneic blood transfusion than the control group. Further investigation is required regarding the safety of TXA before it can be generalized in the use of idiopathic scoliosis surgery.