Arthroscopic Fixation of Osteochondral Fracture of Head of Femur. Case Study.

This article describes the case of an 18-year-old male after hip dislocation caused by snowboard injury, which resulted in osteochondral fracture of the head of femur with displacement of a loose body. CT as well as MRI confirmed the presence of a loose osteochondral fragment (20x14x4mm) fractured from the weight-bear-ing superoanterior part of head of femur (Pipkin type II). The surgical management undertaken was only arthroscopic, this representing a very rare case when com-par-ed to the literature. The article describes in detail the technical aspects of the procedure. At 4 months post-surgery, the replanted fragment had healed properly and the patient was pain-free and had the full range of movements. A low-invasive arthroscopic procedure is associated with less local tissue damage, reduced risk of infection and less blood loss. With this approach, it is possible to fix an osteochondral fragment without unnecessary defects in the cartilaginous surface.

Ribbon like appearance of the midsubstance fibres of the anterior cruciate ligament close to its femoral insertion site: a cadaveric study including 111 knees.

PURPOSE: Recently, the configuration of the anterior cruciate ligament (ACL) from its direct femoral insertion to midsubstance was found to be flat. This might have an important impact for anatomical ACL reconstruction. The purpose of this anatomical study was to evaluate the macroscopic appearance of the ACL from femoral to midsubstance. METHODS: The ACL was dissected in 111 human fresh frozen cadaver knees from its femoral insertion to midsubstance, and the shape was described. The anatomical findings were documented on digital photographs and on video. Thirty knees were sent for computed tomography (CT), magnetic resonance imaging (MRI) and histology of the femoral ACL insertion. RESULTS: Two millimetres from its direct femoral insertion, the ACL fibres formed a flat ribbon in all dissected knees without a clear separation between AM and PL bundles. The ribbon was in exact continuity of the posterior femoral cortex. The width of the ribbon was between 11.43 and 16.18 mm and the thickness of the ACL was only 2.54-3.38 mm. 3D CT, MRI and the histological examination confirmed above findings. CONCLUSION: This is a detailed anatomical study describing the ribbon-like structure of the ACL from its femoral insertion to midsubstance. A key point was to carefully remove the surface fibrous membrane of the ACL. A total of 2-3 mm from its bony femoral insertion, the ACL formed a flat ribbon without a clear separation between AM and PL bundles. The ribbon was in exact continuity of the posterior femoral cortex. The findings of a flat ligament may change the future approach to femoral ACL footprint and midsubstance ACL reconstruction and to graft selection.

Traumatic detachment of the inferior angle of the scapula in a 5-year-old boy--a sonographic diagnosis.

A complete slip of the cartilage of the inferior angle of the scapula was diagnosed in a 5-year-old boy who fell inside a wooden construction at a kindergarten playground. Radiographs of the scapula were normal, and ultrasound demonstrated complete cartilage detachment, which was displaced deep and laterally. Computed tomography (CT) additionally demonstrated a thin rim of bone displaced along with the detached cartilage. Radiologic findings were confirmed during surgery. We report what we believe to be the first published case of traumatic detachment of the cartilaginous lower angle of the scapula in a child demonstrated by ultrasound.