Osteochondroma of the talus in a 19-year-old female: A case report and review of the literature.

CASE: Osteochondroma is a benign bone tumor usually affecting areas around the knee, pelvis, neck and tibia. This disease rarely affects the talus. A case of a 19-years-old female with anteromedial ankle impingement with 8 years follow-up is reported. Surgery removal was the treatment of choice and histopathology examination revealed a benign solitary osteochondroma. CONCLUSION: Osteochondromas in the anterior and anteromedial side of talus are rarer and can cause multiple clinical manifestations including important ones such as limitation of ankle movement and pain. Different locations of solitary osteochondromas can influence both patients' symptoms and clinical examination findings.

Effect of platelet-rich plasma combined with demineralised bone matrix on bone healing in rabbit ulnar defects.

INTRODUCTION: This study evaluates the effect of autologous platelet-rich plasma (PRP) combined with xenogeneic demineralised bone matrix (DBM) on bone healing of critical-size ulnar defects (2-2.5 times the ulnar diameter) in New Zealand White rabbits. METHODS: Critical-size defects were created unilaterally in the ulna of 36 rabbits, while keeping the contralateral limb intact. They were divided into three groups. In Group A, the defect was filled with autologous PRP and in Group B, with autologous PRP combined with DBM; in Group C, the defect remained empty. The rabbits were euthanised 12 weeks postoperatively. Radiological, biomechanical and histological assessments were carried out and statistical analysis of the results was performed. RESULTS: Group B had significantly higher radiological and histological scores than Groups A and C. Defects in Group B showed significant new bone formation, whereas there was minimal or no new bone formation in Groups A and C. Only specimens in Group B showed macroscopic bone union. Biomechanical evaluation of the treated and intact contralateral limbs in Group B showed significant differences. CONCLUSION: In this study, statistically significant enhancement of bone healing was found in critical-size defects treated with PRP and DBM, as shown by radiological findings, gross assessment, and biomechanical and histopathological results. Defects in the two other groups remained unbridged. Therefore, PRP was effective only when it was used in combination with a bone graft.

Mid-term results of total knee arthroplasty after high tibial osteotomy.

BACKGROUND: The outcome of total knee arthroplasty (TKA) after high tibial osteotomy (HTO) is still controversial. In order to determine if osteotomy has any effect on this outcome we performed a medium-term review of a cohort of patients with knee osteoarthritis. MATERIALS AND METHODS: Thirty-two patients (38 knees), who were treated with a HTO before the TKA during the last 8 years, were compared with a matched group who underwent primary TKA. The knees were evaluated preoperatively and postoperatively according to the scoring systems of the Knee Society and Hospital for Special Surgery (HSS). The anteroposterior tibiofemoral alignment, the Insall-Salvati patellar position ratio, range-of-motion and the location of the lateral joint line, were also recorded. The patients were reviewed with a mean follow-up of 4.5 years after TKA. RESULTS: The preoperative and postoperative knee scores had no statistically significant differences between the two groups. So was the case with the intraoperative releases, blood loss, thromboembolic or neurologic complications and infection rates in either group. Access to perform the arthroplasty was reportedly more difficult and took an average of 25 min longer. A significant difference (p < 0.05) was detected in terms of impingement of the tibial stem on the lateral tibial cortex, patellar subluxation and patella baja between the two groups but this did not have any influence on the outcome of the prosthesis. Knee alignment and stability so as range of motion (ROM) measurements were also found with no statistical significance. CONCLUSION: Although we did manage to detect statistically significant differences mainly in radiographic results between the two groups, this situation did not appear to influence the clinical outcome of the patients, however. The fact that most of the patients had good or excellent results at an average follow-up of 4.5 years suggests that HTO does not have a significant negative effect on later TKA.

External fixation of intertrochanteric fractures in elderly high-risk patients.

This study concerns 56 elderly high-risk patients with an intertrochanteric fracture of the femur, who were treated with the Citieffe/Ch-N external fixator between November 2002 and February 2004. A short intraoperative time (37 minutes), no need for peroperative blood transfusion, fast mobilisation and a short hospitalisation (average 6 days, thus reducing the total cost) were noted. Union was obtained in all patients after 6 months. There was no significant difference between the functional status before the injury and at follow-up after 12 months (p > 0.05). No deep pin track or wound infections occurred, but a superficial skin reaction was seen in 39.3%. The mortality rate was 16.1% at 6 months, and 20.4% at 12 months, which contrasts favourably with other types of treatment. External fixation with this device can be used successfully for the treatment of elderly high-risk patients with intertrochanteric fractures.

Unusual patterns of Monteggia fracture-dislocation.

BACKGROUND: High-energy trauma may result in uncommon open injuries around the elbow joint. The management of these injuries can be difficult. CASE DESCRIPTION: Fourteen patients were treated between 1999 and 2003 and their injuries consisted of Monteggia fracture-dislocations combined with segmental fractures of the ulna or fractures of the forearm bones and/or various more complex trauma such as neural injuries, bone comminution and severe soft tissue injuries around the elbow. Eight of them (57%) were multiply injured with severe additional injuries. All patients underwent surgery within first 4-6 hours. Internal fixation, external fixation or a combination of both methods were used to stabilize fractures while open wounds had secondary closure. RESULTS: Additional operations were required in 6 patients. The functional results according to the Mayo Elbow Performance Index were excellent or good in eleven patients, and fair or poor in the remaining three. The patients with fair and poor results had suffered from severe neural and soft tissue trauma and/or multiple fractures of the upper extremity. CONCLUSION: These injuries should be treated as an emergency. The surgeon should apply any available method that can provide stability to the bone fragments and safe handling of the soft tissues giving priority to internal fixation of the fractures. Severe osseous, soft tissue and neural trauma affect the functional results of the elbow region.

Knee osteonecrosis due to lead poisoning: case report and review of the literature.

BACKGROUND: Though rare, a relationship between toxic heavy-metal accumulation and bone necrosis exists. CASE REPORT: A 28-year-old man suffered from chronic bilateral knee pain accompanied by muscle fibrillations and night cramps. On examiniation he presented tenderness and mild quadriceps muscle atrophy, but unaffected range of movement, sensation, and tendon reflexes and no effuision. He also complained of blurred vision, lethargy, and tremor. CONCLUSIONS: On the basis of these data it appeared that these infarcts were attributable to lead poisoning. This situation has not been described in the knee region, but finrther clarification of a possible causal relationship between toxic trace element concentration and idiopathic bone necrosis appears necessary.

Clear cell sarcoma of the scapula. A case report and review of the literature.

BACKGROUND: Clear cell sarcoma of tendons and aponeuroses (CCSTA) appears usually in the extremities and rarely in the trunk. CASE PRESENTATION: We present an unusual case of CCSTA overlying the scapular region and with secondary osseous extension in the lower scapula. The patient underwent a wide local excision with removal of the tumor and the lower two thirds of the scapula. He had no local recurrences but he developed lung metastases after 5 months in spite of postoperative chemotherapy. He finally died ten months later. CONCLUSION: The patients with CCSTA have a variable unpredictable course. Despite treatment the overall prognosis is poor.

External fixation of femoral fractures in multiply injured intensive care unit patients.

We report the results of a prospective study of 42 patients with multiple injuries, including femoral fractures, who required intensive care unit (ICU) admission and whose fractures were treated by means of external fixation. The Injury Severity Score (ISS) ranged from 18 to 41 and the average Glasgow Coma Scale (GCS) on admission was 12. Seventeen fractures were open. All patients had their fractures stabilised within 6 hours from admission by means of external fixation. After a follow-up of 11 months (range 4-20), 28 fractures had healed within 6 months (range 4.5-8) and 13 developed non-union which was treated successfully with secondary intramedullary nailing. One patient developed deep infection following secondary nailing and another patient died from adult respiratory distress syndrome (ARDS). We conclude that external fixation of severe femoral fractures in critically ill patients is an easy and quick method of stabilisation which does not compromise their condition. If however it is intended to be used as a final method, these patients require a close follow-up since the rate of delayed and non-union is high.