Comparative Study for Surgical Treatment of Acute Distal Tibiofibular Syndesmotic Lesions Using the Modified Suture-Button Fixation Versus Static Syndesmotic Screw Fixation.

INTRODUCTION: Several techniques to treat acute distal tibiofibular instability are described consisting in static and dynamic fixation procedures. The aim of our work is to compare the outcomes of acute syndesmotic injury fixation between the modified technique of dynamic fixation using the suture-button principle as an efficient and low-cost method and the classic static fixation. METHODS: It is a prospective study including patients presenting with acute syndesmotic injury. After fracture fixation, residual syndesmotic instability was managed using syndesmotic screw in group A and dynamic fixation with a double Ethibond suture in group B. Functional results were assessed using the American Orthopaedic Foot and Ankle Society score (AOFAS) score. Radiological evaluation was done by a postoperative computed tomography (CT) scan of both ankles and plain X-rays of the ankle after surgery and at 18 months. RESULTS: Group A included 20 patients meanwhile 35 patients were in group B. The reduction was satisfactory in the 2 groups according to the postoperative CT scan measurements. The mean healing time in group A was 49.65 days and 51.49 days in group B (P = .45). We did not find any significant difference in terms of loss of reduction in the 2 groups. The return to work was faster in group B (P = .04). Patients in group B had better AOFAS score (P = .03) and ankle range of motion than those in group A. The difference was statistically significant (P = .02 for dorsal flexion and P = .001 for plantar flexion). For group A, we did not note any early complications. Meanwhile, 7 patients developed skin complications in group B (P = .03). However, no significant difference was found in terms of late complications. CONCLUSIONS: The modified dynamic suture-button fixation remains a therapeutic alternative in low-income countries that could achieve better outcomes than static fixation, with easy postoperative follow-up. LEVELS OF EVIDENCE: Level II.

A rare concomitant ipsilateral hip and knee dislocations: A case report and review of the literature.

Ipsilateral hip and knee dislocation is a rare and complex injury that usually results from high-energy trauma. Only 14 cases were reported in the literature so far. We report the case of a 35-year-old man who presented with an ipsilateral right hip and knee dislocation after being involved in a road traffic accident. A contralateral floating knee was associated. The hip dislocation was associated to a posterior wall fracture of the acetabulum and a femoral head fracture. The knee dislocation was compound and associated with a patella fracture. The hip dislocation was reduced. The posterior wall and the femoral head fractures were treated conservatively. The knee dislocation was reduced and stabilized by external fixator. Early postoperative infection occurred and was treated surgically. At the last follow-up, the knee was ankylosed at 5° of flexion with a bony bridge between the femoral condyle and the tibial plateau. The patient described an occasional hip pain on exertion. He had full range of motion of the right hip. No avascular necrosis of the femoral head was seen. Outcomes of simultaneous hip and knee dislocation are very variable and remain unpredictable. The timing of reducing the hip joint and the knee.

Surgical management of tibia refracture with a bent intramedullary nail: A case report and review of the literature.

Intramedullary nailing is the gold standard for long bone fractures in the lower limbs. Fractures of the tibia with bending of the intramedullary nail is a very uncommon complication. Removing a bent nail is an unpredictable and challenging procedure for any trauma surgeon. We report the case of a 34-year-old man presenting a refractured tibia with a bent intramedullary nail following a motor vehicle accident. We describe the management of this patient as well as a substantial review of the literature to depict the peculiarities of this entity compared to its more commonly reported femoral counterpart. When approaching a deformed tibia nail, standard extraction techniques should be attempted and are more likely to be successful than in deformed femoral nails.

Risk factors for malunion of distal tibia fractures treated by intramedullary nailing.

BACKGROUND: The treatment of distal tibia fractures (DTF) has historically been a difficult challenge for orthopedic surgeons because of the particular characteristics of this anatomical region. Intra medullary nailing (IMN) remains the best treatment option. However, achieving and maintaining perfect reduction and stable fixation with IMN can be technically challenging due to the large medullary cavity within a short distal fragment. The aim of our study is to determine the risk factors for malunion in DTF treated with IMN. METHODS: It is a retrospective study including DTF treated surgically by IMN in the Orthopedics and Trauma Department at a tertiary hospital over a period of 7 years. The quality of reduction was evaluated by radiological assessment of the antero-posterior (AP) and lateral views of the tibia and ankle at the last follow-up. RESULTS: Our series included 90 patients with an average age of 44.8 years. Sex-ratio was 2.6. Tobacco use was reported in 35.6% of the patients. Diabetes was present in 11.1% of the patients, and 12.2% of them had open fractures. According to the OTA/AO classification, the majority of injuries were classified as type A1 (76.7%). Fibula fractures were present in 86.7% of cases. The mean follow-up was 48 months. Malunion occurred in 13 cases. Based on the univariate analysis, smoking and dynamic fixation were significantly associated with malunion. In the multiple logistic regression analysis, dynamic fixation was found to be a significant factor that increased the risk of malunion by 7.5 times. CONCLUSION: Neither patient demographics nor fracture characteristics were risk factors for malunion. Nevertheless, it should be noted that dynamic nailing must be avoided as it is associated with a higher risk of malunion. Furthermore, one to two medial to lateral distal locking screws provide sufficient stability without the need for additional fibular fixation. TRIAL REGISTRATION: Not applicable.

Extraspinal osteoarticular tuberculosis: A diagnostic and therapeutic challenge.

Tuberculosis (TB) is a major cause of morbidity and mortality, representing a challenge for health-care providers worldwide. Extraspinal osteoarticular tuberculosis (ESOTB) represents a rare location of TB. We aim to describe ESOTB focusing on clinical, diagnostic, and therapeutic characteristics of this entity. We report a retrospective case series of patients diagnosed with ESOTB, treated, and followed up between 2015 and 2022. The diagnosis was based either on bacteriological results (culture and polymerase chain reaction [PCR]) or histological analysis. Five patients with confirmed ESOTB, three women and two men, with a mean age of 46.4 (16-72), were enrolled in study. The affected sites were the elbow (one case), the shoulder (one case), the greater trochanter (one case), the second metatarsal (one case), and the distal interphalangeal joint (one case). The mean delay to diagnosis was 5.8 months (3-10)]. The most common symptoms on presentation were pain (all cases), swelling (all cases), and limited joint range of motion (all cases). One case presented with a draining sinus (20%). Radiological findings were soft tissue swelling (two cases) and periarticular bone destruction (all cases). Four patients presented with pathognomonic histology. PCR was performed in two patients and was positive in both of them. All cases were cured after 9-12 months of oral TB treatment without relapse for the 12-18 months of follow-up. Only one patient underwent surgery for abscess drainage to gain local infection control. ESOTB is a mysterious condition that must not be overlooked and should be suspected in cases of long-standing bone and joint pain and swelling.

Sternoclavicular septic arthritis in a healthy adult: A case report and a review of the literature.

Sternoclavicular joint septic arthritis is rare and commonly associated with specific risk factors. We report the case of a 58-year-old female with no previous medical or surgical history who presented complaining of a warm, indurated mass overlying the right sternoclavicular joint. Computed tomography of the chest showed erosion of the sternal end of the clavicle and the manubrium sternum associated with thickening of the synovium and a sternoclavicular joint space narrowing, suggestive of an infective process. Intraoperative finds a purulent collection extending both over the clavicle and the sternum. Limited destruction of small parts of the sternoclavicular joint was noted. The abscess was drained. Simple debridement and limited curettage were preferred to en bloc resection given the limited size of necrotic tissues. Sternoclavicular joint septic arthritis is a condition with significant morbidity and potential mortality. All medical practitioners must maintain a high degree of suspicion, even in healthy patients, as it can lead to serious complications.

Surgical management of neck of femur fractures in patients younger than sixty-five years: a comparative study of three fixation methods.

PURPOSE: Several surgical implants have been used for the treatment of neck of femur fracture (NOF) in younger patients such as dynamic hip screw (DHS) and cannulated compression screw. However, the superiority of one or another osteosynthesis device remains a matter of debate. The aim of this work is to evaluate and compare three fixation modalities: Cannulated Hip Screws (CHS), DHS and DHS associated to anti-rotating screw for surgical treatment of femoral neck fracture in young adults. METHODS: It is a retrospective comparative study of three series of NOF fractures treated surgically over a period of ten years; including young adult patients (age > 18 years and < 65 years) treated conservatively using closed or open reduction and internal fixation. All types of NOF fractures according to Garden classification were included. Pathological, basi-cervical fractures and fractures on previously operated hips were excluded. The minimum follow-up recommended was two years. Clinical evaluation was based on the Postel Merle d'Aubigné score (PMA), the visual analogue scale (VAS), the Parker score, and the Hip Disability and Osteoarthritis Outcome Score (HOOS score). Reduction quality was assessed on X-rays. RESULTS: Our series included 72 patients that were divided in three groups: Group A: Fixation using cannulated hip screws (33 patients). Group B: Fixation using DHS only (21 patients). Group C: Fixation using DHS associated to anti-rotation screw (18 patients). The patients of group A had better PMA and VAS scores, but there was no statistically significant difference. However, a significant difference (p=0.001) was found for the HOOS score. The fractures treated with DHS associated with anti-rotating screws, had the highest loss of reduction in the vertical axis (Yp) with the highest femoral head collapse (Zp) values. Group A had the lowest loss of reduction in the horizontal axis (Xp). There was no significant difference between the three methods of osteosynthesis in terms of loss of correction though. CONCLUSION: We found comparable results in terms of healing and complication rates and loss of reduction for the three groups with no significant difference. However, the HOOS score was significantly better in the cannulated hip screw group.

Unusual case of lateral subtalar joint dislocation associated with calcaneal fracture and lateral malleolus fracture.

Introduction: Subtalar dislocation is defined by a simultaneous total separation of the talocalcaneal and talonavicular joints. Lateral variety is the rarest. It is the result of a high energy trauma. It occurs following forced eversion, with the foot locked in a rut with pressure on the lateral aspect of the leg. Articular fractures of the calcaneus occur as a result of axial impact on the greater tuberosity.We report the case of a lateral subtalar dislocation associated with a calcaneal fracture. Case presentation: A 62-year-old man who presented to the emergency room following a 9 m fall. Initial examination revealed a swelling of the right foot and ankle with a deformity giving the appearance of a "flat foot" without skin opening. The neuro-vascular examination was normal.A radiological assessment including an antero-posterior and lateral X-ray of the right ankle and a axial view if the calcaneus, showed a calcaneal articular fracture and a lateral dislocation of the subtalar joint. CT scan confirmed the diagnosis. Closed reduction by external maneuvers failed. Through a lateral mini-approach centered on the subtalar joint, open reduction of the dislocation was achieved and controlled fluoroscopically. Osteosynthesis of the calcaneal fracture was performed using a percutaneous pinning. Consolidation was obtained at 3 months post-operatively.At the last follow-up, the patient reported occasional pain. The radiological assessment showed early arthritic changes of the subtalar joint. Conclusion: In rare cases of subtalar dislocation, the direction of displacement, associated bone injuries, and open reduction would be responsible for a poor functional outcome. At present, there is no certain way to avoid subtalar osteoarthritis.