Spontaneous Recovery of Paraplegia in a Polytrauma Patient following Spinal Cord Ischemia due to Type B Traumatic Aortic Dissection.

Aortic dissection is a life-threatening acute condition characterized by the separation of the aortic wall's layers. It is caused by a tear in the internal vascular wall (intimal layer and middle layer), which results in bleeding between the layers and causes abrupt and excruciating pain. The appropriate consideration must be given to the condition's dynamic nature, and variations in clinical presentation, without neglecting the urgency for intervention. In this case study, a 65-year-old male engaged in a car accident is admitted to urgent care with a traumatic aortic dissection diagnosis that included the aortic arch, a segmental exposed fracture of 1/3 distal of the right femur AO 32C3k, and an intertrochanteric fracture AO 31A1.3. The patient developed transient paraplegia as the initial manifestation of acute aortic dissection, which represents a high mortality and morbidity entity without adequate and prompt treatment, and prompt diagnosis and management were critical. A patient with severe thoracic and abdominal trauma caused by high-energy injury should be properly evaluated for the possibility of traumatic aortic dissection. The endovascular aortic repair was performed, resulting in a positive clinical evolution due to the important participation of the multidisciplinary trauma team involved in patient management and prompted decision-making.

Noncontiguous Multifocal Spondylodiscitis in 3 Regions of the Spine.

Spondylodiscitis is an uncommon infectious disease of the spine, usually presenting in 1 or 2 contiguous levels, associated with risk factors such as diabetes, intravenous drugs, corticosteroids, and invasive procedures. The most common presentation is pain with nonspecific systemic manifestations. Diagnosis relies on clinical suspicion, laboratories, and imaging studies. Urgent treatment is important due to the high morbid mortality associated with sepsis or a fulminant disease course. We report the case of a 39-year-old female diagnosed with noncontiguous multifocal spondylodiscitis, in the cervical, thoracic, and lumbar spine. The patient initially presented with back pain, inability to walk and severe neurological deficit in the upper and lower extremities, upon diagnosis broad-spectrum antibiotics were initiated. A staged surgical approach was performed in the 3 spine segments. During the 6 month follow-up, the patient presented walking with assistance, with the recovery of strength in the upper and lower extremities.

Trivalent reconstruction for posterolateral and lateral knee instability.

Chronic posterolateral rotatory and lateral instability of the knee is approached from multiple anatomic and functional points of view. Traditional surgical techniques provide one-directional stabilization using autologous tendon transplantation and the split-tendon biceps procedure. Both of these resolve the lateral opening of the joint but do not secure the rest of the anatomic structures that are very important, such as the arcuate ligament and the capsule. This new approach to solving an old problem acts by tightening the fibular collateral ligament, arcuate ligament, the capsule (partially), and biceps tendon in 1 step by performing an oblique fibular-head osteotomy and pulling down these structures with good results. We report 2 cases in which this technique was used. The first was a 26-year-old man who hit the dashboard in an automobile accident and presented 1 week later with posterolateral instability associated with a tear of the posterior cruciate ligament. The second was a case of pure chronic lateral instability of the knee in a 32-year-old man who sustained a fall that caused a rupture of his lateral collateral ligament. This was repaired using a trivalent reconstruction at 3 months. Both patients successfully achieved good stability after reconstruction.