A Novel Technique for Restricted Kinematic Alignment Total Knee Arthroplasty Without Computer-Assisted Devices.

Kinematic-alignment total knee arthroplasty (KA-TKA) aims to restore natural limb alignment and joint line obliquity, thereby improving patient satisfaction. Restricted KA-TKA (rKA-TKA) addresses abnormal knee anatomies and seeks to replicate natural anatomical structures within safe alignment boundaries. This study introduces a novel device and technique that enables rKA-TKA without computer-assisted surgery (CAS). The new device allows for precise cartilage thickness measurement and adjustment of osteotomy angles, facilitating accurate alignment. A heel-lift technique for tibial osteotomy is presented, offering a reproducible method for determining the osteotomy volume and angle. These innovations make KA and rKA-TKA feasible in any surgical setting, avoiding the high costs and limited availability associated with CAS.

Surgical Treatment for Non-union of the Great Toe Proximal Phalanx Stress Fracture in an Adolescent Jumping Athlete.

Stress fractures of the proximal phalanx of the great toe are primarily attributed to repetitive shear forces, with the vertical ground reaction forces exerting several times the body weight. In the initial stages of injury, conservative management anticipates bone healing within approximately five weeks, followed by a gradual return to sports activities over an additional five weeks. Athletes presenting with pain in this region warrant a thorough evaluation for stress fractures to initiate timely conservative care. In instances of delayed healing or non-union, surgical intervention is indicated. However, literature on the management and optimal timing of surgery, particularly in adolescent athletes, remains sparse. This case report, complemented by a literature review, offers insights into management based on the patient's clinical course.

Extraforaminal Stenosis at L2-L3 Treated with Microendoscopic Surgery: Report of Two Cases.

Introduction: The many cases of far-out syndrome that have been reported have involved extraforaminal stenosis at L5-S1. We report two cases of extremely rare extraforaminal stenosis at L2-L3. Case Report 1: A 59-year-old man presented with a 1/2-year history of the right leg pain. Radiological examination revealed stenosis of the right L2 spinal nerve between the osteophyte of the vertebral body and the L3 right transverse process. The right L2 spinal nerve was decompressed with microendoscopic surgery. Postoperatively, the pain in the right lower extremity was relieved. Case Report 2: An 80-year-old man presented with a ½-year history of the right leg pain. He had undergone posterior lumbar fusion (L4-L5 and L5-S1) approximately 30 years earlier. Radiological examination revealed stenosis of the right L2 spinal nerve between the osteophyte of the vertebral body and the L3 right transverse process. The right L2 spinal nerve was decompressed with microendoscopic surgery. Postoperatively, the patient had no symptoms and his course over the next 6 months was good. Conclusions: In both cases, we performed microendoscopic decompression of the L2 spinal nerve with good post-operative results. In both our patients, extraforaminal stenosis was caused by osteophytes that formed as a result of degenerative spondylosis.