The Surgical Procedure in Managing Peroneal Tendon Injury: A Case Series.

Introduction: Peroneal tendon injury is one of the pathological ankle conditions which causes pain and is frequently misdiagnosed as ankle sprain. There is a variety of peroneal tendon injuries, depending on the mechanism of injury. We report a series of three peroneal injuries in our institution. Case Presentation: All three of the patients presented with ankle pain and instability following injuries. There was a presence of peroneus quartus in one of the patients. Retromalleolar pain was revealed in all of the patients, in addition to instability. All of the three patients received open peroneal tendon repair with groove tubular deepening for the 1st patient. Following the surgery, the patients could partially weight-bear after 3-4 weeks. Full range of motion was restored 6 weeks after surgery. Discussion: The peroneal muscle functions as a dynamic stabilizer of the ankle, which is vital to control the dynamic stability of the lateral ankle. There is a variety of peroneal injuries ranging from split tear to chronic dislocation. The treatment for peroneal tendon subluxation can be conservative or surgical. There are several surgical techniques for peroneal tendon subluxation repair, such as: 1) direct repair of retinaculum; 2) retromalleolar groove deepening; 3) tendon graft reconstruction; 4) bone block procedure; 5) tendon rerouting procedure. Conclusion: Peroneal tendon injury should always be considered following inversion ankle trauma, especially in case of chronic lateral retromalleolar pain. Surgeries are often required after failure of conservative treatment which can cause impaired walking, decreased sports performance, or chronic pain and muscle strain.

Management of synovial chondromatosis of the hip by open arthrotomy debridement only VS total hip replacement: A case report.

INTRODUCTION: Synovial chondromatosis is an unusual nonneoplastic condition of joints. Clinical symptoms usually insidious, and the patient often came in the late stage of the disease. Treatment generally include arthroscopy debridement, open arthrotomy debridement to evacuate loose bodies, or in a very late stage with a collapsing joint, it might need a joint replacement arthroplasty. METHODS: We report two cases of a 55-year old and a 22-year-old man with synovial chondromatosis of the hip. Both patients came with hip pain, but the former presents at a late stage with osteoarthritis of the hip. The former underwent open arthrotomy debridement to evacuate loose bodies, synovectomy then followed by a total hip replacement. The latter underwent open arthrotomy debridement only to evacuate loose bodies and synovectomy without performing dislocation of the hip. Postoperative outcome was evaluated using plain hip x-ray, pain scale with VAS, and functional score with Harris Hip Score (HHS). RESULTS: At 1-year follow up, both subjects demonstrate an improving functional outcome. The former patient had an improved HHS from 39 to 91 while the latter had an improved HHS from 68 to 93. With complete removal of the metaplastic tissue and synovectomy, the recurrence of the chondromatosis is not apparent yet until now. DISCUSSION: Arthrotomy debridement only or arthrotomy debridement followed by total hip replacement can be considered as an option in treating synovial chondromatosis of the hip as both show a successful outcome. A selective method of treatment must be considered in our decision making for each individual.

Allograft Reconstruction of Spontaneous Tibialis Anterior Tendon Rupture in a Diabetic Patient.

INTRODUCTION: The tibialis anterior (TA) is a powerful dorsiflexor of the ankle. Ruptures of the TA can be a distressing condition that needed a surgical intervention. Fortunately, despite being the third most common lower limb tendon rupture (after Achilles and patellar tendon), ruptures of the TA remain a rare clinical entity. We present a case of spontaneous rupture of the TA in an elderly diabetic lady as well as our successful repair using a TA allograft to bridge the defect gap. CASE REPORT: A 73-year-old known diabetic lady complains of a 6-month history of progressive right ankle pain and swelling over the dorsum of her foot. She did not recall any trauma or twisting injury. She had tenderness over the anterior ankle, an erythematous cystic soft tissue mass, and weakness in ankle dorsiflexion. In addition, she demonstrated notable prominent first metatarsophalangeal hyperextension on ankle dorsiflexion. Loss of contour of normal TA anatomy was noted over anterior aspect of ankle joint. Magnetic resonance imaging reported a complete rupture of the TA tendon with a 4.2 cm tendon gap. Surgical repair using a TA allograft whip stitched side to side to the proximal TA stump and the remaining allograft secured on the medial cuneiform with bio absorbable screw. Rehabilitation consisted of a structured program with protected weight bearing. At 3 months after surgical repair, the patient was able to return to daily activities. CONCLUSION: This case report highlights the successful use of a TA allograft in the repair of a chronic TA rupture in an elderly diabetic patient. This repair has demonstrated to be reliable at 12-month post-surgery and allows prompt return to daily activities.

Comparison of the use of antibiotic-loaded calcium sulphate and wound irrigation-suction in the treatment of lower limb chronic osteomyelitis.

AIMS: We sought to compare the efficacy of antibiotic-loaded calcium sulphate with wound irrigation-suction in patients with lower limb chronic osteomyelitis. PATIENTS AND METHODS: Adult patients with lower limb chronic osteomyelitis treated at our hospital by means of segmental bone resection, antibiotic-loaded calcium sulphate implantation or wound irrigation-suction, followed by bone transport with external fixator from January 2011 to July 2015 were retrospectively evaluated. The clinical presentation, laboratory results, complications, docking obstruction, infection recurrence were compared. RESULTS: There were totally 74 patients met the inclusion criteria. Docking obstruction rate and infection recurrence were higher in the irrigation group with significant difference. The success rate of the first operation was 90.74% in the calcium sulphate group compared with 45% in the irrigation group. Postoperaton leakage of the incision happened more in the calcium sulphate group, but it wasn't a risk factor for docking obstruction and infection recurrence. Patients in the calcium sulphate group had shorter hospital stay and systemic antibiotic treatment, also with less external fixator index. CONCLUSIONS: The findings of our study suggest that antibiotic-loaded calcium sulphate implantation for lower chronic limb osteomyelitis was a more successful method than wound irrigation-suction, it greatly decreased infection recurrence and docking obstruction. Postoperative leakage after implantation didn't worsen patient's outcome.