Technique Tricks for the Gleich-Koutsogiannis Surgical Procedure for Correction of the Adult Acquired Flatfoot.

Gleich-Koutsogiannis is a widely known extra-articular closing calcaneal osteotomic technique for correction of the adult flatfoot. Absolute care must be observed during each procedural step to avoid undesirable drawbacks, such as nerves and tendons lesions, incorrect fixation, and hardware painful prominence. It is the purpose of this report to introduce tricks to critical steps in order to improve the technique and minimize potential surgical complications.

Smoking Effects in a Distal Tibia Fracture Treated With External Fixation.

Distal tibia fractures are one of the most demanding injuries in orthopaedic traumatology, due mainly to frequent coexistence of covering tissue problems and poor blood supply. Smoking exerts a detrimental effect on fracture healing, increasing the time to union. We report the case of a 60-year-old heavy-smoker (about 20 cigarettes a day) with a distal tibia fracture that necessitated synthesis with an external fixator to maximize the healing process, which nevertheless required more than one and half year to heal. We consider this case as a "take-home message" against tobacco use during the treatment of any orthopaedic issue.

Mason type 3 radial head fractures: proposal of a synthesis technique using bioabsorbable thread.

Multifragmentary fractures of the radial head (Mason type 3) are challenging for the surgeon. They are usually treated by means of complete removal of the injured head and sometimes by implantation of a metal prosthesis. Indeed, the bone fragments are often too small to allow stabilization through screws or even wires. The Author proposes an alternative technique, tested on a sawbone model, in which bioabsorbable thread is used, introduced in a figure-of-eight fashion. A review of the literature is provided.

Asymptomatic Congenital Absence of Lateral Pedal Rays.

Complete absence of 1 or more pedal rays is a rare condition. In the present report, the case of an adult male with complete congenital absence of his right fourth and fifth pedal rays is described. The condition had been asymptomatic until he had sustained an acute third metatarsal fracture and was satisfactorily treated with cast immobilization.

Watch out for luxatio erecta of the shoulder.

Traumatic inferior dislocation of the shoulder (also termed "luxatio erecta") is a very rare injury. The correct diagnosis may be overlooked and results after reduction can often result in significant morbidity of the affected joint. It is described in a clinical case in which a male adult reported a luxatio erecta that was correctly diagnosed and reduced with uneventful recovery. Since it is a quite rare event in the emergency room, a careful review of the literature warned us about potential pitfalls in diagnosis and treatment of this peculiar injury. Our brief case report is intended to furnish educational images and stress the importance of a correct clinical and radiographic evaluation.

Targeting the Plantar Fascia for Corticosteroid Injection.

Plantar fasciitis is often a difficult condition to treat. It is related to repetitive strain of the fascia at its attachment to the heel bone. This condition quite often appears with the concomitant presence of a plantar calcaneal heel spur. Corticosteroid injection is a popular treatment choice for plantar fasciitis, and accurate localization of the injected medication is essential for successful resolution of symptoms after the injection. In the present brief technical communication, a method for targeting the attachment of the plantar fascia to the medial tubercle of the tuberosity of the calcaneus is described. The targeting method uses the lateral radiograph of the foot to aid in localization of the proximal attachment of the plantar fascia to the calcaneus.

Unicompartmental knee prosthetization: Which key-points to consider?

Unicompartmental knee arthroplasty (UKA) has evolved into a suitable option for diseased knees that cannot be managed with arthroscopic treatment and at the same time are not good candidates for total knee replacement. Since meticulous execution of the surgical technique is essential to optimizing UKA outcome, some procedural key-points are mandatory. Templates (phantoms) are then used to size the required prosthetic component (using these radiographs. Arthritic varus (or valgus) knees with an asymptomatic patello-femoral joint are typically ideal for UKA. Metal-backed tibial components should be favourite instead of all-polyethylene tibial components to avoid polyethylene creep that may occur in fixed bearings. Moreover, a proper thickness of the polyethylene layer is mandatory, in order to avoid early failure.

Acute compartment syndrome of the foot in a 17-year-old boy.

Acute compartment syndrome is both a life and limb threatening surgical emergency, caused by an increase in compartment contents due to either trauma or surgery. We illustrate a foot compartment syndrome, clinically diagnosed, that took place after direct injury during a football match. Compartments release through fasciotomies promptly relieved symptoms. Educational images are furnished.

[Epicondylitis: etiology, pathogenesis and therapy]. / Epicondylites: etiologie, pathogénie et traitement.

Epicondilites are pathologies poorly understood from the aetiopathogenetic point of view. In this regard, many hypotheses have been considered and numerous anatomical structures are involved. Current therapeutic options are either conservative or surgical. Conservative treatments are: immobilization of the elbow flexed at 90-degrees, stretching the forearm muscles, manipulating the wrist, the application of low-energy extracorporeal shock waves, acupuncture, autologous blood injection under the extensor carpi radialis brevis, laser therapy and pulsed electromagnetic field therapy. Surgical treatments are: fasciotomy, excision of angiofibroblastic hyperplasias located at the origin of extensor carpi radialis brevis, partial release of the orbicular ligament, release of the extensor muscles, elongation of the tendon of extensor carpi radialis brevis and arthroscopic treatment. Advantages and disadvantages are described for each treatment according to the international literature.