Open total talar dislocation is a rare but well known injury. Its management is controversial and fraught with complications such as infection, avascular necrosis, and post-traumatic osteoarthritis. We report the case of a woman sustaining a pure open talar dislocation reduced in the emergency room. Debridement was done three days after the injury in the operating room. There was no infection. One year after surgery she complained of occasional pain. Ambulation was normal. She wore regular shoes. The overall alignment of the ankle, hindfoot, and midfoot was normal. Movements of the tibiotalar and subtalar joints were not impaired. She has resumed her regular activities. Radiographs showed no signs of avascular necrosis. All components of the treatment strategy of open total dislocation should be carried out in emergency. This results in environment close to the original biological state. Good results can be achieved if infection is avoided.
We present a case of combined avulsion fracture of the tibial tubercle (AFTT) and avulsion of the patellar ligament in a 15-year-old boy. This injury was treated by open reduction and fixation of both lesions using staples with satisfactory results. This constellation of injury is rare but a high index of suspicion is needed when faced with a displaced AFTT. Open reduction and internal fixation should be the treatment of choice.
a b s t r a c tObjectives: The aim of this retrospective study was to present our experience using condylar buttress plate in the treatment of distal femoral fractures. Results: There were 22 men and 10 women with an average age was 44 (range 19e87) years.The fractures were classified as A1 (n ¼ 7; 21.8%), A2 (n ¼ 4; 12%), A3 (n ¼ 5; 15.6%); C1 (n ¼ 4; 12.5%), C2 (n ¼ 6; 18.8%), and C3 (n ¼ 6; 18.8%). The mean delay from injury to operation was 15 (range 1e27) days. Iliac bone graft was performed in four patients. Postoperatively, a posterior splint or a plaster cast was applied for 3 weeks. No patient had an intra-articular step-off of more than 2 mm. Sepsis of the operative wound occurred in two patients.Fractures healed in 22 (91.7%) patients with a mean duration of 4 (range 3e8) months.Twenty-four patients were followed up on an average of 15 (range 7e28) months. Varus deformity (>10 ) was observed in five (20.8%) patients. Knee flexion was less than 90 in 11 (45.3%) cases. Non-union occurred in two (8.3%) patients. Functional results were good to excellent in 11 (45.8%) patients and considered as fair or failure in 13 (54.2%).
Conclusion:The current report also identifies varus deformity as a major concern of this implant. The main finding of this study was the ensuing knee stiffness after a prolonged immobilization and delay in performing surgery and rehabilitation program due to socioeconomic and logistic reasons.
Distal metatarsal osteotomy
Hallux valgusMini-invasive surgery a b s t r a c t Objectives: To evaluate the early clinical and radiological results using the Bö sch technique to treat hallux valgus.
Material and methods:We reviewed retrospectively four patients with 6 feet undergoing the Bö sch technique for mild and moderate hallux valgus from 2009 to 2012 with an average follow-up of 10.8 months. All patients complained of pain around the first metatarsophalangeal joint. They had cosmetic concerns, and difficulty in wearing shoes. At final follow-up patients were asked about the improvement of pain, cosmetic appearance of the foot, problems with wearing shoes, the ability to walk, and their satisfaction with the operation. Complications encountered were also recorded. The radiographic evaluation considered osteotomy site union, the hallux valgus angle, and the intermetatarsal angle.Results: All patients complained of mild or no pain. They had a satisfactory cosmetic result, wore normal shoes without problems with no limitation of walking ability. They were satisfied with the procedure. One case of superficial infection was noticed. All osteotomies healed primarily within three months. The average hallux valgus angle improved from 32.7 preoperatively to 14.8 at final follow-up and the average intermetatarsal angle from 17.5 to 9.2 .
Conclusion:The Bö sch technique is a cost effective procedure that yields good clinical and radiological results while correcting mild and moderate symptomatic hallux valgus with reduced risk of surgery related complications.
Closed Hackethal's technique using K-wires gives satisfactory results in terms of bone union and elbow and shoulder function in selected humeral shaft fractures. The articulated support precludes the transolecranon traction.
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