Reconstruction of the anterior cruciate ligament using autografts is a common procedure performed in the modern era. The peroneus longus tendon is an upcoming graft with several advantages over traditional autografts. It has minimal donor site morbidity in relation to biomechanical properties of the ankle. Common peroneal nerve injury during harvest is a theoretical concern while harvesting the peroneus longus tendon. The following case highlights the importance of careful surgical technique and timely intervention while dealing with such complications. A 25-year-old male suffered an anterior cruciate ligament rupture while wrestling. He had an unstable knee and difficulty performing daily activities. He underwent an arthroscopic anterior cruciate ligament reconstruction using peroneus longus tendon autograft. Following surgery, the patient reported a foot drop and decreased sensations over the dorsum of the foot. The patient was advised of a foot drop splint and neuroprotective medications. Neurophysiological studies were not performed since they cannot differentiate between partial and complete nerve injury in the first week after injury. A surgical exploration of the nerve was done. An intraneural hematoma was found with contusions over the peroneus longus tendon. Neurolysis was performed to decompress the nerve. The functioning of the anterior cruciate ligament was satisfactory during follow-up. An advancing Tinel's sign was noted on followup. The patient finally recovered after a 3-month follow-up.
A Morel-Lavallee Lesion (MLL) is a closed traumatic soft tissue degloving injury characterized by separation of the dermis from the underlying fascia due to a shearing force often seen in the polytrauma patient with underlying pelvis or proximal femoral fractures. This process leads to the development of a potential space in which fatty tissue, blood and necrotic debris can collect and can potentially result in abscesses, cellulitis, or osteomyelitis. Most of these cases have predilection for the greater trochanter, gluteal musculature at hip, proximal femur and around the knee. Here, we present a case of a morel lavallee lesion in left hip in a 24 year old male who presented to us with a cystic swelling in left hip and its further management.
Fibrolipoma is one of the rare variants of the lipoma, and very few cases have been reported in the thigh. These lesions are generally painless, but can grow to large size due to malignant transformation to liposarcoma. Surgical excision is the treatment of choice. The prognosis is generally good as recurrence rate is very less if adequate excision is done. In old age patient, risk of malignant transformation is very high leading to early excision. Here, we present a case of fibrolipoma in thigh in 57 year old female and its further management.
Background: Fixation of intra-articular distal humerus fractures has remained a challenge to orthopaedic surgeons due to complicated anatomy of elbow, comminution at fracture site and osteopenia of articular surfaces. We aimed to evaluate the functional outcomes and complications after dual plating for distal humerus fractures with triceps tongue technique. Material and methods: We conducted a retrospective study which consisted of 20 cases of distal humerus fracture with intraarticular extension and treated with open reduction and internal fixation with dual column plating using triceps tongue technique. Triceps Tongue approach allows exposure of distal humerus articular surface by forming an inverted V-shaped flap of distal triceps at the musculotendinous junction. Results: Union was achieved in all cases. Mean time of fracture union was 12.55±1.82 weeks. There was no case of non-union although elbow stiffness occurred in one patient. The mean MEPS score was 84.45±8.18 with a range of 70-96. Conclusion:Triceps Tongue approach is a simple and less technically demanding approach for the surgeon that can be used in management of the majority of the distal humeral fractures, giving adequate exposure of the surgical field, aiding in proper reduction of fracture fragments and thus obviating the need for an olecranon osteotomy.
Giant cell tumor (GCT) of the bone is a benign, locally aggressive neoplasm of epiphyseal origin. Most common sites for GCTs include the distal femur, proximal tibia, and the distal end of radius with the distal humerus being involved rarely. GCT is predominantly managed by extended curettage followed by adjuvant therapy to reduce recurrence. Juxta-articular GCTs are difficult to manage due to the destruction of the articular cartilage and subchondral bone which necessitates the need for joint reconstruction or fusion to salvage the joint. Aggressive and recurrent GCTs can be managed by wide resection of the tumor to reduce local recurrence followed by joint reconstruction or fusion. Joint reconstruction using a total elbow arthroplasty has been described for limb salvage as it provides a good functional outcome. We present a case of an aggressive GCT of the distal humerus that was treated using wide resection with humero-ulnar arthrodesis as an alternative in situations where joint reconstruction is not possible due to the unavailability of the prosthesis or socio-economic factors. The patient was asymptomatic after two years of follow-up, had no signs of recurrence, and had good hand functions.
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