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Abstract: Introduction: Ankle fractures are among the most common injuries treated by orthopaedic surgeons. Malunion is one of the possible complications, and corrective surgery is often used to avoid long-term disability. However, few studies address medial malleolus malunion and the best revision surgery technique is controversial. We describe a new surgical technique, the «box resection¼. Material and methods: We present two cases of medial malleolus malunion with secondary talus lateral translation and syndesmotic incongruence. In order to restore a congruent tibiotalar joint, we performed the described technique. Results: We record significant improvement of AOFAS Score and range of motion in both cases, with resolution of pain symptoms. Postoperative radiographs show a congruent mortise with syndesmosis reduction. Conclusion: The box resection allowed immediate talus medial translation to its original position. It is a simple and effective solution, with a good functional outcome.
Resumen: Introducción: La consolidación viciosa del maléolo interno es una posible complicación en las fracturas maleolares. Su tratamiento es difícil y controvertido, por el momento no hay una solución estándar. Proponemos una nueva técnica quirúrgica para el tratamiento de estos casos que denominamos «resección en caja¼. Material y métodos: Presentamos dos casos de consolidación viciosa del maléolo interno, asociados con traslación lateral del astrágalo y incongruencia de la sindesmosis, donde aplicamos la técnica quirúrgica descrita. Resultados: En ambos casos, obtuvimos una mejora significativa en el puntaje AOFAS y en el rango de movilidad, así como en la resolución de las molestias por dolor. Las radiografías muestran mortajas congruentes y anatómicas, con una reducción satisfactoria de la sindesmosis. Conclusión: La técnica de «resección en caja¼ es simple y eficaz produciendo un buen resultado clínico y funcional.
ABSTRACT
Background: Traditional bone setters (TBSs) occupy an important role in the management of musculoskeletal injuries in the societies of many developing countries and Manipur society is no exception to this. This study was conducted to evaluate the reasons for patronising TBSs and their relevance in modern society. Methods: An observational cross-sectional study was conducted during 2015-17 in a teaching medical college in Imphal, Manipur. Patients with fractures and dislocations attending the orthopaedic department after ‘treatment’ by TBSs were included in this study. They were evaluated clinically and radiologically for presence or absence of any complication. Appropriate treatment was provided to all the patients according to the hospital protocol. Results: There were 302 males and 150 females with maximum number of patients belonging to the age group 1-20 yrs. There were 320 closed fractures, 90 compound/open fractures and 42 dislocation cases. Upper limb was involved in 290 patients, lower limb in 110 patients and axial bones in 52 patients. Most of the patients were educated and most of them had a firm belief in traditional bone setting (TBS) system. Mal-union was the most common complication (53%) which was followed by non-union (13.2%). Conclusion: In spite of availability of state of the art modern orthopaedic care facilities in Imphal, Manipur the general population still used to continue to patronize TBS for any musculoskeletal injury as they have an age-old firm belief in this system of treatment (46.5%). Easy availability and affordability made their service all the more attractive to the people (23.5%). Educational status of the patient had no role in patronizing TBS. Perhaps it is high time the TBS are imparted basic training on bone and joint care in order to minimise the associated complications, in the line of training “dais” to “trained birth attendants”.
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Objective: To investigate the effectiveness of corrective osteotomy for shortened medial foot column after old talar neck fracture. Methods: The clinical data of 10 patients with shortened medial foot column after old talar neck fracture between June 2012 and May 2017 was retrospectively analyzed. There were 7 males and 3 females with an average age of 45.8 years (mean, 21-67 years). The time from fracture to corrective osteotomy was 9-60 months (mean, 20.9 months). The preoperative visual analogue scale (VAS) score was 7.1±1.2, the American Orthopaedic Foot and Ankle Society (AOFAS) score was 48.5±12.3, and the short-form 36 health survey scale (SF-36) score was 46.7±10.5. All 10 cases received open wedge osteotomy of medial talus. Among them, 2 received subtalar fusion and Achilles tendon lengthening, 2 lateralizing calcaneal osteotomy, and 2 Achilles tendon lengthening. Results: All incisions healed by first intention. All patients were followed up 13-72 months (mean, 38.0 months). The X-ray film showed that the angle between longitudinal axis of 1st metatarsal bone and talus increased from (-9.6±4.5) ° before operation to (1.3±2.7) ° at last follow-up ( t=16.717, P=0.000); the angle between longitudinal axis of calcaneus and tibia increased from (-12.0±7.4) ° before operation to (-1.5±4.8) ° at last follow-up ( t=5.711, P=0.000). At last follow-up, the VAS score, AOFAS score, and SF-36 score were 1.6±1.0, 88.3±5.4, and 85.4±9.2, respectively, which increased significantly when compared with the preoperative scores ( t=13.703, P=0.000; t=14.883, P=0.000; t=16.919, P=0.000). X-ray film and CT showed that the osteotomy and arthrodesis sites healed well at 2-4 months after operation. Conclusion: It's a proper procedure of anatomic reduction and reconstruction for patients with shortened medial foot column and good articular cartilage morphology after old talar fracture. Opening wedge osteotomy of medial talus is recommended and can obtain satisfactory clinical and radiographic results.
ABSTRACT
En el manejo de las fracturas diafisiarias distales de tibia aún existe controversia acerca de cuál técnica quirúrgica ofrece mayores beneficios. El objetivo de este trabajo es describir y comparar las utilizadas, clavo endomedular y placa percutánea, y los resultados en cuanto a consolidación y complicaciones, en pacientes tratados entre enero 2004 y mayo 2008 en el Hospital de San José y una institución asociada de tercer nivel de atención. Se describe una cohorte histórica de 55 pacientes con seguimiento a doce meses. El 76,4% de la población fue de sexo masculino con promedio de edad de 36 años. Se observó mayor porcentaje de mala unión en los pacientes intervenidos con CE (10,7% vs. 7,4%, RR 1.45). La consolidación se presentó en el 92,9% (26/28) de los pacientes manejados con CE contra un 88,9% (24/27) de aquellos con PP. La pseudoartrosis se encontró en dos tratados con CE y en tres con PP (7,1% vs. 11,1%, RR 0.64). La falla del material de osteosíntesis no se observó con el uso de CE, mientras que dos con PP presentaron el evento (0% vs. 7,4%). En cada grupo se vieron dos casos de infección (7,1% vs. 7,4%). Se requirió reintervención en 17,9% (5/28) con CE y en 25,9% (7/27) con PP. El manejo con CE aunque muestra un índice de mala unión mayor que con empleo de PP, evidenciaría un porcentaje de consolidación mayor y unos de complicaciones y reintervención menores. Se requieren estudios futuros multicéntricos para demostrar diferencias entre los dos tipos de tratamientos.
There is still controversy regarding which surgical technique is the most beneficial to manage distal tibial dia- physeal fractures. This paper describes and compares intramedullary nailing and percutaneous plating and results as to consolidation and complications in patients treated between January 2004 and May 2008 at the San José Hospital and at an associate tertiary level health care facility. A 55-patient historical cohort and 12-month follow-up was described. The mean age was 36 years and 76.4% were male patients. A greater incidence of mal-union was observed in those who underwent an intramedullary nailing (10.7 % vs 7.4%, RR 1.45). Consolidation was achieved in 92.9% (26/28) of patients who received nailing compared to 88.9% (24/27) of those managed with plating. Pseudoarthrosis was present in 2 patients treated with a nail fixation and in 3 patients treated with a plate (7.1% vs 11.1%, RR 0.64). Failure of the osteosynthesis material was not observed with the use of nailing while two patients with plating presented this type of event (0% vs 7.4%). Two cases of infection presented in each group (7.1% vs 7.4%). A second surgical intervention was necessary in 17.9% (5/28) of patients with nailing and in 25.9% (7/27) of those in the plating group. Although management with intramedullary nailing shows a greater incidence of mal-union compared to plating, it would evidence a greater percentage of consolidation and less complications and need of a second procedure. Further multicentric trials are required in order to demonstrate the differences between these two treatment modalities.
Subject(s)
Humans , Male , Female , Middle Aged , Bone Nails , Bone Plates , Tibial Fractures/surgeryABSTRACT
Reduction of a malunited femoral diaphyseal fracture can be achieved by osteotomy and immediate internal fixation or gradual skeletal traction followed by delayed internal fixation. We retrospectively reviewed 27 patients with malunited and shortened femur. Nine patients with mean shortening of 4.7 cm (2.5 10.0) underwent acute one stage reduction and gained 2.5 to 5.0 cm length. Eighteen patients with mean shortening of 5.3 cm (3.5 to 9.0) underwent twostage reduction and gained 2.0 to 5.0 cm length. Ther