Digital technology in repair of soft tissue defect in hand by anterior tibial artery perforator flap / 中华显微外科杂志

Objective:To investigate the clinical value of digital technology in repair of soft tissue defect in hand by anterior tibial artery perforator flap.Methods:From January 2015 to February 2021, 9 patients with soft tissue defects in hand were repaired with anterior tibial artery perforator flap assisted by digital technology in flap design, including 6 males and 3 females aged from 19 to 63 years with a mean age of 33 years. The size of defects varied from 2.0 cm×1.5 cm to 4.0 cm×3.0 cm, with exposed bones or tendons. Preoperative CTA scan of lower limb was performed and three-dimensional image was reconstructed with Mimics 20.0. The anterior tibial artery perforator flap was designed according to the shape and size of the defect, then the resection of flap was digitally simulated. The flap based on the digital design was harvested and the defect was repaired in the operation. The size of flap was 2.5 cm×2.0 cm~4.5 cm×3.5 cm. Outpatient clinic follow-up was performed to evaluate the survival of flaps. Disability of Arm, Shoulder and Hand(DASH) was used for function evaluation.Results:All flaps were harvested successfully and all donor sites were closed directly. After surgery, 8 flaps survived completely. One flap developed venous occlusion that showed partial necrosis of the flap, and it was rescued after exploration and re-anastomosis. The follow-up period ranged from 6 to 21 months, with an average of 13 months. The DASH scores of the affected limb were 2 to 15 points at the last follow-up, with an average of 6.4 points. Mild scar hyperplasia occurred at donor site in 1 case without sensory abnormality.Conclusion:The digital technology is able to accurately locate the perforators by allowing an individualised design of the anterior tibial artery perforator flap. The flap is suitable for repair of small and medium-sized soft tissue defect in hand, and the digital technology has certain value in clinical application.

Algunas especificidades en torno a la rótula baja / Some specificities around the low patella

La rótula baja es una enfermedad infrecuente, de causa congénita o adquirida, caracterizada por dolor en la zona anterior de la rodilla y limitación del movimiento articular. La radiografía simple, en proyección lateral, ayuda al diagnóstico a través de determinadas mediciones; asimismo, el tratamiento conservador no resulta muy exitoso, de ahí que las modalidades quirúrgicas son más empleadas. Debido a la importancia de esta temática y a la escasa información disponible en la bibliografía nacional e internacional, en el presente artículo se comenta brevemente al respecto, con el objetivo de brindar información sobre esta enfermedad para que sirva como guía de trabajo.

The low patella is an uncommon disease, of congenital or acquired cause, characterized by pain in the anterior area of the knee and limitation of the articular movement. The simple x-ray, in lateral projection, helps to make a diagnosis through certain measurements; also, the conservative treatment is not very successful, so that surgical modalities are the most used. Due to the importance of this subject matter and the lack of information available in the national and international bibliography, it is shortly commented in this work, aimed at offering information on this disease so that it serves as working guide.

Endovascular revascularization of chronic total arterial occlusion of the lower limb using the SAFARI technique / Revascularização endovascular utilizando a técnica SAFARI em casos de oclusão arterial total do membro inferior

Abstract The SAFARI technique or Subintimal Arterial Flossing with Antegrade-Retrograde Intervention is an endovascular procedure that allows recanalization of Chronic Total Occlusive (CTO) lesions when conventional subintimal angioplasty is unsuccessful. Retrograde access is usually obtained through the popliteal, anterior tibial, dorsalis pedis artery, or posterior tibial arteries and may potentially provide more options for endovascular interventions in limb salvage. The case of an 81-year-old man with a history of uncontrolled hypertension, diabetes mellitus, and dyslipidemia is presented. He presented with a cutaneous ulcer on the right lower limb with torpid evolution and poor healing. The Doppler ultrasound and arteriographic study revealed a CTO lesion of the popliteal artery that was not a candidate for antegrade endovascular revascularization, but was successfully treated using the SAFARI technique. The patient had no perioperative complications, the wound showed better healing, and he was discharged with an indication of daily dressings and control by an external outpatient clinic.

Resumo A técnica SAFARI, ou Subintimal Arterial Flossing with Antegrade-Retrograde Intervention, é um procedimento endovascular que permite a recanalização de lesões por oclusão total crônica (OTC) em caso de fracasso da angioplastia subintimal convencional. O acesso retrógrado é geralmente obtido através da artéria poplítea, tibial anterior, pediosa ou tibial posterior e pode fornecer mais alternativas de intervenções endovasculares para o salvamento do membro. É apresentado o caso de um homem de 81 anos com histórico de hipertenção não controlada, diabetes melito e dislipidemia. Ele apresentava uma lesão ulcerativa cutânea no membro inferior direito com evolução tórpida e má cicatrização. O ultrassom Doppler e o estudo arteriográfico revelaram uma lesão por OTC na artéria poplítea. O paciente não era candidato a revascularização endovascular anterógrada; sendo assim, esta foi realizada com successo utilizando a técnica SAFARI. O paciente não apresentou complicações perioperatórias e recebeu alta com indicação de cuidados diários com a ferida e controle em um ambulatório externo. Além disso, a ferida apresentou melhor cicatrização.

Significance of the anterior tibial translocation sign in predicting the presence of anterior cruciate ligament tears in arthroscopically-proven cases

@#Anterior cruciate ligament (ACL) injury remains a common orthopedic case, especially in young adults with an active lifestyle. Activities of daily living and sports performance may be vastly compromised; thus, immediate diagnosis is essential. The researchers tested the diagnostic ability of the anterior tibial translocation sign (using the 5 mm cut-off) against the gold standard knee arthroscopy using cross-sectional study design. Analysis of the 23 magnetic resonance imaging (MRI) scans showed a sensitivity of 42.9% (true positives: 6 had ≥5 mm reading out of 14 positive arthroscopy fi ndings), specifi city of 77.8% (true negatives: 7 had <5 mm reading out of 9 negative arthroscopy fi ndings) and positive predictive value (PPV) of 75.0% (6 out of 8 positive arthroscopy fi ndings among ≥5 mm). In the sample data, 7 mm cut-off had the optimal trade-off between sensitivity and type I error, thus being the most predictive of ACL tear.

Anterior tibial artery perforator propeller flap relay peroneal artery terminal perforator propeller flap for foot and ankle defect / 中国修复重建外科杂志

Objective: To investigate the clinical application of the anterior tibial artery perforator propeller flap relay peroneal artery terminal perforator propeller flap in repair of foot and ankle defects. Methods: Between October 2014 and October 2018, 18 cases with foot and ankle defects were treated. There were 12 males and 6 females with an average age of 32.8 years (range, 8-56 years). There were 11 cases of traffic accident injuries, 3 cases of falling from height injuries, and 4 cases of heavy objects injuries. The wound was at the dorsum of the foot in 9 cases, the heel in 4 cases, the lateral malleolus in 5 cases. The time from injury to flap repair was 7-34 days (mean, 19 days). The size of wound ranged from 6.0 cm×2.5 cm to 11.0 cm×6.0 cm. The foot and ankle defects were repaired with the peroneal artery terminal perforator propeller flap in size of 6 cm×3 cm-18 cm×7 cm, which donor site was repaired with the anterior tibial artery perforator propeller flap in size of 8 cm×3 cm-16 cm×6 cm. Results: One patient had a hemorrhagic swelling in the peroneal artery terminal perforator propeller flap, and survived after symptomatic treatment. All recipient and donor sites healed by first intention. Eighteen patients were followed up 6-15 months (mean, 12.5 months). At last follow-up, the shape, color, texture, and thickness of the flaps in the donor sites were similar with those in the recipient sites. There were only linear scars on the donor sites. The two-point discrimination of the peroneal artery terminal perforator propeller flap ranged from 10 to 12 mm (mean, 11 mm). According to American Orthopaedic Foot and Ankle Society (AOFAS) score criteria, the results were excellent in 15 cases and good in 3 cases, with an excellent and good rate of 100%. Conclusion: The foot and ankle defects can be repaired with the anterior tibial artery perforator propeller flap relay peroneal artery terminal perforator propeller flap. The procedure is not sacrificing the main vessel and can avoid the skin grafting and obtain the good ankle function.

Surface electromyogram features of the lower limb muscles in cerebral palsy children standing and walking on tiptoes / 中国组织工程研究

BACKGROUND: Under well-controlled conditions, changes in myoelectric signal activity can largely reflect muscle changes such as muscle function, muscle tension, muscle strength, and multi-muscle coordination, providing objective analysis of the muscle function. OBJECTIVE: To investigate the changes in surface electromyography (SEMG) of the lower limb muscles in cerebral palsy children standing or walking on tiptoes. METHODS: Using TELEMYO 2400R G2 SEMG telemeter produced by NORAXON Company in the United States, surface EMG features of bilateral anterior tibial muscles and medial gastrocnemius muscles were detected in 20 cerebral palsy children standing or walking on unilateral tiptoes. The myoelectric activity of the testicular muscles between the pointed and contralateral side was compared in all the subjects. The study protocol was approved by the Ethics Committee of Shanghai Ruijin Hospital, and all subjects and their guardians signed an informed consent prior to the participation in the study. RESULTS AND CONCLUSION: When the subjects were standing and walking normally, the average SEMG amplitude and average SEMG integral of the medial gastrocnemius at the tiptoe side were significantly lower than those at the contralateral side (P < 0.05); the mean and median frequencies of the anterior tibial muscles and medial gastrocnemius muscles at the tiptoe side were significantly higher than those at the contralateral side (P < 0.05). These findings indicate that there are abnormal SEMG signals in the anterior tibial muscles and medial gastrocnemius muscles at the tiptoe side in children with cerebral palsy, and the muscle activity of the lower limbs in such children is not balanced. Therefore, SEMG is of practical value in evaluating the functional status of the neuromuscular system in children with cerebral palsy.

Síndrome do aprisionamento da artéria tibial anterior bilateral pelo retináculo extensor do tornozelo: relato de caso / Bilateral anterior tibial artery entrapment by the ankle extensor retinaculum: case report

Resumo Os aprisionamentos vasculares são raros. Nos membros inferiores, geralmente são assintomáticos, mas podem causar claudicação intermitente atípica em indivíduos jovens sem fatores de risco para aterosclerose ou doenças inflamatórias. O vaso mais frequentemente acometido é a artéria poplítea, causando a síndrome do aprisionamento da artéria poplítea (SAAP), com sintomas na região dos músculos infrapatelares. Quando o desconforto ao esforço é mais distal, deve-se pensar em outros locais de aprisionamento arterial, como a artéria tibial anterior. Neste trabalho, é relatado o caso de um paciente com claudicação intermitente nos pés devido ao aprisionamento da artéria tibial anterior (AATA) bilateral, causado pelo retináculo dos músculos extensores e diagnosticado pela ultrassonografia vascular e angiotomografia durante flexão plantar. O paciente foi tratado cirurgicamente, evoluindo com melhora dos sintomas clínicos.

Abstract Vascular entrapment is rare. In the lower limbs it is generally asymptomatic, but may cause atypical intermittent claudication in young people without risk factors for atherosclerosis and inflammatory diseases. The most common type of compression involves the popliteal artery, causing symptoms in the region of the infra-patellar muscles. When discomfort is more distal, other entrapment points should be considered, such as the anterior tibial artery. This article reports the case of a patient with intermittent claudication in both feet due to extrinsic compression of the anterior tibial artery bilaterally by the extensor retinaculum of the ankle, diagnosed by vascular ultrasonography and angiotomography during plantar flexion maneuvers. The patient was treated surgically, resulting in improvement of clinical symptoms.

The anatomical basis of the vascularized fibularis brevis grafts / Base anatómica de los injertos vascularizados del músculo fibularis brevis

Fibularis brevis grafts have been extensively used, especially as distally-based grafts, to cover defects in the lower leg and foot. The study has contributed to analyze the blood supply of the fibularis brevis muscle and the vascular basis of its possible different grafts. Both legs of twelve preserved cadavers, without congenital vascular anomalies, were utilized in the study. Fibularis brevis was exposed in all selected legs along with the verification of different arterial pedicles. The total means and standard deviations of the length and width of the muscle together with diameters of major vessels were calculated. Total length and width of middle portion of fibularis brevis were at means of 28.7±0.4 cm and 3±0.02 cm respectively. The upper and middle portions of the muscle were supplied by the fibular and the anterior tibial artery. The middle portion was supplemented by the upper perforating branch of the posterior tibial artery. The lower portion of the muscle was supplied by the lower perforating branch of the posterior tibial and the periosteal arteries. The muscle could be used as a proximally or distally based flap, free vascularized muscle graft, free vascularized osteo-muscular flap, and distally-based split flap. It can be split completely into two flaps; each of which can be used as a proximally or distally.

Los injertos de músculo fibularis brevis son usados ampliamente, especialmente como injertos de base distal, para cubrir defectos en la parte inferior de la pierna y el pie. El objetivo de este estudio fue analizar el suministro de sangre del músculo fibularis brevis y la base vascular de los posibles diferentes injertos. Para el estudio se utilizaron ambas piernas de 12 cadáveres preservados, sin anomalías vasculares congénitas. El músculo fibularis brevis fue encontrado en todas las piernas junto con los diferentes pedículos arteriales. Se calcularon las medias totales y las desviaciones estándar de la longitud y el ancho del músculo, junto con los diámetros de los vasos principales. La longitud y el ancho totales de la porción media del músculo fibularis brevis fueron de 28,7±0,4 cm y 3±0,02 cm, respectivamente. Las partes superior y media del músculo estaban suplidas vascularmente por la arteria fibular y la arteria tibial anterior. La parte media se complementó con la rama perforante superior de la arteria tibial posterior. La parte inferior del músculo fue suplida por una rama perforante inferior de la arteria tibial posterior y las arterias periósticas. El músculo podría usarse como un colgajo de base proximal o distal, injerto de músculo vascularizado libre, colgajo osteomuscular vascularizado libre y colgajo dividido distal. Se puede dividir por completo en dos colgajos; cada uno de estos puede ser utilizado como proximal o distal.

Static Anterior Tibial Translation after Anterior Cruciate Ligament Injury: Incidence and Clinical Characteristics / 中国运动医学杂志

Objective To explore the incidence and clinical characteristics of the anterior tibial translation(ATT) after anterior cruciate ligament injury.Methods One hundred and fifty-three patients with the anterior cruciate ligament injury underwent standard magnetic resonance imaging scans with full knee extension.Based on the relative location between the lateral tibial plateau and the lateral femoral condyle,all the patients were divided into an ATT positive group and an ATT negative group.Moreover,the posterior tibial slope angle(PTSA),the continuity of anterolateral ligament(ALL),and the integrity of posterior horn of the lateral meniscus of all the patients were detected so as to find the risking factors for ATT.Results Among the 153 patients,46 patients were finally confirmed to have ATT.Moreover,the average PTSA of the ATT positive group was significantly larger than that of the ATT negative group.However,there were no significant differences between the two groups in the continuity of ALL and the integrity of posterior horn of lateral meniscus.Conclusion In this study,the incidence of ATT was 30.1％,which may be correlated to the increased PTSA.

Anatomy study and clinical application of periosteal perforator bone-skin fiap of proximal lateral tibial / 中华显微外科杂志

Objective To provide anatomical information and clinical application of periosteal perforator bone-skin flap of proximal lateral tibia. Methods From March, 2015 to March, 2017, 15 fresh cadavers who underwent injected with imaging technology and dissected with layer by layer. The origins, branches, distribution and anastomosis of periosteal perforator vessels in the proximal lateral tibial were observed. Sixteen patients of composite tissue defect in hands and feet were repaired with the method of free transplantation of this flap from March, 2015 to March, 2017. Injured area was from 3.0 cm × 0.8 cm to 6.0 cm × 5.5 cm. Bony defect size was from 1.7 cm × 1.5 cm × 1.0 cm to 5.0 cm × 1.0 cm × 1.0 cm. The bone-skin flap size ranged respectively from 3.0 cm × 0.8 cm to 6.0 cm × 5.5 cm and 1.6 cm ×1.0 cm × 0.8 cm to 5.0 cm×1.0 cm × 1.0 cm. Postoperative followed-up was done termly. Results The diameter and superficial length of the main perforators respectively were 0.5 to 1.2 mm and from 2.5 to 4.3 cm. The followed-up time was from 6 to 24 months in 14 cases, with the results of the bone-skin flaps presented favourable contours and good functions. The healing time of bone flap was 2 to 4 months. The function of shank was normal. Conclusion The periosteal perforator of proximal lateral tibia has favourable appearance, constant vascular pedi-cle, reliable blood supply and large diameter. The free transplantation of this flap offers a satisfactory alternative for repairing the small and medium-sized area of composite tissue defects of hands and feet.

Multiple interventional models combined via anterior tibial veins in treatment of acute deep venous thrombosis / 中国介入影像与治疗学

Objective To explore the efficacy of multiple interventional models combined through anterior tibial veins approach in treatment of acute deep venous thrombosis (DVT).Methods The clinical data and the imaging materials of 10 patients with acute DVT were analyzed retrospectively,and the interventional treatment strategies were discussed.Results The percutaneous mechanical thrombectomy (PMT) was performed after a temporary inferior vena cava filter implanted in all patients,and thrombus clearance rate of grade Ⅲ was obtained in 7 patients while 3 patients reached grade Ⅱ criteria.There were 7 patients underwent angioplasty,then the inferior vena cava filter was retrieved during the same procedure in 5 patients while 4 patients in the second stage and 1 patient rejected to retrieve the filter.All swelling limbs alleviated significantly after those procedures.There was no critical complications occured.The total hospital stay ranged from 4 to 7 days,with a mean time of (6.00±0.94) days.All patients were followed up with a mean time of (3.60± 1.84) months (ranged from 1 to 6 months).No thrombus recurrences of the previously affected vessels were reported.Conclusion The multiple interventional models combined via anterior tibial veins for acute DVT is simple,safe and effective,combined with mechanical thrombectomy device can reduce thrombus burden quickly,and combined with angioplasty can consolidate the therapeutic effect,all those methods combined can shorten the overall hospitalization time.

Fractura por avulsión de la tuberosidad anterior de la tibia en adolescentes / Fracture-avulsion de la tubérosité tibiale antérieure chez l'adolescent / Avulsion fracture of the anterior tuberosity of the tibia in adolescents

Las fracturas por avulsión de la tuberosidad anterior de la tibia ocurren generalmente en adolescentes atletas. Estas lesiones son más frecuentes en el sexo masculino y su incidencia puede cifrarse entre el 0,4 por ciento al 2,7 porciento del total de las lesiones epifisarias. Presentamos un adolescente masculino de 15 años de edad, que durante la práctica de voleibol sufrió fractura por avulsión de la tuberosidad anterior de la tibia tipo II A de Odgen. Se le realizó reducción abierta y fijación interna e inmovilización. No presentó complicaciones. Hacemos una revisión de esta entidad por ser poco frecuente(AU)

Avulsion fractures of the anterior tuberosity of the tibia generally occur in adolescent athletes. These lesions are more frequent in males and their incidence can range 0.4 percent to 2.7 percent of the total epiphyseal lesions. We present a 15-year-old male adolescent, who during the volleyball practice suffered an avulsion fracture of the anterior tuberosity tibia Odgen type II A. He underwent open reduction and internal fixation and immobilization. He had no complications. A review of this entity is conducted since it is rare(AU)

Les fractures-avulsion de la tubérosité tibiale antérieure se produisent généralement chez de jeunes athlètes. Ces lésions touchent souvent les garçons, et leur incidence peut aller de 0,4 pourcent à 2,7 pourcent de la totalité des lésions épiphysaires. Le cas d'un garçon âgé de 15 ans, ayant souffert une fracture-avulsion de la tubérosité tibiale antérieure type IIA selon la classification d'Odgen au cours de sa pratique de volleyball, est présenté. Il a subi alors une réduction ouverte et fixation interne, ainsi qu'une immobilisation. Il n'a pas eu de complication. Due à sa rareté, une révision de cette affection est réalisée(AU)

Seudoaneurisma postraumático de arteria tibial anterior secundario a fractura diafisiaria de tibia. Reporte de caso / Post-traumatic pseudoaneurysm of the anterior tibial artery secondary to tibial shaft fracture. Case report

Resumen: El seudoaneurisma arterial en la extremidad inferior es una entidad poco frecuente, en particular en el segmento infrapoplíteo. Comúnmente se le asocia a reparaciones vasculares o secundario a una lesión arterial localizada, posterior a fractura o a un evento quirúrgico. En México poco se ha documentado sobre esta entidad que afecta la arteria tibial anterior secundaria a proceso traumático y osteosíntesis. El sangrado súbito debido a una ruptura del seudoaneurisma es un posible desenlace catastrófico para la viabilidad del segmento, por lo cual es de suma importancia detectarla y diagnosticarla a tiempo. Las indicaciones en cuanto al tratamiento siguen siendo controvertidas en las publicaciones internacionales. Las opciones resolutivas pueden ser quirúrgicas o endovasculares. Según reportes actuales, la mejor opción terapéutica es el injerto autólogo de vena safena que mantiene el flujo sanguíneo y minimiza el riesgo de isquemia periférica. El objetivo de este trabajo es exponer el caso de un paciente que presentó la complicación descrita previamente y de la misma forma, realizar una revisión de la bibliografía consultada. Es importante indagar más sobre este tema, que bien puede pasar inadvertido en un gran número de casos por su sintomatología silente.

Abstract: Arterial pseudoaneurysm of the lower limb is an infrequent entity, particularly in the infrapopliteal segment. It is commonly associated to vascular repairs or follows a localized arterial lesion, a fracture or a surgical procedure. There is little information in Mexico about this entity in cases involving the anterior tibial artery, and secondary to trauma and osteosynthesis. Given that sudden bleeding due to rupture of the pseudoaneurysm is a possible catastrophic outcome for the viability of the segment, it is important to timely detect and diagnose the pseudoaneurysm. Treatment indications contained in the international literature are controversial. Solution-oriented approaches may be either surgical or endovascular. Current reports show that the best treatment option is an autologous saphenous vein graft, which maintains blood flow and minimizes the risk of peripheral ischemia. The purpose of this paper is to report the case of a patient who sustained the above mentioned complication and provide a literature review. This topic should be further investigated, as this condition may go unnoticed in a large number of cases, given that its symptoms are silent.

Chronic Tibialis Anterior Tendon Rupture Treated with Semitendinosus Autograft: A Report of Two Cases / 대한족부족관절학회지

The tibialis anterior tendon functions as a major dorsiflexor of the ankle. A rupture in this tendon can cause serious problems in the ambulatory function. A closed traumatic rupture without open wound or an atraumatic rupture can delay diagnosis and treatment. There are not enough guidelines for an effective surgical treatment on this chronic condition. Herein, we report two cases of chronic tibialis anterior disruption successfully treated by semitendinosus autograft.

Coil Embolization of a Pseudoaneurysm of the Anterior Tibial Artery: A Case Report / 대한족부족관절학회지

Development of a pseudoaneurysm around the ankle is an uncommon complication after surgery. We experienced a case of a pseudoaneurysm, which developed from the anterior tibial artery. A 44-year-old woman had sustained painful swelling of her right ankle after the removal of implants for a distal fibular fracture. The pseudoaneurysm was confirmed by ultrasonography and angiography. The patient was treated with an intervention using a coil and recovered without further complaints. This case report aims to increase the awareness of this complication with review of literature.

A segmental hypoplastic anterior tibial artery coexisting with a hypertrophied perforating fibular artery a case report and clinical implications / Coexistencia de una arteria tibial anterior hipoplásica segmentaria con una arteria fibular perforante hipertrofiada. Reporte de caso e implicancias clínicas

Vascular injuries of the lower limb, especially from penetrating gunshot wounds, and peripheral arterial diseases are on the increase and management of these and many other lower limb injuries involve increasing usage of vascular interventions like by-pass surgery, per-cutaneous transluminal angioplasty, arterial cannulation, arterial bypass graft or minimally invasive measures like percutaneous trans-arterial catheterization, among others. A thorough knowledge of infrapopliteal branching most especially their pathways and luminal diameters are important to surgeons in selecting appropriate surgical interventions or procedures. We report the case in which one of the 3 terminal branches of the popliteal artery (PPA), the anterior tibial artery (ATA) of good caliber size at origin became hypoplastic in the anterior leg region after giving off numerous muscular branches. Continuing as an almost attenuated dorsalis pedis artery (aDPA) in the dorsum of the foot, the latter was reinforced by an enlarged hypertrophied fibular artery. This case illustrates yet the importance of the fibular artery as the dominant of the 3 infrapopliteal branching arteries, reinforcing or replacing the posterior tibial artery (PTA) when it is weak or absent by a strong communicating branch or, reinforcing a weak ATA and dorsalis pedis artery (DPA) by a strong perforating fibular artery as being reported. The PTA however travelled a normal course yielding the medial and lateral plantar arteries posterior to the abductor hallucis muscle. This case demonstrates the importance of collateral communications and reinforcements from other infrapopliteal arteries, whenever one of its members or subsequent branches are absent or hypoplastic. A very sound knowledge of the various branching patterns of the PPA can be gained via pre-operatively vascular angiography, designed to guide the surgeon in the selection of appropriate surgical interventions, adding value to patients care in helping to reduce iatrogenic surgical vascular complications and reduction in total number of limb loss.

Las lesiones vasculares de los miembros inferiores, especialmente las heridas penetrantes por arma de fuego y enfermedades arteriales periféricas, están en aumento. Su manejo, así como el de otras lesiones en los miembros inferiores, implican un mayor uso de intervenciones vasculares como la cirugía de by-pass, angioplastía transluminal percutánea, canulación arterial, injerto de derivación arterial o medidas mínimamente invasivas como el cateterismo transarterial percutáneo, entre otros. El conocimiento profundo de las ramificaciones infrapoplíteas, muy especialmente sus vías y diámetros luminales son importantes para los cirujanos en la selección de las intervenciones o procedimientos quirúrgicos apropiados. Presentamos un caso en el cual, una de las 3 ramas terminales de la arteria poplítea (APP), la arteria tibial anterior (ATA), de buen calibre en su origen se hizo hipoplásica en la región anterior de la pierna después de un desprendimiento de numerosas ramas musculares. Continuó como una arteria dorsal del pie (ADP) casi atenuada en el dorso del pie; esta última se vio reforzada por una amplia arteria fibular hipertrofiada. Este caso ilustra la importancia de la arteria fibular como dominante de las 3 ramificaciones de las arterias infrapoplíteas, un refuerzo o sustitución de la arteria tibial posterior (ATP) cuando es débil o está ausente, por una fuerte rama comunicante, o bien refuerzo de una débil ATA y ADP por una fuerte arteria fibular perforante como en el caso reportado. La ATP sin embargo tenía un trayecto con un curso normal generando las arterias plantares medial y lateral, posterior al músculo abductor del hállux. Este caso demuestra la importancia de las comunicaciones colaterales y refuerzos de otras arterias infrapoplíteas, cada vez que uno de sus componentes o ramas posteriores están ausentes o hipoplásicas. Un conocimiento detallado de los diferentes patrones de ramificación de la APP puede ser adquirido a través de una angiografía vascular previo a la cirugía, diseñada para guiar al cirujano en la selección de las intervenciones quirúrgicas adecuadas, agrega valor a la atención de los pacientes, ayuda a disminuir las complicaciones vasculares quirúrgicas iatrogénicas y reduce el número total de pérdidas de miembros inferiores.

Hyperthyroid-associated EMA syndrome:four cases report and review of literature / 中华内分泌代谢杂志

[Summary] Four patients with hyperthyroid-associated exophthalmos, myxedema, acropachy ( EMA ) syndrome, including three male patients and one female patient were diagnosed with Graves′diseases and treated by 131 I therapy. Complaints of thyrotoxicosis were presented at the onset. Tibia myxedema and acropathy appeared, and eye symptoms aggravated in two patients after anti-thyroid drug therapy and 131 I therapy. Four cases were all given clobetasol propionate, miconazole nitrate, neomycin sulfate and urea cream alone or in combination with compound betamethasone local injection treatment, and three cases were given low-dose oral prednisone treatment. Complaints of tibia myxedema and eye symptoms were significantly improved after the treatment. Therefore, we should be wary of the occurrence of hyperthyroid-associated EMA syndrome after 131 I therapy. Corticosteroid might be the effective therapy for myxedema and eye symptoms of EMA syndrome.

Complete Rupture of the Tibialis Anterior Tendon Due to Intratendinous Ganglion Cyst / 대한정형외과학회잡지

Spontaneous rupture of the tibialis anterior tendon is rare among ordinary people. The tendon rupture usually occurs in patients iatrogenically after local steroid injection to the tendon or with pre-existing systemic disease such as diabetes mellitus, gout, and rheumatic disease. However, no case of complete rupture of the tibialis anterior tendon due to an intratendinous ganglion cyst has been reported. We report on a case of a 39-year-old female with spontaneous rupture of the tibialis anterior tendon due to intratendinous ganglion cyst and her clinical results.

Osteotomía de apertura anterior de tibia bilateral en recurvatum de rodilla: a propósito de un caso / Anterior tibial osteotomy in bilateral knee recurvatum. Case report

En los recurvatum de rodilla, existen varios métodos de corrección, la osteotomía descripta por Brett y Lexer E. modificada es una opción para su tratamiento. El objetivo de este trabajo es describir la técnica como una solución para los recurvatum de rodilla tibiales y mostrar la evolución de un caso clínico. El paciente presentaba un recurvatum bilateral de rodilla de origen tibial idiopático, con valores angulares de 26 grados a derecha y 20 grados a izquierda de ángulo diafiso-epifisario. Con el objetivo de corregir la deformación para calmar el dolor de características mecánicas por sobrecarga articular y evitar la pérdida del equilibrio articular, se decidió realizar esta técnica. Las cirugías fueron realizadas comenzando con la derecha y un año y medio después la rodilla izquierda. Para la rodilla derecha se logró corregir la deformidad llevando el platillo tibial de 26° de inclinación anterior a 6°. En cuanto a la rodilla izquierda de 20° se corrigió a 0°. Resulta una técnica reproducible, que soluciona los recurvatum de origen tibial epifiso-metafisarios, que no altera la biomecánica del aparato extensor como otras osteotomías. Esta técnica no permite corregir las deformidades diafisarias. Creemos que es una de las mejores opciones para la corrección del recurvatum, que a pesar de no lograr corrección total de la alteración ósea, mejora la función de la rodilla y la sintomatología, sin alterar la mecánica del aparato extensor.

In the knee recurvatum, there are several methods of correction osteotomy, the modified Brett and Lexer E. osteotomy is an option for this type of pathology. The aim of this paper is to describe the technique as a solution to the tibial recurvatum and show the outcome of a case. The patient had a bilateral tibial idiopathic knee recurvatum, with angular values of 26 degrees right and 20 degrees left of diafiso-epiphyseal angle. In order to correct the deformation and release pain secondary to mechanical overload and prevent loss of articular balance, we decided to perform this technique. The surgeries were performed first the right and a year and a half after his left knee. His right knee, we managed to correct the tibial plateau deformity from 26° of anterior tilt, to 6°. As for the left knee was corrected from 20° to 0°. It is a reproducible technique that solves tibial epiphyseal-metaphyseal origin recurvatum, which does not alter the biomechanics of the extensor mechanism as other osteotomies. This technique does not allow correction of diaphyseal deformities. We believe it is one of the best options for the correction of recurvatum, which despite not achieveing full correction of bone alteration improves knee function and symptoms without altering the extensor mechanism.

Tratamiento artroscópico de las fracturas avulsión de espina tibial anterior. Nueva técnica CrossFix con arpones BioSwivelock con FiberTape sin nudos: técnica quirúrgica / Arthroscopic surgery of anterior tibial avulsion fractures

Describimos una técnica quirúrgica sin nudos (Knotless) con arpones Bioswivelock con sutura FiberTape (Arthrex inc. Naples Florida) con técnica cruzada; denominándola técnica CrossFix para reducción y osteosíntesis artroscópica de las fracturas avulsión de espina tibial anterior, logrando reducción anatómica estable, mínimamente invasiva sin la necesidad de realizar la extracción del implante al final del tratamiento. Nuestra técnica es aplicable tanto en pacientes con inmadurez esquelética como en adultos ya que no daña la fisis o cartílago de crecimiento y no requiere una segunda intervención para el retiro del implante; combinando las ventajas de la fijación con suturas de alta resistencia FiberTape, con la tecnología de los implantes sin nudos.

We describe a new surgical technique without knots (knotless technique) with Bioswivelock anchor and FiberTape suture (Arthrex inc. Naples Florida) with crossing technique, calling it CrossFix technique for arthroscopic reduction and internal fixation of avulsion fractures of the anterior tibial tubercle, achieving anatomic reduction, stable, minimally invasively without the need for removal of the implant at the end of treatment. Our technique is applicable to both patients adult and skeletal immaturity as not damage the cartilage growth plate or fisis and does not require a second surgery to remove the implant, combining the advantages of fixation with high strength sutures like the FiberTape, with an implant technology without knots like Bioswivelock.