Treatment of congenital pseudarthrosis of the tibia with the Ilizarov technique. Case report and review of the literature

Congenital pseudarthrosis of the tibia continues to pose one of the most difficult problems in paediatric orthopaedic surgery. The surgical procedures most used for treating congenital pseudarthrosis of the tibia are intramedullary nailing associated with bone grafting, vascularized fibular graft and the Ilizarov external circular fixator. Even when union is achieved, the residual deformities in the affected limb often result in significant disability. These deformities include leg-length discrepancy, angular tibial deformities, ankle mortise valgus and fibular non-union. The Ilizarov method allows simultaneous excision of the pseudarthrosis site, correction of the deformity and lengthening. However, refractures, ankle joint stiffness, fibular non-union with progressive ankle valgus are frequent sequelae with the Ilizarov technique. The surgeon should know when to abandon reconstructive procedures and create a more functional patient with an amputation. The authors discuss the indications and results of the Ilizarov external fixator in two patients with this complex problem. In addition, a critical review of the current literature is undertaken.

The Illizarov method in infected non-union of long bones / El método Illizarov en la no unión infectada de los huesos largos

OBJECTIVE: To review the results of the management of infected non-union of long bones using the Illizarov fixator. METHODS: Eight patients with non-union of long bones associated with current or prior infection were treated between 1998 and 2006. Seven patients were treated between 2004 and 2006. There were seven males and one female with an average age of 32 years (range 17-53 years). Four non-unions were located in the tibia, two were present in the humerus, one was present in the femur and one was intraarticular. Five non-unions were treated with acute compression, two were treated with bone transport and the frame was used in a static mode in one. RESULTS: There was one excellent, three good, one fair and three poor results. CONCLUSION: The Illizarov technique is an important treatment method for surgeons performing posttraumatic reconstructive surgery. Non-union, infection, shortening and deformity are all addressed simultaneously.

Objetivo: Examinar los resultados del tratamiento de la nounión infectada de los huesos largos usando el fijador de Illizarov. Métodos: Ocho pacientes con nounión de huesos largos asociada con infecciones presentes o previas fueron tratados entre 1998 y 2006. Siete pacientes fueron tratados entre 2004 y 2006. Hubo siete varones y una hembra con edad promedio de 32 años (rango 17­53 años). Cuatro nouniones estaban localizadas en la tibia, dos se hallaban presentes en el húmero, una se encontraba en el fémur y otra era intra-articular. Cinco nouniones fueron tratadas con compresión aguda, dos fueron tratados con transporte óseo, y en uno se usó el aparato de un modo estático, Resultados: Hubo un resultado excelente, tres buenos, uno aceptable y tres resultados pobres. Conclusión: La técnica de Illizarov es un importante método de tratamiento para los cirujanos que realizan cirugía reconstructiva post-traumática. Nounión, infección, acortamiento, y deformidad, pueden ser todos abordados simultáneamente.

Femoral lengthening using the Ilizarov technique / Alargamiento Femoral Mediante la Técnica de Ilizarov

The Ilizarov method allows the surgeon to perform extended lengthening of both congenital and acquired short limbs. The technique can be difficult, time consuming and is associated with many complications. Generally, the number of complications and failures of lengthenings increases in proportion to the length of the distraction and the severity of the preoperative problems. The rate of major complications decreases substantially as the experience of the surgeon increases.

The accuracy of joint line tenderness in the diagnosis of meniscal tears / Precisión del dolor en la línea de la articulación en el diagnóstico del desgarro meniscal

The accuracy of joint line tenderness in the diagnosis of meniscal tears was assessed in 129 knees. Arthroscopy was performed in each case to establish the diagnosis. The diagnosis was correct in 100 knees (77.5%) and incorrect in 29 (22.5%). A preoperative diagnosis of a medial meniscal tear was made in 63 knees and confirmed in 46 (73%) at arthroscopy. There were 46 true-positive, 17 false-positive, four false-negative and 62 true-negative results for the medial side. A lateral meniscal tear was suspected in 45 knees and confirmed in 39 (86.7%). Thus, 39 true-positive, six false-positive, two false-negative, and 82 true-negative interpretations were found. In this study, joint line tenderness as a test for lateral meniscal tears was accurate (93%), sensitive (95%), and specific (93%), but for medial tears the rates were lower.

La precisión del dolor en la línea de la articulación a la hora de hacer el diagnóstico del desgarro meniscal fue evaluada en 129 rodillas. En cada uno de los casos se realizó una artroscopia a fin de determinar el diagnóstico. El diagnóstico fue correcto en 100 rodillas (77.5%) e incorrecto en 29 (22.5%). Se llevó a cabo un diagnóstico preoperatorio del desgarramiento meniscal medial en 63 rodillas, confirmado en 46 (73%) por artroscopia. Hubo 46 resultados verdadero-positivos, 17 falsopositivos, 4 falso-negativos y 62 verdadero-negativos para el lado medial. Se sospechó un desgarro meniscal lateral en 45 rodillas, y se confirmó en 39 (86.7%). Por consiguiente, se hallaron 39 interpretaciones verdadero-positivas, 6 falso-positivas, 2 falso-negativas, y 82 verdadero-negativas. En este estudio, el dolor en la línea de la articulación como prueba para el desgarro meniscal lateral fue preciso (93%), sensible (95%), y específico (93%), pero para el desgarro medial los índices fueron más bajos.

Judet quadricepsplasty for extension contracture of the knee / La cuadricepsplastia operación Judet para la contractura en extensión de la rodilla

Extension contracture of the knee is a well known complication of severe femoral fractures, especially in the supracondylar region. Traditional management by the Thompson quadricepsplasty may result in a variable return of knee flexion and the possibility of significant extension lag. The Judet technique of quadricepsplasty offers the advantages of a controlled, sequential release of the intrinsic and then the extrinsic components limiting knee flexion and a reduced potential for iatrogenic quadriceps rupture or extension lag. The modified Judet quadricepsplasty has definite advantages over the Judet technique since it usually involves less soft tissue dissection and consequently less blood loss.

La contractura en extensión de la rodilla es una complicación bien conocida de las fracturas femorales severas, sobre todo en la región supracondilar. El tratamiento tradicional mediante la cuadricepsplastia de Thompson, puede traer como resultado un retorno variable de la flexión de la rodilla y la posibilidad de un intervalo de extensión significativo. La técnica de cuadricepsplastia de Judet ofrece como ventajas un accionar secuencial y controlado de los componentes intrínsecos y extrínsecos que limitan la flexión de la rodilla, así como un potencial reducido para la ruptura de los cuadriceps iatrogénicos y el intervalo de extensión. La cuadripcepsplastia de Judet modificada tiene ventajas definidas sobre la técnica de Judet, ya que usualmente involucra menos disección de tejido blando, y por consiguiente menos pérdida de sangre.

Routine prophylactic antibiotics for arthroplasty patients receiving dental care. Is it necessary?

Much of the debate regarding the prophylactic use of antibiotics for patients who have had a total joint replacement has focussed on their use before dental procedures. Despite the fact that almost all orthopaedic surgeons routinely recommend antibiotics for patients with prosthetic joints who require dental treatment, there is little evidence of a definitive link between transient bacteraemia occurring during dental procedures and late infections around prosthetic joints. An extensive review of the literature reveals that most authors recommend prophylactic antibiotics in high-risk patients or in those who undergo extensive dental surgery

Chondro-epiphyseal separation of the distal humerus in the newborn. A case report and review of the literature

Chondro-epiphyseal separation of the distal humerus is a rare injury, and when it occurs in the newborn, it may be difficult to diagnose and is easily mistaken for a dislocation of the elbow. The unimpressive clinical appearance of such an injury of the elbow in an infant, as well as the absence of ossific nuclei of the distal humerus in the newborn, are responsible for the dilemma in making the diagnosis. Ultrasonography, a readily available, non-invasive technique, can be used to evaluate the non-ossified epiphysis about the elbow of infants to demonstrate dislocations, fractures, and physeal separations. Closed reduction with or without percutaneous Kirschner wire fixation is the treatment of choice for these injuries. In this article, we report on a case of complete epiphyseal separation in a neonate and discuss the problems arising in its diagnosis

The Ilizarov technique in the treatment of tibial bone defects. Case reports and review of the literature

Autogenous cancellous bone grafting has long been the hallmark of skeletal defect management. Unfortunately, the small number of donor sites in the human body constitutes an absolute limit on the quantity of fresh autogenous cancellous bone available for filling a segmental defect. In addition, the donor sites are always a source of discomfort and morbidity for the patients. Intercalary defects resulting from trauma, infection or tumour can be treated with transport of a segment of bone within the limb using the Ilizarov technique. We report on three cases of local bone transportation for intercalary tibial defects by the Ilizarov method

Treatment of pilon fractures using the Ilizarov technique. Case reports and review of the literature

Tibial pilon fractures are difficult to manage because of their severity. These injuries are frequently open and contaminated, with marked comminution of the articular surface and metaphysis. The results of open reduction and internal fixation are dependent on the severity of the initial injury and the quality and stability of the reduction. The literature reports numerous complication rates associated with open reduction and internal fixation of pilon fractures. The Ilizarov technique of external fixation has fewer complications, and allows restoration of joint surfaces, reconstruction of length, and alignment of the extremity while maintaining a sufficient range of joint motion. Two cases of pilon fractures in which the Ilizarov method was utilized are reported, along with a review of the literature.

Iatrogenic ulnar neuropathies post-pinning of displaced supracondylar humerus fractures in children

A retrospective review of 141 displaced supracondylar fractures in children at the Bustamante Children's Hospital and the University Hospital of the West Indies from 1994 to 1999 revealed ten ulnar nerve palsies. Of the 141 supracondylar fractures, 27 were treated with open reduction and internal fixation, while 114 had closed reduction and percutaneous pinning. All fractures were fixed with crossed Kirschner wires. Of the ten cases, the ulnar nerve was explored in two cases; the medial pin was removed in two cases, while the other six cases were observed. Follow-up ranged from three to 18 months. Full nerve recovery occurred in all cases except one in which there was partial return of function. Recommendations are made regarding the management of these injuries.

Acute carpal tunnel syndrome secondary to thrombosis of a persistent median artery

An ususual case of thrombosis of a persistent median artery as a cause of acute carpal tunnel syndrome is reported. The sudden onset of numbness in the median nerve distribution and pain in the fingers were main symptoms. The embryonic development of the median nerve vascular supply and the reported incidence of persistent median artery are reported

Treatment of spinal tuberculosis by decompression and anterior spinal fusion: case report and review of the literature

The treatment of a young man with lumbar spinal tuberculosis and neurological involvement is described. Decompression and anterior spinal fusion were performed. Dramatic improvement in the patient's condition was obtained following surgery. The literature on the treatment of tuberculosis of the spine is reviewed.

Chronic triangular fibrocartilage complex tears: a case report and review of the literature

The treatment of a young man with chronic symptomatic gross subluxation of the distal radio-urlnar joint of the right wrist secondary to traumatic disruption of the triangular fibrocartilage complex(TFCC) is described. At operation, a strip of tensor fascia lata was used to stabilize the distal radio-ulnar joint. Complete relief of pain and restoration of normal function was obtained following surgery. The literature on TFCC disorders is also reviewed.