Significant Incidence of Extra-Articular Tibia Vara Affects Radiological Outcome of Total Knee Arthroplasty

PURPOSE: To identify and quantify the presence of extra-articular tibia vara that might influence the mechanical axis alignment after total knee arthroplasty (TKA). MATERIALS AND METHODS: A total of 48 TKAs in 30 osteoarthritic Indian patients were prospectively evaluated. The hip-knee-ankle angle (HKA), joint line convergence angle, and varus angulation at the femur and tibia were measured from the preoperative and postoperative standing hip-to-ankle radiographs. Four different methods were used to measure the varus angulation at the tibia: metaphyseo-diaphyseal angle (MDA), the angle between the anatomical axis and mechanical axis of the tibia, the angle between the proximal third and distal third of tibia and the angle between the proximal half and distal half of tibia. RESULTS: Extra-articular tibia vara quantified using MDA had the most positive correlation with HKA. Receiver operating characteristic plotting showed that MDA of >4degrees predicts abnormal postoperative HKA. Twenty-eight out of 48 knees had MDA of >4degrees, and 78.6% of these had postoperative HKA under-correction and 21.4% had less than ideal tibial component position. CONCLUSIONS: A significant inherent extra-articular varus angulation best measured using MDA exists in the proximal tibia in osteoarthritic Indian patients undergoing TKA. MDA of >4degrees is associated with abnormal postoperative HKA. Computer navigation may be useful for achieving ideal correction in such cases.

Isolated Tuberculosis of Sacrum with Monoparesis: An Atypical Presentation

Tuberculosis is a major health problem in developing nations. Spine is the most commonly affected site for skeletal tuberculosis but involvement of sacrum is rare. Isolated involvement of sacrum has been reported in literature but none of the reports has mentioned its clinical presentation as monoparesis. Our case presented with symptoms of sensory and motor deficit in right lower limb. The magnetic resonance imaging spine and non contrast computerized tomogram revealed a sacral lesion but were inconclusive of diagnosis. Histological examination after computed tomography guided biopsy revealed the condition as tuberculosis. Anti tubercular treatment was started after confirmation of diagnosis and continued for 18 months. Erythrocyte sedimentation rate and C-reactive protein drooped to normal range and patient was symptom free at two-year follow up. This case report intends to emphasize that sacral tuberculosis, being itself a rare condition, may present atypically as monoparesis.

Axillary artery thrombosis with anteroinferior shoulder dislocation: a rare case report and review of literature / 中华创伤杂志(英文版)

A very rare and serious complication of shoulder dislocation is a lesion to the axillary artery in the elderly population, whose vascular structures have become less flexible. Axillary artery injury secondary to anteroinferior shoulder dislocation is much rarer, especially in the young people. Proper recognition and treatment of this entity offers a full recovery to the patient. Present report highlights the possibility of axillary artery injury with anteroinferior shoulder dislocation. A few case reports and small case series of this injury have been reviewed. And recommendations for management have been brought up to date, in line with current thinking.