Vesicocutaneous Fistula Presenting Groin Abscess and Chronic Osteomyelitis in Pubic Bone

The authors report a case of bladder fistula associated with a medial thigh cutaneous fistula and chronic osteomyelitis of the pubic bone 11 years after surgery for a pelvic bone fracture and bladder rupture. In the presenting case, despite the clinical suspicion, none of the diagnostic tools demonstrated the bladder fistula preoperatively. This case suggests that bladder repair should be prepared, even if the bladder fistula cannot be confirmed by imaging studies because the amount of urine leakage can be minimal or the fistula can close spontaneously.

Syndesmosis Injury Associated with the Weber Type B Lateral Malleolar Fracture / 대한정형외과학회잡지

PURPOSE: We evaluated the syndesmosis instability associated with Weber type B lateral malleolar fractures. MATERIALS AND METHODS: Eighty one Weber type B lateral malleolar fractures were evaluated and classified according to the radiologic criteria. Syndesmosis instability was checked with a hook test during operation. The radiological and clinical results were assessed. RESULTS: Twenty two cases were associated with a widening of the distal tibiofibular distance. Sixteen (73%) had syndesmosis instability confirmed with a hook test and were fixed with a syndesmotic screw. Eight (66%) out of 12 Wagstaffe fractures were fixed with a syndesmotic screw due to the instability. The distal tibiofibular distance was 7.4+/-2.4 mm, 4.6+/-1.9 mm and 4.9+/-1.9 mm preoperatively, postoperatively, and at the final follow up, respectively. All cases achieved union and good clinical results with more than 85 on the AOFAS score were obtained. CONCLUSION: Weber type B lateral malleolar fractures can be associated with a syndesmosis injury. An intraoperative hook test should be carried out for accurate diagnosis. Considerable attention needs to be paid to Wagsteffe fractures, because of the high probability of combining syndesmosis instability.