Targeted Minimally Invasive Percutaneous Posteromedial Release of Residual Clubfoot in Myelomeningocele Patients: A Report of Two Cases.

Congenital talipes equinovarus (CTEV) is commonly associated with myelomeningocele (MMC). It is thought to be a mixture of intrauterine development and a result of an imbalance in muscular innervation. Conservative management has been explored for those cases, but most resulted in recurrence. In this study, we report two cases where targeted minimally invasive percutaneous posteromedial release of residual clubfoot was done using an 18-gauge needle and a small incision for the cuboid osteotomy. In both cases, we achieved plantigrade shoeable/braceable feet. Both cases are still followed in our clinic. They require further follow-up to assess their long-term outcomes.

Extraarticular Pretibial Synovial Cyst After Arthroscopic Anterior Cruciate Ligament Reconstruction: A Case Report.

Arthroscopic reconstruction of the anterior cruciate ligament has been modernized through new materials and novel surgical techniques. The usage of bioabsorbable screws for tibial fixation may potentially lead to complications, such as formation of a tibial tunnel or pretibial cysts. This is a relatively rare complication, but it has been described in the literature. The pathomechanism of cyst formation, however, still remains poorly understood. In this case report, we present a case of a healthy 23-year-old gentleman who had left tibia vara, which was treated surgically with proximal tibia corrective osteotomy with plate and screw fixation and subsequent hardware removal. Later in his life, he injured his anterior cruciate ligament, which required arthroscopic reconstruction. Years after, he developed a pretibial synovial cyst, which was visualized on magnetic resonance imaging. We reviewed previously published cases with similar presentations to help describe the possible etiology of intraosseous (tibial tunnel) cysts.

Traumatic fracture of the polyethylene tibial post and cone in a posterior-stabilized total knee arthroplasty: A case report.

INTRODUCTION AND IMPORTANCE: Very few reports addressed polyethylene tibial post and cone fractures requiring revision surgery. Up to our knowledge, this particular pattern of wear, involving 2 fracture areas simultaneously, has not been previously described. CASE PRESENTATION: A 70 year-old female developed a fracture involving both the tibial insert post and cone after a minor trauma after undergoing posterior-stabilized total knee replacement 4 years prior. CLINICAL DISCUSSION: This unique pattern of wear may occur even after minor trauma. CONCLUSION: We recommend having a low threshold to investigate minor trauma in this patient population, even years after undergoing primary knee arthroplasty.

Bilateral Lisfranc Injury in a Young Female: A Case Report.

Lisfranc injuries are relatively rare, accounting for only 0.2% of all injuries. It is even rarer to have this injury bilaterally, and not many case reports have been published on this topic. In this report, we present a case of a bilateral Lisfranc injury in a healthy 17-year-old woman that fell from a flight of stairs landing on both feet. The diagnosis was made by weight-bearing x-rays and computed tomography. Weight-bearing x-rays showed a subtle Lisfranc injury in the right foot with widening between the first and second rays and a disruption involving the overlapping bases of the lesser metatarsals as well as a left comminuted fracture of the proximal third and fourth metatarsals (MT) with intra-articular extension at the proximal fourth MT. CT scan of the right foot showed a fracture of the lateral margin of the medial cuneiform with a displaced bony fragment as well as a comminuted fracture of the third and fourth metatarsals with intra-articular extension and no dislocation. Surgical management, in the form of open reduction and internal fixation, was undertaken for both feet in the same setting. She had an expected course postoperatively and has been doing well, with no pain nor limitation in her activity at her six-month postoperative visit. Moreover, we present a brief review of similar published cases and an overview of Lisfranc injuries.

Bilateral trochlear avascular necrosis: A case report and brief review of the literature.

INTRODUCTION AND IMPORTANCE: Trochlear AVN is a very rare entity with only a limited number of cases being reported. CASE PRESENTATION: Our case is interesting as it presents a case of an incidentally found bilateral trochlear AVN in a 12 year-old child when he presented with an undisplaced right supracondylar fracture. CLINICAL DISCUSSION: It is highly likely that an unknown underlying predisposing factor, possibly recurrent microtrauma, was responsible for the bilateral occurrence. CONCLUSION: We recommend further research to identify other etiological and predisposing factors, as the etiological factors still remain unclear, despite the available literature.

Assessment of serum vitamin D levels in surgical adolescent idiopathic scoliosis patients.

BACKGROUND: The mechanism behind idiopathic scoliosis and its progression is not fully understood. Vitamin D insufficiency is known to play a role in the progression and/or occurrence of a variety of bone diseases. In this study, we aimed to estimate the prevalence of vitamin D insufficiency among patients with adolescent idiopathic scoliosis. Additionally, we aimed to calculate the differences in serum vitamin D levels, Cobb angles, spinal bone mass densities, and serum alkaline phosphatase levels between the sexes in the sample and to assess the possibility of a correlation between any of these factors. METHODS: Demographic details, vitamin D levels, Cobb angle, spinal bone mass density, and alkaline phosphatase were collected from the records of 67 patients who were eligible for corrective surgery. These values were compared to normal levels and between the sexes within the study. RESULTS: Of the 67 patients, 54 (80.6%) were female. The mean serum vitamin D level was 37.86 ± 26 nmol/L, and levels below normal were found in 92.5% of the patients. Statistical analysis showed significant differences (p = 0.002) in serum alkaline phosphatase levels between the sexes. No correlation was found between vitamin D levels and the Cobb angles, spinal and bilateral femoral neck bone mass densities, and serum alkaline phosphatase levels. CONCLUSIONS: Most adolescent idiopathic scoliosis patients had insufficient serum vitamin D levels and also suffered from low bone mineral density at an early age.

Outcomes of Arthroscopy-assisted Closed Reduction and Percutaneous Pinning for a Displaced Pediatric Lateral Condylar Humeral Fracture.

BACKGROUND: Since 2015, we have performed arthroscopy-assisted closed reduction and percutaneous pinning (A/S-CRPP) for children with a displaced lateral condylar humeral fracture (LCF). The purpose of this study is to introduce our A/S-CRPP method and present its outcomes. METHODS: In total, 39 displaced (>2 mm) LCFs for which A/S-CRPP was initially attempted and with available follow-up data of >12 months were retrospectively reviewed. A/S-CRPP is performed in the following order: closed reduction, 1 provisional K-wire fixation, arthroscopic verification of the reduction status, rereduction if needed, and additional fixation. Our reduction technique using articulations of the ulnohumeral and radiohumeral joints and direct compression is introduced. For rereduction, modified reduction forces were applied based on the arthroscopic findings. To evaluate the learning curve effect, the initial 6 months after the first case of A/S-CRPP was regarded as the "initial period." There were 12 cases during this period. RESULTS: Among the 39 cases, surgical method was intraoperatively converted to open reduction and percutaneous pinning in 9 and A/S-CRPP was completed in 30. Among the 9 open reduction and percutaneous pinning conversion cases, 7 conversions occurred in the initial period. Among the 30 patients who underwent A/S-CRPP alone, 10 needed rereduction after an arthroscopic examination. No patients presented with >10-degree angular deformity or elbow motion limited >20 degrees, compared with the contralateral elbow. Postoperative radial nerve palsy occurred in 2 patients, all in the initial period. Both were resolved within 5 months, postoperatively. CONCLUSIONS: We suggested our A/S-CRPP surgical technique for displaced pediatric LCF. It may require a 6-month learning curve period. Although more studies are needed, it seems to be a safe and appropriate surgical technique for treatment. LEVEL OF EVIDENCE: Level IV-therapeutic study.