ABSTRACT
Osteoid osteoma (OO) is a common benign tumor that tends to affect children and young adults. Patients typically present with nocturnal pain that is relieved with non-steroidal anti-inflammatory drugs (NSAIDs) and a unique round or oval radiolucent area with surrounding sclerotic bone on X-ray. The cortex of the diaphysis or metaphysis of long bones is the usual anatomical location, with only 4% of cases localizing to the foot and ankle. Treatment options include medical management, surgical excision, and less invasive techniques such as radiofrequency ablation (RFA). We present a case report of a 21-year-old female with an osteoid osteoma of the calcaneus, a rare presentation for this type of tumor. She was successfully treated with RFA and had an excellent functional outcome.
ABSTRACT
Introduction This study aimed to evaluate the knowledge of tourniquet use among orthopedic surgeons in Saudi Arabia and assess the practical aspects of their use of tourniquets and the complications they have experienced in their practices. Materials and methods This cross-sectional study was conducted from December 2022 to February 2023. An online questionnaire was distributed among orthopedic surgeons and trainees in Saudi Arabia, and the surgeons' knowledge of tourniquet use was assessed using 17 questions. To investigate tourniquet usage, the participants were divided into three groups: orthopedic residents, specialists, and consultants. An upper limb cuff pressure (CP) of 200 mmHg and a lower limb CP of 250 mmHg were chosen as the cut-off values, and the doctors' choices were compared against literature recommendations using these measures. Result A total of 205 participants filled out the questionnaires; 130 residents, 15 consultants, and 60 specialists, with more males (175/205) than females responding. One hundred and twenty-one surgeons placed the cuff on patients by themselves, while 50 (24.3%) surgeons asked nurses for aid; 135 (65.6%) of them work in teaching hospitals, while 50 (24.3%) work in community hospitals. The incidence of post-tourniquet syndrome was unrelated to expertise (p=0.12). Conclusion When applied properly, tourniquets prevent excessive bleeding and keep the operative field clean during limb surgeries. This study aims to inspire the orthopedic community to reconsider long-held practices, especially regarding tourniquet pressure. The addition of ligature safety education to orthopedics training and outlining the settings and procedures for applying pressure should also be considered. The orthopedic community should set CP and process criteria to avoid complications. This study showed the importance of modifying the training of orthopedic residents to raise awareness and prevent unpleasant events from occurring.
ABSTRACT
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.
ABSTRACT
Klippel-Trénaunay-Weber syndrome (KTWS) is a rare condition characterized by a classic clinical triad. However, it can also have other features, such as cavocarus foot deformity, which is a rare presentation in a patient with KTWS. In this case report, we present our surgical technique of correcting such a complex deformity. Also, there are no other similar cases reported in the literature. An 18-year-old girl who is a known case of KTWS with a complaint of progressive unilateral left foot deformity. Her examination, revealed a rigid pes cavus with an equinus deformity in the left foot. Radiography of the left foot revealed marked cavus as well as hindfoot and forefoot varus. A successful surgical correction of the deformity was described in a stepwise fashion. The management of foot cavocarus deformity in KTWS patients is associated with high intra- and post-operative risk due to its complexity. Therefore, the management requires a multidisciplinary team approach.
