Treatment of Open Traumatic Medial Malleolus Bone Loss With Osteochondral Allograft: A Case Report.

Osteochondral damage to the ankle joint can be a difficult problem to manage in a young active patient. There are several described surgical treatments ranging from cartilage repair techniques to arthrodesis and ankle replacement. In this case, we present a 28-year-old male who sustained a right type IIIA open medial malleolus fracture following an all-terrain vehicle crash. After sharp debridement, the clinical decision was made to treat the patient with an osteochondral allograft. At one- and two-year post-allograft reconstruction, radiographs demonstrated good incorporation of the graft. The patient was ambulating with no pain or assistive devices. Our case report specifically describes the successful treatment of a traumatic medial malleolus ankle fracture with bone loss using an osteochondral allograft in a young active patient.

The Use a Prophylactic Intramedullary Tibial Nail for a Stress Fracture in a High-Level Athlete.

INTRODUCTION: Mid-diaphyseal anterior tibial stress fractures can be debilitating injuries. They have been described occurring in athletes due to repetitive lower extremity trauma. The purpose of our study was to highlight a case of an athlete sustaining a tibial stress fracture with multiple cortical defects. CASE REPORT: We present an 18-year-old collegiate bound athlete who sustained a tibial stress fracture with multiple cortical defects. The clinical decision, after failure of conservative treatment, was made to treat the patient with tibial intramedullary nailing. She was able to return to full unrestricted activities, including high-level sports participation. Our case report specifically describes a case of a high-level athlete with multiple anterior tibial linear cortical defects from a chronic stress fracture. CONCLUSION: When conservative management for mid-diaphyseal anterior stress fractures fails, the utilization of prophylactic tibial nailing is a viable option. The decision for surgical intervention is dependent on many factors including patient's activity level and characteristics, failure of conservative management, and radiographic evidence of non-healing stress fractures.

Postlaminectomy kyphosis in an achondroplastic adolescent treated for spinal stenosis.

We report a case of a skeletally immature achondroplastic adolescent with significant thoracolumbar lordosis who presented with neurogenic claudication and urinary incontinence progressing over a 1-year period. She underwent decompressive lumbar laminectomy from T12 to L5 with preservation of the facet joints. Over the ensuing 4 years of follow-up, she developed a progressive thoracolumbar kyphosis that progressed to 105 degrees. She remained neurologically intact and was fully ambulatory, but had severe back pain in the area of the deformity. Because of the severity and progression of her deformity, a combined anterior and posterior fusion and stabilization was required. We present this case and a review of the literature on spinal stenosis in achondroplasia and the complication of post-laminectomy kyphosis.