Medial malleolus malunion with secondary tibiotalar and syndesmotic incongruence - two case reports and ''box resection'' for its treatment.

INTRODUCTION: Ankle fractures are among the most common injuries treated by orthopaedic surgeons. Malunion is one of the possible complications, and corrective surgery is often used to avoid long-term disability. However, few studies address medial malleolus malunion and the best revision surgery technique is controversial. We describe a new surgical technique, the "box resection". MATERIAL AND METHODS: We present two cases of medial malleolus malunion with secondary talus lateral translation and syndesmotic incongruence. In order to restore a congruent tibiotalar joint, we performed the described technique. RESULTS: We record significant improvement of AOFAS Score and range of motion in both cases, with resolution of pain symptoms. Postoperative radiographs show a congruent mortise with syndesmosis reduction. CONCLUSION: The box resection allowed immediate talus medial translation to its original position. It is a simple and effective solution, with a good functional outcome.

INTRODUCCIÓN: La consolidación viciosa del maléolo interno es una posible complicación en las fracturas maleolares. Su tratamiento es difícil y controvertido, por el momento no hay una solución estándar. Proponemos una nueva técnica quirúrgica para el tratamiento de estos casos que denominamos "resección en caja". MATERIAL Y MÉTODOS: Presentamos dos casos de consolidación viciosa del maléolo interno, asociados con traslación lateral del astrágalo y incongruencia de la sindesmosis, donde aplicamos la técnica quirúrgica descrita. RESULTADOS: En ambos casos, obtuvimos una mejora significativa en el puntaje AOFAS y en el rango de movilidad, así como en la resolución de las molestias por dolor. Las radiografías muestran mortajas congruentes y anatómicas, con una reducción satisfactoria de la sindesmosis. CONCLUSIÓN: La técnica de "resección en caja" es simple y eficaz produciendo un buen resultado clínico y funcional.

Medial malleolus malunion with secondary tibiotalar and syndesmotic incongruence - two case reports and «box resection¼ for its treatment / Mal unión del maléolo medial con incongruencia tibiotalar y sindesmótica: «resección en caja¼ para su tratamiento

Abstract: Introduction: Ankle fractures are among the most common injuries treated by orthopaedic surgeons. Malunion is one of the possible complications, and corrective surgery is often used to avoid long-term disability. However, few studies address medial malleolus malunion and the best revision surgery technique is controversial. We describe a new surgical technique, the «box resection¼. Material and methods: We present two cases of medial malleolus malunion with secondary talus lateral translation and syndesmotic incongruence. In order to restore a congruent tibiotalar joint, we performed the described technique. Results: We record significant improvement of AOFAS Score and range of motion in both cases, with resolution of pain symptoms. Postoperative radiographs show a congruent mortise with syndesmosis reduction. Conclusion: The box resection allowed immediate talus medial translation to its original position. It is a simple and effective solution, with a good functional outcome.

Resumen: Introducción: La consolidación viciosa del maléolo interno es una posible complicación en las fracturas maleolares. Su tratamiento es difícil y controvertido, por el momento no hay una solución estándar. Proponemos una nueva técnica quirúrgica para el tratamiento de estos casos que denominamos «resección en caja¼. Material y métodos: Presentamos dos casos de consolidación viciosa del maléolo interno, asociados con traslación lateral del astrágalo y incongruencia de la sindesmosis, donde aplicamos la técnica quirúrgica descrita. Resultados: En ambos casos, obtuvimos una mejora significativa en el puntaje AOFAS y en el rango de movilidad, así como en la resolución de las molestias por dolor. Las radiografías muestran mortajas congruentes y anatómicas, con una reducción satisfactoria de la sindesmosis. Conclusión: La técnica de «resección en caja¼ es simple y eficaz produciendo un buen resultado clínico y funcional.

Integration and Vascular Ingrowth of a Collagen Meniscal Implant: A Case Report.

Meniscectomy is the most common surgery in orthopaedics. The absence of meniscal tissue might be related to irreversible damage to the articular cartilage. Meniscal replacement is a tissue-engineering technique for post-meniscectomy syndrome. Its success depends on the implant integration which was vastly proven in animal model studies. Histological evidence is hard to obtain in humans due to ethical issues. We report a clinical case in which a collagen scaffold meniscal implant was harvested six months after implantation due to mechanical failure. Histological analysis was performed revealing vascularisation not only of the peripheral attachment of the implant but also on the anterior horn. These morphologic findings demonstrate that this implant allows the colonisation by precursor cells and vessels, leading to the formation of a fully functional tissue. This present report is one of the few independent reports of scaffold biological integration in the literature.

Integration and Vascular Ingrowth of a Collagen Meniscal Implant: A Case Report

@#Meniscectomy is the most common surgery in orthopaedics. The absence of meniscal tissue might be related to irreversible damage to the articular cartilage. Meniscal replacement is a tissue-engineering technique for postmeniscectomy syndrome. Its success depends on the implant integration which was vastly proven in animal model studies. Histological evidence is hard to obtain in humans due to ethical issues. We report a clinical case in which a collagen scaffold meniscal implant was harvested six months after implantation due to mechanical failure. Histological analysis was performed revealing vascularisation not only of the peripheral attachment of the implant but also on the anterior horn. These morphologic findings demonstrate that this implant allows the colonisation by precursor cells and vessels, leading to the formation of a fully functional tissue. This present report is one of the few independent reports of scaffold biological integration in the literature.

Creatinine reabsorption by the newborn rabbit kidney.

Plasma creatinine levels are elevated in the first postnatal days, and the highest plasma creatinine values are observed in the most premature infants. These high plasma creatinine levels remain "elevated" beyond the period in which the high plasma creatinine levels can be explained by maternal transfer of creatinine. To better define the renal handling of creatinine by the immature kidney, creatinine and inulin clearances were simultaneously measured in two groups of neonatal and one group of adult anesthetized, ventilated rabbits. In the adult animals the ratio of the creatinine and inulin clearance was as expected more than one (1.21), indicating an overestimation of the true GFR due to tubular secretion of creatinine. The creatinine and inulin clearance ratio in the first group of newborn animals, who received an exogenous creatinine infusion to achieve plasma creatinine levels comparable to those in the adult animals (84.1 +/- 1.0 mumol/L; 0.95 +/- 0.01 mg/dL), was 0.84. When in the second group of neonatal animals the plasma creatinine level was artificially doubled to 155.0 +/- 3.9 mumol/L (1.33 +/- 0.17 mg/dL), no significant difference between both clearance values was found (ratio: 0.96). These data show that in the newborn rabbit creatinine is reabsorbed along the tubule, an observation that can best be explained by the back-leak of creatinine across leaky immature tubules.

Renal effects of tolazoline in newborn and adult rabbits.

The effect of tolazoline on renal function was studied in normoxemic newborn and adult anesthetized rabbits. Adult animals responded to 1 mg/kg + 1 mg/kg/h of tolazoline with a marked increase in systemic blood pressure and renal vascular resistance along with a decrease in urine flow rate, glomerular filtration rate and renal blood flow. Blood pressure also increased in newborn rabbits given a similar dose of tolazoline, but the same renal parameters remained remarkably stable. The renal effect of tolazoline in adult animals probably corresponds to a partial alpha-agonist action of tolazoline. It is suggested that a relative adrenergic renal immaturity present in the newborn rabbit protects him from the deleterious effect of tolazoline.