Foreign body reaction to artelon spacer: case report.

Anecdotal reports of painful synovitis after implantation of the Artelon spacer (Small Bone Innovations, Inc., Morrisville, PA) have emerged. The manufacturer claims that this type of reaction is related to the method of fixation and/or to suture material. This report illustrates one case in which a patient exhibited sustained painful synovitis after implantation of the Artelon spacer in the scaphotrapezio-trapezoidal joint, which clinically resolved on removal of the implant. Furthermore, pathology specimens of the soft tissue, synovium, and bone demonstrated an exuberant granulomatous foreign body giant cell reaction to the implant material. Patients should be made aware of the potential of the Artelon spacer to cause a foreign body reaction that may necessitate reoperation for removal of the implant.

Acute pediatric upper extremity compartment syndrome in the absence of fracture.

BACKGROUND: To determine the etiologies and outcomes associated with acute pediatric upper extremity compartment syndrome in the absence of fracture. METHODS: A retrospective review was performed looking at children treated for acute upper extremity compartment syndrome in the absence of fracture at a major teaching hospital. Reason for admission, age, etiology, sensorium, time to fasciotomy, involved compartments, secondary procedures, and functional outcome were recorded. RESULTS: A total of 14 extremities in 13 children with acute compartment syndrome in the absence of fracture were identified over a 22-year period at this single institution. There were 8 boys and 5 girls, with an average age of 7.2 years. Average follow-up was 22 months. Ten patients were being managed in the intensive care unit and had an obtunded sensorium. The cause was iatrogenic in 8 patients, and 2 of these resulted in loss of the involved limb. Six patients required 9 secondary procedures, including 4 amputations, 3 contracture releases, and 2 skin grafts. Of the 3 patients who required a total of 4 amputations, 2 of the patients were in the intensive care unit, and all were younger than 3 years. Only 7 patients had normal hand function. Upon comparing patients with a normal outcome versus those with an abnormal outcome, there was a statistically significant difference if surgery was performed in shorter than 6 hours (P = 0.033). CONCLUSIONS: This problem is often iatrogenic in etiology and can be diagnosed late in this population. An increased level of vigilance should be adopted for this entity because the final outcome can be catastrophic for both the patient and the hospital and early fasciotomy is associated with improved results. LEVEL OF EVIDENCE: Level IV Case Series.

Pseudo os trigonum sign: missed posteromedial talar facet fracture.

BACKGROUND: Posteromedial talar facet fracture (PMTFF) is a rare injury, sparsely reported in the literature. This article proposes that PMTFF is often left undiagnosed by orthopaedic surgeons and suggests the routine application of advanced radiographic studies (i.e., CT scan) in the recognition of PMTFF. It also evaluates nonoperative management of PMTFF. METHODS: After obtaining Institutional Review Board approval, the medical records over a 5-year period (1997-2001) were retrospectively reviewed from the foot and ankle service of a level 1 trauma center, identifying all cases of PMTFF. Charts were reviewed for relevant data. Results of treatment were assessed during follow-up physical examination. RESULTS: Six cases of PMTFF were identified over a 5-year period. All injuries were associated with medial subtalar joint dislocation. Four of six (66%) patients were not initially diagnosed with PMTFF, but instead misdiagnosed as an os trigonum. The remaining two patients had an established diagnosis of PMTFF at the time of initial treatment. All had short leg cast immobilization for medial subtalar dislocation. CT evaluation yielded additional diagnoses in all six patients. All six patients showed a PMTFF. Five patients (83%) revealed persistent subtalar joint subluxation. Five of six (83%) patients required at least one additional procedure as a result of an undiagnosed or nonoperatively treated PMTFF. Four patients underwent subtalar joint fusion, and one patient underwent tibiotalar calcaneal fusion secondary to concomitant ankle/subtalar arthritis. The patient who did not undergo recommended fusion continued to be symptomatic. CONCLUSIONS: Diagnosis of PMTFF necessitates a heightened clinical suspicion, especially when a medial subtalar joint dislocation is present. Proper imaging studies, such as coronal CT scan, should be performed after any subtalar dislocation. Timely treatment, in the form of open reduction and internal fixation for large fragments involving the articular surface or surgical excision for smaller fragments, is recommended in order to restore proper anatomy and function of the subtalar joint. This study verifies the significant morbidity associated with an undiagnosed or nonoperatively treated PMTFF.