Weil's osteotomy versus distal metatarsal metaphyseal osteotomy for the treatment of metatarsalgia. A metaanalysis of outcome and complications.

BACKGROUND: Weil's osteotomy (WO) and distal metatarsal metaphyseal osteotomy (DMMO) are considered to be the gold standard of managing metatarsalgia. Stiffness and floating toe are the main disadvantages of the WO, whereas delayed union or malunion and prolonged swelling are the main complications of the DMMO. The purpose of this study is to compare these two methods, in terms of outcome and complications, through a metaanalysis of the literature. MATERIALS AND METHODS: Pubmed, Google Scholar and Mendeley databases were searched for studies comparing directly the outcome of DMMO and Weil's osteotomy, with a minimum follow up of six months. The random effects model was used for the metaanalysis. The quality of studies was assessed using the MINORS criteria. RESULTS: Four studies were eligible for the analysis including 211 patients in total. The mean difference of the postoperative American Orthopaedic Foot and Ankle Society (AOFAS) score and the visual analogue scale (VAS) among the two techniques was - 1,04 (C.I.: -3,50 - 1,43) and - 0,39 (CI: -0,83 - 0,08) respectively. The risk difference regarding postoperative stiffness, swelling and residual metatarsalgia was - 0,09 (95% C.I.: -0,23 - 0,06), - 0,17 (95% C.I.: -0,62 - 0,29) and - 0,06 (95% C.I.: -0,20 - 0,08) respectively. CONCLUSION: Based on the existing literature, Weil's osteotomy and DMMO are equally safe and effective for the treatment of metatarsalgia. More studies of better quality are required, in order to extract safer and absolute conclusions regarding this topic.

Bizarre Parosteal Osteochondromatous Proliferation of the Hand: A Report of an Atypical Case and Current Concepts.

Bizarre parosteal osteochondromatous proliferation (BPOP), or Nora's lesion, is an unusual, benign, bony lesion often found in the tubular small bones of the hand and foot. In general, two characteristic radiological signs are used to diagnose the lesion, namely, (1) the absence of corticomedullar continuity and (2) BPOP developed from the parosteal surface of bones with an intact underlying cortex. Here, we present an atypical case of Nora's lesion of the proximal phalanx of the index finger, in which BPOP was diagnosed only histologically, with preoperative imaging examinations (X-ray and MRI) suggesting another lesion (enchondroma). Therefore, imaging (X-ray and MRI) alone may be inadequate to achieve the correct diagnosis of the lesion because many cartilaginous neoplasms may surround a broad range of lesions that mimic BPOP. Only histopathological evidence can confirm the correct diagnosis of the lesion.

Can Nondisplacement Osteoporotic Pubic Rami Fracture Be Life-Threatening Injuries? A Case Report, Overview, and Algorithm Protocol for Management.

Pubic rami fractures in the geriatric population are usually osteoporotic fractures resulting from low energy trauma and are characterized as stable injuries. Established treatment of these injuries is conservative, including rest, analgesic medication, and progressive active mobilization. These injuries are life-threatened when pubic rami fractures are accompanied by acute bleeding, either from an injury to a vessel (corona mortis) or from medication (anticoagulant or antiplatelet) for comorbidities, then. In this case study, we present the unusual case of an 82-year-old woman admitted to the emergency department 24 hours after a simple fall, causing nondisplacement osteoporotic pubic rami fracture, who, after 48 hours, developed a hematoma on the contralateral side of the pelvis, with progressive anemia and acute abdominal pain. This study has 2 objectives: to increase awareness of this life-threatening injury in the emergency department and to describe diagnosis and treatment modalities.

Lower Limb Paralysis as Initial Presentation of Arterial Embolism Secondary to Heparin-Induced Thrombocytopenia after Hip Fracture - a Case Report.

Introduction: Prophylactic anticoagulation (AC) with low molecular weight heparins (LMWHs) following hip fracture has reduced the incidence of severe thromboembolic events. However, heparin-induced thrombocytopenia (HIT) remains a serious complication in these patients. Clinical case: We report an unusual case of thrombosis due to severe HIT in a 75-year-old female patient following intramedullary nailing for a hip fracture. The patient was taking Verapamine. On the fourth postoperative day she developed paralysis, paresthesia and mild pain over the right lower extremity; faint pulses were palpated. Computed tomography angiogram identified superficial artery occlusion leading to limb ischemia. Anti-platelet factor 4 (PF4) heparin antibody positivity confirmed the diagnosis of HIT. Urgent embolectomy was performed and the patient achieved full recovery. Discussion: Arterial embolism presenting with severe neurological deficits is a rare complication of HIT. Conclusion:A high index of suspicion and close platelet count monitoring is warranted for early diagnosis and treatment of this devastating condition that can be limb and life threatening.

Sciatic nerve injury after acetabular fractures: a meta-analysis of incidence and outcomes.

PURPOSE: To investigate the incidence and the outcome of post-traumatic and iatrogenic sciatic nerve palsy (SNP) associated with fractures of the acetabulum. The results of sciatic nerve grafting for treatment were also investigated. METHODS: PUBMED, SCOPUS and COCHRANE databases were searched for longitudinal observational studies reporting sciatic nerve palsy related to acetabular fractures in adult patients over the last 20 years. Data regarding patients demographics, type of acetabular fracture, rate of post traumatic and iatrogenic sciatic nerve palsies as well as recovery rate are reported. Studies were assessed for their quality. Random effects meta-analyses were carried out to pool overall proportions of SNP incidence and complete recovery. Variations in SNP incidence by main study characteristics were assessed by subgroup analysis and meta-regression. A narrative review of sciatic nerve grafting was also conducted. RESULTS: Twenty studies reporting 44 post-operative and 18 iatrogenic SNPs in 651 patients were reviewed. The pooled incidence of posttraumatic SNP was 5.1% (95% CI 2.7-8.2%). The pooled incidence of iatrogenic SNP was 1.4% (95% CI 0.3-2.9%). Complete recovery of post-traumatic and iatrogenic SNP occurred in 64.7% (95% CI 41.7-85.4%) and 74.1% (95% CI 31.5-100%), respectively. CONCLUSION: A favorable outcome of both post-traumatic and iatrogenic SNP related to acetabular fractures has been found. Due to the poor results of sciatic nerve grafting, a "wait and see" approach may be the best option, in cases of a contused but anatomically intact sciatic nerve.

Pseudoaneurysm of the Anterior Interosseous Artery and Anterior Interosseous Nerve Palsy. A Rare Postoperative Complication of Ulnar Fracture Osteosynthesis: A Case Report.

Peripheral arterial pseudoaneurysm is an uncommon complication after open reduction and internal fixation of bone fractures. Here, we describe a rare case of a 72-year-old man who developed a delayed pseudoaneurysm of the anterior interosseous artery after open reduction and internal fixation of an isolated ulnar fracture (nightstick fracture). He presented with a painful forearm mass and anterior interosseous nerve (AIN) neuropathy. Though rare, the appearance of AIN neuropathy is a potential complication of forearm fractures' fixation that should be diagnosed early and managed with a prompt and appropriate treatment.

Isolated Radial Nerve Palsy as a Complication After Anterior Dislocation of the Glenohumeral Joint: A Case Report and Clinical Review.

Shoulder dislocation is the most common feature in emergencies, while the anterior dislocation of the glenohumeral joint is the most frequent and requires reduction. Accompanied nerve injury is common with an incidence of 21%, while radial nerve palsy is very rare. We describe the case of a 56-year-old man who presented with an anterior dislocation of the left shoulder due to a fall on an outstretched hand with wrist drop 8 hours after injury. Neurological examination revealed loss of sensation along the radial border of the forearm. Closed reduction with Kocher procedure was performed. Magnetic resonance image demonstrated a rotator cuff tear, and 3 weeks after the injury electromyography showed complete radial nerve palsy. A physiotherapy program was applied to the wrist and fingers with the goal of maintaining a full passive range of motion in all joints affected while shoulder rehabilitation started 6 weeks after his fall. Isolated radial nerve palsy associated with an anterior dislocation of the shoulder is very rare but not impossible to occur. Correct diagnosis of the nerve injury associated with the anterior dislocation is very important because it has serious implications on the management and activity morbidity.

Pasteurella multocida wound infection transmitted by a pet dog.

INTRODUCTION: Human pasteurellosis is a severe human infection that accounts for 20-30 human deaths annually worldwide. Mucous secretions derived from pets comprise the primary source of infection, which are transmitted through animal scratches or bites. CASE REPORT: We describe a case of Pasteurella multocida wound infection in an immunocompetent adult with a decubitus ulcer of the lower extremity. The organism was also isolated from an oral swab of the patient's dog with which he reported close contact. The patient had a favorable outcome following aggressive surgical debridement, antimicrobial treatment and subsequent wound care. CONCLUSION: Our case illustrates that licking of open wound is an alternative source of infections by Pasteurella multocida, and emphasizes the need for avoidance of wound contact with animals.