Acute Dislocation of the Elbow: An All-Arthroscopic Repair of the Lateral Ligament Complex.

The elbow is one of the most commonly dislocated joints. While conservative management is frequently performed for simple elbow dislocations, the importance of primary surgical treatment is still undetermined. However, promising results have been reached after surgical repair. We propose an arthroscopic surgical repair of the lateral ligament complex (LCL), performed with a horizontal suture and 2 Fibertak Knotless implants (Arthrex) placed on the LCL origin, one anterior and the other posterior. Operative treatment should be performed in patients with moderate and gross elbow laxity to avoid post-traumatic sequelae and decrease revision rates. Arthroscopic techniques create fewer complications. This procedure allows one to address intra-articular elbow joint pathology with less chance of wound complications and the ability to use bone anchors if desired.

Pearls and tips in coverage of the tibia after a high energy trauma.

Coverage of soft-tissue defects in the lower limbs, especially open tibial fractures, is currently a frequently done procedure because of the high incidence of high-energy trauma, which affects this location. The skilled orthopedic surgeon should be able to carry out an integral treatment of these lesions, which include not only the open reduction and internal fixation of the fracture fragments but also the management of complications such as local wound problems that may arise. There is a wide variety of muscular or pedicled flaps available for reconstruction of lower limb soft-tissue defects. These techniques are not commonly used by orthopedic surgeons because of the lack of familiarity with them and the potential for flap failure and problems derived from morbidity of the donor site. We present a coverage management update for orthopedic surgeons for complications after an open tibial fracture. We choose and describe the most adequate flap depending on the region injured and the reliable surgical procedure. For proximal third of the tibia, we use gastrocnemius muscle flap. Middle third of the tibia could be covered by soleus muscle flap. Distal third of the tibia could be reconstructed by sural flaps, lateral supramalleolar skin flap, and posterior tibial perforator flap. Free flaps can be used in all regions. We describe the advantages and disadvantages, pearls, and tips of every flap. The coverage of the tibia after a major injury constitutes a reliable and versatile technique that should form part of the therapeutic arsenal of all the orthopedic surgeons, facilitating the integral treatment of complex lower limb injuries with exposed defects.