[Anterolateral ankle pain: differential diagnosis and approach. A case report]. / Dolor anterolateral de tobillo, diagnóstico diferencial y abordaje. Presentación de un caso.

The ankle soft tissue pathology represents a very painful disorder for patients who, often times, are not precisely diagnosed. Anterolateral ankle impingement is a condition that occurs in young people and athletes due to a plantar flexion-inversion mechanism. We report a case of anterolateral ankle impingement describing the arthroscopic technique and making the differential diagnosis considering other conditions.

[Benefit of the stabilization of long-bone fractures in polytraumatized patients]. / Beneficio de la estabilización de fracturas de huesos largos en politraumatizados.

INTRODUCTION: Early fracture fixation is increasingly common in medical practice, and femur shaft fractures are the perfect prototype of the lesion warranting early surgery in polytraumatized patients. Damage control orthopedics (DCO) is defined as the minimally-traumatic interventions intended to provide quick stabilization of orthopedic injuries to minimize the systemic inflammatory response. MATERIAL AND METHODS: By means of an evidence-based medicine tool (CAT) we approach the benefit of long-bone fracture stabilization in polytraumatized patients trying to answer a specific clinical question from a concrete situation: What is the evidence of the safety and benefit of early stabilization of long-bone fractures in polytraumatized patients? RESULTS: The patient group whose fractures were stabilized after 48 hours had more clinical complications, alterations of lung parameters and a longer hospital stay. There is no complete evidence showing that early stabilization of long bones in patients with moderate or severe head trauma worsens or improves the outcomes. CONCLUSIONS: Urgent fracture stabilization should be an adjuvant to resuscitation. Early fracture stabilization contributes to reducing the ICU stay, the incidence of acute respiratory distress syndrome (ARDS), multiple organ failure (MOF) and sepsis, thus improving patient survival.

Dolor fémoro-rotuliano. Tratamiento mediante denervación rotuliana artroscópica / Patellofemoral pain: treatment by arthroscopic patellar denervation

Introducción. El objetivo de este estudio es presentar una nueva técnica artroscópica que permite el tratamiento de pacientes con dolor fémoro-rotuliano, y nuestra experiencia y los primeros resultados de la denervación rotuliana artroscópica.Material y método. Se presentan 10 pacientes (8 mujeres y2 hombres; media de 33 años) con dolor fémoro-rotulianoy sin causas evidentes que justifiquen su clínica, tratados mediante denervación rotuliana artroscópica.Resultado. Se ha conseguido una mejoría significativa clínica y funcional en todos los casos. A los 6 meses todos los pacientes habían vuelto a sus actividades cotidianas sin dificultad, incluida la práctica deportiva sin limitaciones. A los dos años de evolución no se han observado cambios clínicos.Conclusiones. La denervación rotuliana artroscópica es una alternativa válida de tratamiento para aquellos casos que presentan dolor fémoro-rotuliano sin alteraciones evidentes. La técnica que se describe es sencilla y segura; al igual que todas las técnicas artroscópicas presenta una escasa morbilidad. A pesar de los buenos resultados el número de pacientes es escaso y es necesario completar el estudio

Introduction. This study presents a new arthroscopic technique for the treatment of patients with patellofemoral pain together with our experience of the procedure and the preliminary results of arthroscopic patellar denervation in patients with intractable patellofemoral pain we have obtained.Materials and methods. Ten patients with patellofemoralpain and no evident alterations (8 women, 2 men; mean age33 years) were treated by arthroscopic patellar denervation, involving a thermal lesion to the peripatellar soft tissue.Results. Considerable functional improvement was obtainedin all cases. At six months after the procedure, all patients had resumed their normal daily activities and the younger patients were able to do sports without difficulty. None of the patients showed any clinical changes during the two-year follow-up period.Conclusions. Patellar denervation may be the solution forcases of intractable patellofemoral pain without evident alterations. The technique described in this study is simple to perform and safe. As with other arthroscopic procedures, morbidity is low. This is a preliminary study in a small number of patients, but the results warrant further study with a control group and long-term follow up

Stress fracture of the ulna associated with crutch use.

Stress fractures of the ulna are extremely rare. The purpose of this article is to report one more case of this occurrence in an eleven-year-old girl, who was using adjustable metal crutches, and to discuss the possible cause.

Bifurcate popliteus tendon.

An 18-year-old woman suffering from lateral patellar pain and subluxation underwent knee arthroscopy. The arthroscope revealed a bifurcate appearance of the popliteus tendon. This is the first report of this appearance at arthroscopy. The bifurcate popliteus tendon is a normal variant finding with no clinical significance.

Arthroscopic medial bipartite sesamoidectomy of the great toe.

This is the first report of a successful first metatarsophalangeal joint medial bipartite sesamoidectomy using great toe arthroscopy. The surgical trauma associated with open operative sesamoidectomy can be minimized using minimally invasive techniques under arthroscopic control. The authors describe the surgical principles and discuss the advantages compared with traditional surgery.

Arthroscopic management of tibial plateau fractures: special techniques.

Arthroscopic assessment and treatment of tibial plateau fractures has gained popularity in recent years. This article describes some maneuvers to facilitate the management of these fractures with the arthroscope. We use a 14-mm rounded curved periosteal elevator to manipulate fragments within the joint instead of using a probe. To facilitate visualization of fractures, we describe the use of loop sutures around the meniscus to retract the meniscus when there is a tear in the meniscus. We suggest the use of the arthroscope for directly viewing the interosseous space to be sure that any internal fixation devices remain outside the articular space. The use of these tactics will allow a faster, more accurate reduction with less radiation exposure in patients with displaced tibial plateau fractures.

Core decompression and arthroscopic bone grafting for avascular necrosis of the knee.

We report a case of spontaneous avascular necrosis of the knee successfully treated with core decompression and arthroscopic bone grafting with a bone plug of autogenous graft obtained from the iliac crest. A 2-year follow-up shows excellent clinical and magnetic resonance imaging results.

Avulsion of the patellar ligament with combined fracture luxation of the proximal tibial epiphysis: case report and review of the literature.

Disruption of the extensor mechanism of the knee joint at the insertion site of the patellar tendon into bone is a somewhat common injury. Avulsion of the patellar ligament associated with fractures of the proximal tibial epiphysis is an extremely rare injury. Only three cases have been published in association with avulsion fracture of the tibial tubercle. We are reporting a case that has previously not been reported to our knowledge: an avulsion of the ligament in a closed fracture of the proximal tibial epiphysis with integrity of the tibial tubercle. We propose a three-type classification of an avulsion patellar ligament injury.

Fracture of the styloid process of the temporal bone. A case report.

A case of fracture of the styloid process of the temporal bone (Eagle's syndrome) is reported. The differential diagnosis is discussed.

The arthroscopic knot technique for fracture of the tibia in children.

A technique for arthroscopic treatment of anterior intercondylar eminence is described. This technique avoids the use of screws, making it unnecessary for a second operation to remove them.

Magnetic resonance imaging (MRI) of a benign cystic teratoma in the gluteus region.

Magnetic resonance imaging (MRI) was used to help in the diagnosis of a teratoma in the gluteus maximus region. As far as we know no case of this kind of tumour has been investigated with MRI examination.