The effectiveness ORIF for neglected periprosthetic femoral fractures after hemiarthroplasty: A case report.

INTRODUCTION AND IMPORTANCE: Periprosthetic fractures are a growing concern due to the increasing frequency of primary joint replacement surgery, with total hip arthroplasty being the most common. The incidence of periprosthetic fractures after revision surgery ranges from 4 to 11 %, with up to 30 % reported after knee revision surgery. This case report aims to describe the treatment of an 81-year-old woman suffering from neglected periprosthetic femoral fracture post hemiarthroplasty. CASE PRESENTATION: An 81-year-old woman with a history of hemiarthroplasty surgery and hypertension was admitted to the ER with pain in her right thigh. She had a middle shaft femoral fracture and was scheduled for open reduction and internal fixation. Despite being fully conscious and having an average pulse rate and blood pressure, she had cardiomegaly and congestive pulmonum. Unfortunately, this patient did not receive appropriate medical treatment after it occurred for 1 month. After surgery, we evaluated the implant, and the implant stabilized the fracture. After 1-3 months after surgery, the LEFS (The Lower Extremity Functional Scale) score was found that the score increase significantly after surgery. CLINICAL DISCUSSION: The Vancouver classification system manages periprosthetic fractures by assessing location, stability, and bone quality. Type A fractures involve the trochanter, while type B fractures are diaphyseal and can extend distally. ORIF is used for subtype B1 fractures, but newer techniques offer shorter operating times and fewer complications. CONCLUSION: From this study, we can conclude that even though neglected cases procedure with ORIF promises a good outcome based on clinical evaluation.

Arthroscopic assisted percutaneous fixation in ankle pilon fracture: A case report.

INTRODUCTION: Results of operative fixation for ankle fractures had been suboptimal, with cases of posttraumatic osteoarthritis occurring following the surgeries. Intra-articular injuries have been suggested as the cause of this problem. This case report aims to present an ankle pilon fracture Ruedi Allgower type II case treated with percutaneous fixation and arthroscopy evaluation. PRESENTATION OF CASE: Female, 17 years old, complained of pain and swelling at the right ankle. The physical examination revealed swelling, deformity, tenderness, and limited range of motion at the right ankle. The radiological examination showed a Ruedi Allgower type II pilon fracture with right ankle dislocation. The patient underwent closed reduction, arthroscopy to evaluate her right ankle and percutaneous internal fixation. The post-surgery evaluation showed a stable ankle. DISCUSSION: Patients undergoing ankle fracture surgery may benefit from ankle arthroscopy because it may increase visualization of articular reductions, assess and repair cartilage and ligament damage, remove loose bodies, decrease soft tissue exposure, preservative vascularity, and evaluate syndesmosis. Moreover, rapid arthroscopic evaluation has a low complication rate. The ability of arthroscopy to improve syndesmotic instability diagnosis suggests that arthroscopy may play a significant role in managing ankle fractures. CONCLUSION: Arthroscopy-assisted internal fixation provides more benefits and information as a single case report, and more studies are warranted; regarding patients' intra-articular injuries, preventing future complications, such as posttraumatic osteoarthritis.

Assessment of Changes in Hindfoot Alignment of Total Ankle Arthroplasty for Ankle Osteoarthritis on Weightbearing Subtalar X-ray View.

Background: Recovering normal hindfoot alignment and correcting deformity of the ankle joint following total ankle arthroplasty (TAA) in osteoarthritis (OA) is essential for improving clinical outcomes and increasing long-term survival. We aim to evaluate hindfoot alignment following standard TAA compared to TAA with a total talar prosthesis ("combined TAA") in varus-type OA patients. Methods: This retrospective study was conducted between 2010 and 2022. We included 27 patients (30 feet) who underwent standard TAA and 19 patients (22 feet) who underwent combined TAA. Hindfoot alignment at the subtalar joint was measured by weightbearing subtalar radiographic view before and after surgery. Results: In the standard TAA, the angle between the tibial shaft axis and the articular surface of the talar dome joint (TTS) changed from 75 to 87 degrees (P < .01), the angle between the tibial axis and the surface on the middle facet (TMC) from 89 to 94 degrees (P < .01), and the angle between the tibial axis and the surface on the posterior facet (TPC) from 80 to 84 degrees (P < .01). The angle between the articular surface of the talar dome and the posterior facet of the calcaneus (SIA) decreased from 4.7 to -2.5 degrees (P < .01). In the combined TAA, TTS angle changed from 77 to 88 degrees (P < .01), TMC angle from 93 to 101 degrees (P < .01), TPC angle from 84 to 90 degrees (P < .05), and SIA from 6.6 to 2.1 degrees (P < .01). Varus deviation to the subtalar joint (TMC, TPC) significantly improved postoperatively in both groups. However, TPC was smaller than TTS and SIA was negative in standard TAA, and TPC was larger than TTS and SIA was positive in combined TAA. Conclusion: The amount of correction of the subtalar joint differed depending on the ligament dissection of the subtalar joint and shape of the talar component. Level of Evidence: Level III, retrospective cohort study.

Patellofemoral functional outcome of gracilis sparing compared to gracilis sacrificing ACL reconstruction.

Introduction: The hamstring is the most popular autograft used for anterior cruciate ligament reconstruction (ACLR). Despite its excellent outcome, donor site morbidity is also irritating. Patellofemoral problems are reported to be one of the side effects after hamstring autograft harvesting, suggested to be due to both gracilis & semitendinosus sacrificing. Some experts propose retaining gracilis to decrease patellofemoral problems. The all-inside technique is an advantageous ACLR technique that can preserve the gracilis muscle while reducing muscle strength loss of affected limbs and the risk of knee joint instability under rotational load. This study aims to compare the patellofemoral functional outcome of both gracilis sparing and sacrificing using a validated Kujala score three months after ACLR. Methods: There was total of 20 subjects who underwent ACLR between December 2021 and May 2022 and met the inclusion criteria. They were then grouped into gracilis sparing group (n = 10) and gracilis sacrificing group (n = 10). Follow up assessment (Kujala Score) was conducted during phase II of the rehabilitation program. The assessed variables were surgery technique, time of surgery-to-evaluation, and Kujala Score. Result: There were no significant differences in Kujala Score between gracilis sparing and gracilis sacrificing groups (p = 0.809). There was a strong positive correlation between the time of surgery-to-evaluation and Kujala Score in each group (p = 0.942 and p = 0.910, respectively). Conclusion: There are no differences in patellofemoral functional outcomes between patients who undergo gracilis sparing and gracilis sacrificing ACLR with good scores of Kujala, which means both gracilis sparing and sacrificing show no harm to the patellofemoral after the ACLR.

Study epidemiology of risk fracture in osteoporosis based on frax score, and osta score, with risk of fall using Ontario score in elderly Indonesia.

Background: Osteoporosis is characterized by a low bone mass of bone tissue. If osteoporosis is not treated properly, it will increase the high risk of fracture. The common causes of fracture on osteoporosis condition due to falls. This study aims to find the correlation between the risk of osteoporosis with fall risk (ONTARIO) based on osteoporosis fracture risk (FRAX). Methods: This study is an analytic study with a cross-sectional method. We collected the sample using random cluster sampling in the six primary health care in Malang on different times service since August-September 2021. Total patient 139, however only 132 patients were included in this study. After collecting data is complete, we analyze using Chi-square tests. Results: The mean age of participants was 63.9 ± 7.14. with the age group was dominated by the range of 60-64. It was found that the result of the FRAX SCORE had a low-risk category for major fracture osteoporosis and risk hip fracture. In contrast, from the OSTA score in this study, more than 68 participants (50.8%) were found medium and high-risk scores. Then, in ONTARIO score of the risk fall assessment, and high score in 57 participants (43.2%). If compared between OSTA and ONTARIO, there was a significant relationship between OSTA score and ONTARIO score (p < 0.000) with high-risk OSTA have a significant relationship with a high risk of falling and vice versa. Conclusion: In this study, there was a relationship between the risk of high osteoporosis and the risk of falling.

Plating technique outcome evaluation in calcaneal fracture based on American orthopaedics foot and ankle score and Böhler-Gissane angle: A case series.

INTRODUCTION: Intraarticular Calcaneal fracture treatment nowadays is still up for debate. Surgical plating treatment is favorable because of the rapid healing process and better anatomical reduction despite the invasive intervention. Hence, clinical evaluation is needed to assess the quality-of-life index from foot and ankle by the American orthopaedics Foot and Ankle Society (AOFAS) score postoperatively. Then, the outcome evaluation of reduction in calcaneal plating of intraarticular calcaneal fracture with Böhler angle and Gissane angle to see if the calcaneal plating technique is a recommended treatment for the calcaneal fracture. METHODS: We treated six patients from December 2020-July 2021 with a calcaneal fracture that underwent surgical plating, mainly by one surgeon. A calcaneal fracture is classified according to sanders classification. In this study, four patients are above the age of 40, and two are under 25. Pre-operative Böhler angle ranged from 8 to 65°, and Gissane angle ranged from 134 to 158°. OUTCOMES: Surgical plating was performed on all six patients. From clinical evaluation using the AOFAS score, we got satisfactory results on all patients who underwent calcaneal plating surgery. Three patients achieved excellent range outcomes with 95% and 99% of AOFAS Scores, and three patients reported AOFAS score good range outcomes with the lowest score of 88%. From the radiological outcome, most of the patient's Böhler and Gissane angles achieved normal value after surgical plating. CONCLUSION: The calcaneal plating technique gives better anatomical reduction depending on Bohler and Gissane angle. These results promise that anatomical reduction can improve clinical outcomes based on the AOFAS score. Thus, the plating method can be used effectively to treat an intraarticular calcaneal fracture.

Superconstructs in reconstruction surgery of Charcot foot Brodsky 1: A case report.

INTRODUCTION: Charcot neuropathic osteoarthropathy (CN) is a chronic, progressive condition of joints, soft tissues, and bones. CN causes considerable high mortality and morbidity. A common issue is early diagnosis and appropriate treatment. Thus, the operative treatment is indicated when patients have progressive deformities, infection and ulceration. The superconstructs method for Charcot foot (CF) is considered giving better clinical outcome than other methods. PRESENTATION OF CASE: A 61-year-old male admitted to an outpatient clinic with chief complaint of swelling and pain on a left foot with history of diabetes mellitus type 2. From the physical examination, left foot revealed a swelling with rocker bottom deformity and limited range of motion. The radiological examination showed sclerotic appearance of bone deformity metatarsal joint of midfoot of toe. The patients were diagnosed with left Charcot foot Brodsky Type 1, Eichenholtz grade III with diabetes mellitus type 2. DISCUSSION: We made superconstructs rather than standard fixation which is frequently inadequate due to changes accompanying the Charcot process. Thus, we performed an adequate reduction of deformity, reduce soft tissue tension, fixation extension beyond a zone of injury, then use of strongest fixation devices that are applied to maximize mechanical function. CONCLUSION: This study showed that superconstructs provide satisfactory clinical and outcomes. This method is useful for achieving construct and stable fixation especially for Charcot foot.

Unusual combination of posterior cruciate ligament tibial avulsion fracture and Segond fracture: A case report.

INTRODUCTION AND IMPORTANCE: Posterior cruciate ligament (PCL) avulsion fracture is an uncommon entity, but it poses significant morbidity to patient's knee and activities. A combination of PCL avulsion fracture with Segond fracture is rare and has not been described much before in known literature. In this case report, we present a rare case of a combination of these two injuries. CASE PRESENTATION: A 16-year-old cyclist who sustained left knee injury after a high-velocity fall while cycling. He fell with his anteromedial side of his left knee hitting the ground in flexion. After the fall, he felt excruciating pain and unable to bear weight. Examination revealed severe joint effusion, tenderness on posterior and lateral side of the left knee, no vascular injury and neurological deficit present. Radiographic examination revealed PCL avulsion fracture and Segond fracture. Five days after the injury, the avulsed PCL fragment and the lateral tibial plateau fragment were reduced and fixed with 3.5 mm cortical screw and washers. On the follow up, the patient stated that there is no pain on weightbearing position and after evaluated with Knee injury and Osteoarthritis Outcome Score (KOOS), the result is 90%. CLINICAL DISCUSSION: Although the combination of PCL avulsion fracture and Segond fracture is rare, this pattern of injury could happen and could be considered when evaluating knee injuries. CONCLUSION: Both fractures need to be addressed and managed adequately to restore knee stability and prevent early joint degeneration.

Double posterior lateral plating arthrodesis for charcot ankle: A case series.

INTRODUCTION: Ankle arthrodesis is one of the managements for a significantly unstable Charcot ankle. Some of the methods of internal fixation for ankle arthrodesis include the use of intramedullary nails, screws, and plates. Ankle arthrodesis using intramedullary nails has become more popular. However, studies evaluating the use of plate fixation, particularly double posterior lateral plating, are limited. We report the clinical and radiological outcomes of double posterior lateral plating ankle arthrodesis in three diabetic Charcot ankle patients. PRESENTATION OF CASE: Three patients, aged 73, 67, and 65 years old, complained of ankle pain and with a history of type 2 diabetes mellitus. The physical examination revealed swelling and erythema without a sign of active infection. The radiological examination showed ankle deformity, and the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot scores were 5, 10, and 0, respectively. All patients were diagnosed with a diabetic Charcot ankle and underwent ankle arthrodesis using double posterior lateral plating. Four months and six months follow up revealed talus union, improved ankle deformity, and improved AOFAS Ankle-Hindfoot scores to 70, 76, and 73, respectively. DISCUSSION: Various methods of ankle arthrodesis are retrograde intramedullary nails, screws, and plates. In this report, we opt for plate fixation because it allows for stable internal fixation, adequate compression, high angular stability, and a lower irreversible deformation in osteoporotic bone. CONCLUSION: Double posterior lateral plating ankle arthrodesis provided satisfactory clinical and radiological outcomes. This method can be an alternative for patients with Charcot ankle requiring ankle arthrodesis.

Successful management of severe manifestation bone cemented implantation syndrome during hemiarthroplasty surgery in patient with multiple comorbidities: A case report.

INTRODUCTION: Bone Cement Implantation Syndrome (BCIS) is a lethal condition with complex physiological changes after the insertion of Methyl Methacrylate (MMA) cement during intraoperative arthroplasty. Despite the etiology and the pathophysiology of BCIS has not been fully understood, several mechanisms have been discovered. Some clinical manifestations of BCIS are hypotension, hypoxemia, a decrease of consciousness, arrhythmia, pulmonary hypertension, and cardiac arrest. PRESENTATION OF CASE: A 67 years old woman underwent cemented hemiarthroplasty operation due to intertrochanteric fracture in her right femur. The hemodynamic was stable before and during operation, but suddenly the patient went into cardiac arrest as the cement inserted. Immediate resuscitation was performed successfully and stable hemodynamic was achieved. DISCUSSION: Several risk factors including underlying cardiovascular disease, advanced age, osteoporosis (enlarged porous cavities increase the risk of emboli generation), fracture type, metastatic bone disease, femoral canal diameter of more than 21 mm, previously non-instrumented femoral canal, and patent foramen ovale (paradoxical embolus). Some studies have shown usage of H1 and H2 antagonists, methylprednisolone, inotropes, vasopressor, and some alterations in surgical technique, can prevent the progression of the BCIS. Communication between the orthopaedic surgeon and anesthesiologist and high-quality cardiopulmonary resuscitation (CPR) will become a good basis in treating BCIS. CONCLUSION: Preoperative optimization by increasing oxygen inspiration concentration, usage of inotropes and vasopressor, and avoiding intravascular volume depletion during operation is essential in cemented arthroplasty procedure. Both orthopaedic surgeon and anesthesiologist should recognize the clinical presentation of BCIS and well-prepared for the management of BCIS including any supportive measures.

Validity and Reliability of the Indonesian Version of the Kujala Score for Patients With Patellofemoral Pain Syndrome.

BACKGROUND: The Kujala score is a useful diagnostic tool to evaluate patellofemoral pain syndrome (PFPS). However, no validated Indonesian version of the Kujala score has been available. PURPOSE: To develop and validate an Indonesian version of the Kujala score. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 3. METHODS: This was a cross-sectional study to develop an Indonesian version of the Kujala score by using a forward-backward translation protocol. The resulting questionnaire was given to 51 patients diagnosed with PFPS. The validity of the questionnaire was evaluated by correlating the final score with the Indonesian version of the 36-Item Short Form Health Survey (SF-36). Reliability was measured by evaluating the internal consistency (Cronbach alpha) and test-retest reliability (intraclass correlation coefficient [ICC]). RESULTS: The Indonesian version of the Kujala score had a positive correlation with the physical components of the SF-36. The internal consistency was fairly high (α = .74), and the test-retest reliability was excellent (ICC, 0.996). CONCLUSION: The Indonesian version of the Kujala score was proven to be a valid and reliable tool to diagnose PFPS. Future epidemiological studies could implement this score to find the prevalence of PFPS in Indonesia. Further, ensuing studies could explore the application of this scoring system in posttreatment and postoperative settings.

Union of Brodsky type 1/Eichenholtz stage III Charcot neuroarthropathy after forefoot arthrodesis.

INTRODUCTION: One of the surgical intervention options for Charcot neuroarthropathy (CN) is arthrodesis. The arthrodesis procedure for the foot and ankle joint have been widely used in previous studies. This study aimed to evaluate the functional and radiological outcomes after arthrodesis procedure for the CN patient with Brodsky type 1/Eichenholtz stage III. PRESENTATION OF CASE: A 49-years-old diabetic woman presented with alteration of her right foot's shape and a cracking sensation while walking in the last six months. Rocker-bottom deformity and a decreased sensation on the right foot were found, and the initial American Orthopaedic Foot & Ankle Society (AOFAS) score was 45. Subsequently, forefoot arthrodesis of the right foot was performed. DISCUSSION: Several studies state that arthrodesis procedure is often used for CN management in order to achieve a plantigrade and stable foot. This study presents an improvement of the foot arch, AOFAS score, and union of the talus six months after surgery. CONCLUSION: The arthrodesis procedure by using screws and Kirschner wire (K-wire) fixation is an effective method in CN management if the patient is compliant. This study showed a good result, anatomically restored the foot arch, and excellent radiological union, but different tools to analyze foot functional status and longer follow up period are needed for a better analysis.

Primary single stage Total Hip Arthroplasty in a patient 40 years post traumatic Hip dysplasia, a case report.

INTRODUCTION: Hip dysplasia refers to an abnormal development of size, shape, or organization of the femoral head, acetabulum, or both. Managing acetabular dysplasia is very challenging in arthroplasty especially in traumatic hip dysplasia case. Mostly, hip dysplasia cases need a special implant, procedure and techniques. CASE PRESENTATION: We performed primary Total Hip Arthroplasty (THA) + partial tenotomy of hamstring, iliotibial band, hip abductor in a 73 year old male. His main complaint was that he was unable to sit due to an increasingly intense pain since 3 months ago and he has been unable to walk properly since 40 years ago when he had a major traffic accident and received inadequate treatment. The procedure had been successfully done using a well press-fit cementless acetabular cup and a cementless narrow stem application 1 cm on leg length discrepancy (LLD). CONCLUSION: Preoperative planning, surgical techniques and a post-surgery rehabilitation are the key to a successful management in this case.

Bilateral iliopsoas haemophilic "soft tissue pseudotumours": A case report.

Haemophilic soft tissue pseudotumour is one of the rarest complications of haemophilia that caused by repetitive bleeding resulting in an encapsulated mass of clotted blood and necrotic tissue. Soft tissue pseudotumour may not only cause flexion contracture but also chronic pain and femoral nerve compression that cause severe disability. Thus, surgical excision is the treatment of choice. It should only be carried out in a major haemophilic center by an integrated multidisciplinary surgical team.