Retrograde calcaneo-talo-tibial nail, subtalar arthrodesis and fibula transposition in the treatment of traumatic bone and articulatory defect of the distal tibia and talocrural joint: A case report.

High-energy trauma of the lower leg can cause conditions such as bone defects, loss of the articular surface or a complex soft tissue injury. Given the type of the injury, as well as the often poor general status of the patient, the initial treatment usually consists of debridement and external fixation. The role of the retrograde calcaneo-talo-tibial nail is acknowledged in the treatment of post-traumatic arthritis of the talocrural joint, rheumatic arthritis, the neuropathic joint as well as some other conditions. We present a case of a thirty-five-year-old man with a lower leg fracture and significant bone defect associated with the loss of the articular surface of the distal tibia which was treated with a retrograde calcaneo-talo-tibial nail. Due to the lack of an adequate implant on the market, an inversely introduced tibial nail was used. Following the nailing of the fracture and the recovery of the soft tissue, transposition of the ipsilateral fibula was performed. Nowadays, different methods for bone defect reconstruction are available such as distraction osteogenesis, bone transport, and the Masquelet technique. However, the calcaneo-talo-tibial nail and transposition of the fibula is another feasible and effective option, especially for unreconstructable joint surfaces.

Sponge Rubber Revealed Two Years After Penetrating Injury: A Case Report.

The present report illustrates a very rare case report of a foreign body granuloma of the foot associated with a 2-year period of a retained spongeous rubber foreign body after a penetrating injury. Because it appeared almost 2 years after the injury, the history of trauma was minimized, the foreign body had migrated from the plantar to the dorsal side of the foot, and the radiographic appearance resembled a malignant process, it was difficult to rule out the possibility of a malignant tumor. This case shows the weakness of magnetic resonance imaging in detecting spongeous rubber in the body. Also, a bone osteoblastic reaction to the foreign body has very rarely been noted. To the best of our knowledge, just 5 cases have been previously reported. Provided suspicion exists of previous trauma with an embedded foreign body, the differential diagnosis of a bone neoplasm should consider the possibility of a foreign body reaction. Biopsy proved to be the best diagnostic tool.

Influence of arthroscopic lateral release on functional recovery in adolescents with recurrent patellar dislocation.

INTRODUCTION: The aim of this study is to prove the influence of the arthroscopic lateral release on functional recovery in adolescents with recurrent lateral dislocation of patella. MATERIALS AND METHODS: From 2006 to 2009, arthroscopic release of the lateral retinaculum was done on 27 adolescent patients (24 women, 3 men) and 33 knees (in 6 patients on both knees). All of them were active in different sports. The severity of patellar subluxation and dislocation was analysed on X-ray; the Q angle, congruence angle, sulcus angle, patellofemoral angle and height ratio were measured. Functional scores (Lysholm, Kujala, Tegner) were measured preoperatively and postoperatively. The average duration of clinical and X-ray follow-up was 4.5 years (range 3-6 years). RESULTS: The mean age of the patients was 14.56 years (range 11-18 years). There was an average of 4.16 dislocations (range 2-28 dislocations) before surgery. The mean Lysholm score improved from 64 to 95 (p = 0.0002), and the mean Kujala score improved from 66 to 94 (p < 0.0001). Congruence angle and lateral patellofemoral angle improved but without any significant differences. CONCLUSION: Arthroscopic lateral release successfully treats recurrent patellar dislocations in adolescents, influences functional recovery and improves knee function.

Navicular index for differentiation of flatfoot from normal foot.

PURPOSE: The height of navicular bone from the floor is in proportion with the height of longitudinal arch of the foot. The study was conducted to evaluate correlation of navicular bone height with most often used angles, heel valgus and a foot print in order to simplify the procedure for the diagnosis of flatfoot. METHODS: A total of 218 operated children (436 feet) because of flexible flatfoot were evaluated clinically and radiologically. Meary angle, lateral talonavicular angle, talocalcaneal angle, calcaneal pitch, heel valgus and arch index (Staheli) were evaluated pre-operatively and postoperatively. In 121 (242 feet) chosen children (age eight to 15) with all clinical values and pre-operative angles corresponding flatfoot, all postoperatively measured values were within the normal range. We got the navicular index by dividing length of longitudinal arch with navicular height. Values of navicular index were then compared with pre-operatively and postoperatively measured values. Pearson correlation and ROC test were used for statistical analysis. RESULTS: Values of the navicular index for flatfeet were in the interval from 4.75 to 31.2 (median 8.98), and for normal-arched feet 3.58-22.6 (median 5.48). Pearson correlation of arch index and measured parameters were significant in majority, and degree according to Colton was good. Area under the ROC curve was 0.861 (p = 0.0001). The cut-off value with 86 % sensitivity and 75 % specificity was 6.7407. CONCLUSION: Navicular index can be used reliably, without measures of the other parameters, to differentiate flatfoot from normal-arched foot. Therefore, the navicular index has an ability to distinguish between the flatfoot and normal-arched foot.