Modified Implant Fixation Technique Is an Alternative for Patients with an Anterior Cruciate Ligament Tear in Limited Resource Settings: A Comparison Functional Outcome Study with Polyether Ether Ketone and Bioabsorbable Screws.

Background: Anterior cruciate ligament (ACL) injury is one of the most prevalent factors contributing to knee instability worldwide. This study aimed to evaluate modified metal fixation techniques for ACL reconstruction compared to factory-made implants, such as polyether ether ketone (PEEK) screws, bioabsorbable screws, and modified metal implants. Methods: A retrospective cohort analysis was conducted to assess the functional outcomes of ACL using various fixation methods. Patients who underwent arthroscopic ACL reconstruction at several healthcare facilities were included in the study. The functional outcomes were evaluated using the Lysholm Knee Scoring Scale and the International Knee Documentation Committee (IKDC) score questionnaire at 6- and 12 months post-surgery. Statistical analyses, including the Shapiro-Wilk test and analysis of variance, were performed to compare outcomes among the fixation groups. Results: Thirty-three patients who underwent ACL reconstruction surgery with varying distributions across the three fixation groups (modified metal implants, PEEK screws, and bioabsorbable screws) were included in the study. As measured by the Lysholm and IKDC scores at 6- and 12 months post-surgery, the PEEK group demonstrated the highest average scores. Nevertheless, these functional outcomes were not significantly different between the groups (p = 0.140, 0.770, 0.150, and 0.200). These findings align with those of meta-analyses comparing different fixation methods for ACL reconstruction. Conclusions: While acknowledging the small sample size as a limitation, this study suggests that modified metal implants represent viable options for ACL reconstruction. The selection of fixation methods should consider patient characteristics and preferences, emphasizing biomechanical stability and long-term outcomes. Further research is needed to validate these findings and explore their biomechanical properties and cost-effectiveness.

Distally based hemisoleus flap for soft tissue defect closure following chronic osteomyelitis of the distal tibia: A case report.

INTRODUCTION AND IMPORTANCE: Chronic osteomyelitis often needs extensive debridement that leaves a gap and needs soft tissue reconstruction procedure. The use of pedicled versus free flap to reconstruct soft tissue following surgical debridement has long been debated. Pedicle flap is more favored by many surgeons for the distal third tibia, mainly due to its lower failure rate. CASE PRESENTATION: We report a 33-year-old man with eight years of chronic osteomyelitis treated with surgical debridement at the distal third tibia, leaving a 5 cm × 6 cm soft tissue defect with exposed bone. Against the common preference, we performed a distally based hemisoleus flap (pedicled flap) covered with a split thickness skin graft. No signs of flap/graft rejection were observed during follow-up, and the patient was able to return to work four months following the surgery. No limitation in patient's daily activity upon two years follow up. CLINICAL DISCUSSION: Preservation of critical perforators is essential during the elevation of the flap. The knowledge and application of the vascularity and angiosome principles are crucial in designing this type of flap, as some anatomical variations do exist. Meticulous tissue handling is required to support the basic knowledge of the lower limb vascular system. CONCLUSION: Distally based hemisoleus flap is a reasonable option for soft tissue defect following chronic osteomyelitis of the distal tibia.

Long term follow-up of Maduromycosis treatment: A case review.

Maduromycosis is a rare deep fungal infection characterized by painless progressive destruction of limb caused by either fungal or filamentous bacteria. Its presentation is usually initiated by trivial penetration injury in farmers or laborers, worsen by immunocompromised status. Due to its painless course, this infection will severely destruct and deform hence leading to high morbidity of patient. We report a rare presentation of maduromycosis in 49-year-old housewife with no history of penetrating injury and no comorbid. Multi-disciplinary team was involved to establish the accurate diagnosis. The patient underwent surgical debridement and was given prolonged anti-fungal therapy. Combination of the treatments with patient's adherence lead to recovery without further recurrence and the patient was able to perform daily living activity.

Estudio cadavérico de anteversión de cuello femoral en Población de Indonesia / Cadaveric Study Of Femoral Neck Anteversion In Indonesian Population

Objective: The normal morphology of femoral anteversion is an essential factor which determines the clinical results of hip replacement to achieve the normal activity and the length of the replaced joint. No previous study has been documented regarding normal value of femoral anteversion in Indonesian population and how they are different with Western, India and African population. This study aimed on measurement of normal femoral anteversion values of Indonesian population and compare it with existing data of Western, African and India values. Method: This cross-sectional study by measuring the femoral neck anteversion angle in 120 samples of Indonesians's cadaveric femur. Comparisons were made between Western, African and India. Result: The result showed that the average values of femoral neck anteversion angle in men were 11.60 ± 4.83 and 12.96 ± 5.1 in the right and left parts respectively, while in women, the results were 14.83+-5.14 and 13.37+-5.66 in right and left parts. The p value of ≤ 0.05 was considered to be significant. Conclusion: The mean femoral anteversion values of Indonesian population is 13.22. It is significantly different in comparison with Western, African, and Indian population.

Good functional outcome evaluation of free vascularized fibular head graft (FVFHG) as treatment after resection of giant cell tumor (GCT) campanacci 3 at proximal humerus: A case report.

INTRODUCTION: Giant cell tumor (GCT) is benign aggressive tumors with a high rate of recurrence and capacity to metastasize. Wide resection is the treatment of choice, but this creates a flaw at the proximal end of the humerus. There are various methods exist as the treatment option to fixed this problem. PRESENTATION OF CASE: We here present our experience on wide resection and free vascularized autogenous fibula head grafting for GCT at the proximal humerus of a 32 years old male. We performed free vascularized fibular head graft (FVFHG) as a reconstruction method followed by sling procedure and used the long head of biceps tendon. Evaluation of anatomical, functional, and radiological outcomes of this management was performed. After 3 years, the patient has a good outcome. DISCUSSION: Free vascularized fibula graft is the most favored as a treatment after resection of a tumor on the proximal humerus. The advantages are can be harvested without many difficulties and rapid healing. In our case, we used a free vascularized fibular head graft (FVFHG) for proximal humerus reconstruction after resection giant cell tumor (GCT) on the right proximal humerus. We use the peroneal artery as vascular pedicle due to well vascularity to the peripheral part of fibula. There is no fibula head reabsorption after three years post-operation. CONCLUSION: FVFHG for reconstruction modality as the treatment after resection of GCT grade Campanacci 3 on proximal humerus shows satisfactory result following long term evaluation.