Regeneration of Fibula Following Distal Fibulectomy for Ankle Arthrodesis Following the Use of Calcium Sulphate Granules: A Case Series and Review of the Literature.

Regeneration of the fibula following partial fibulectomy is a common and well-reported phenomenon in children. However, there is limited literature on the regeneration of fibula in skeletally mature individuals. We report a case series of regeneration of the distal fibula following partial distal fibulectomy. In both these cases, calcium sulphate (Stimulan-Biocomposites, Keele, UK) antibiotic-loaded beads were used for local delivery of a high concentration of antibiotics. However, calcium sulphate worked as an osteoconductive agent and led to regeneration of the fibula. Regeneration of the fibula has its benefits and downside. Regeneration can be beneficial in patients in whom future arthroplasty is considered as total ankle replacement would not be possible in the absence of distal fibula. On the contrary, a regenerated fibula can be a source of ankle pain related to the syndesmotic joint. There is also a report of infection recurring in the regenerated fibula. Hence, while using calcium sulphate beads either as a spacer or as a vehicle for local delivery of antibiotics, the operating surgeon needs to be aware of the risk of regeneration of the fibula if the periosteum is preserved. How to cite this article: Goru P, Haque S, Hirst T, et al. Regeneration of Fibula Following Distal Fibulectomy for Ankle Arthrodesis Following the Use of Calcium Sulphate Granules: A Case Series and Review of the Literature. Strategies Trauma Limb Reconstr 2021;16(2):123-126.

Hip fracture fixation in a patient with below-knee amputation presents a surgical dilemma: a case report.

INTRODUCTION: Hip fracture fixation surgery in patients with below-knee amputations poses a challenging problem to the surgeon in terms of obtaining traction for reduction of the fracture. The absence of the foot and part of the leg in these patients makes positioning on the fracture table difficult. We highlight this difficult problem and suggest techniques to overcome it. CASE PRESENTATION: A 73-year-old man with bilateral below-knee amputations presented with a history of fall. Radiographs revealed an inter-trochanteric fracture of the femur. A dynamic hip screw fixation was planned for the fracture but the dilemma was on how to position the patient on the fracture table for the surgery. Special attention was needed in positioning the patient and in surgical fixation of the fracture. CONCLUSION: Hip fracture fixation in patients with below-knee amputations poses a special problem in positioning for fracture reduction and fixation. In this case report, we share our experience and suggest techniques to use when encountering this difficult problem.

A comparison of radiation exposure with the conventional versus mini C arm in orthopedic extremity surgery.

BACKGROUND: The mini C arm is a mobile fluoroscopic device for use on extremities. It has been reported that this type of device has several advantages over a conventional C arm, the most important of which is a decreased level of radiation scatter to the surgeon. METHODS: This was a case control study. The radiation dose to the surgeon was calculated from the radiation exposure time and distance from the x-ray emitter. Cases using the mini C arm were compared with operation-matched controls that had the identical procedure performed with a conventional C arm. RESULTS: The mini C arm caused statistically less radiation scatter to the surgeon, but there was no statistically significant difference in the radiation exposure to the patient. This was despite a significantly larger number of exposures with the mini C arm for each operation type. CONCLUSIONS: The mini C arm should be used in preference to the conventional C arm for extremity surgery, if both are available.

The effects of mass immunization on Haemophilus influenzae type B-related orthopaedic disease.

Haemophilus influenzae type B has been responsible for a significant proportion of cases of septic arthritis in children in the past. This study looks at the effects of vaccination on childhood orthopaedic infection. Data were collected from 1988 by the Public Health Laboratory Services. Data were analysed with a two-sample t-test. A total of 16 of 17 cases were attributed to H. influenzae type B. Fourteen cases occurred in 5 years before mass immunization. Only two cases occurred in the 8 years following immunization. The incidence of H. influenzae septic arthritis in children has fallen significantly since the introduction of immunization (P=0.009). Vaccination has resulted in a significant fall in the incidence of H. influenzae type B septic arthritis in children.

Avulsion of the L4 spinous process: an unusual injury in a professional rugby player: case report.

STUDY DESIGN: A case of L4 spinous process avulsion following a hyperflexion injury treated with surgical excision. OBJECTIVE: To show that single photon emission computerized tomography is essential for the diagnosis and that excision can provide a successful outcome. SUMMARY OF BACKGROUND DATA: The avulsion resulted from a forced hyperflexion injury at the L4/5 area, where the interspinous ligament provides a high resistance to flexion. METHODS: A 29-year-old international rugby football player injured his low back during a match. Plain radiography and magnetic resonance imaging did not reveal the injury. Single photon emission computerized tomography and computerized tomography showed the lesion. RESULTS: Initial conservative therapy failed to control the symptoms, and, therefore, late excision was performed with pain-free return to contact sports at 3 months. CONCLUSIONS: Few cases of interspinous process avulsions have been described, and, to our knowledge, this is the first reported case of rugby football player who had a successful outcome with late surgical excision.