Clinical observations on surgical details of resection of heterotopic ossification at the hip in traumatic brain-injured adult.

Heterotopic ossification (HO) complicated with neurovascular bundle can be a very challenging operation. Preoperative planning before any HO resection is imperative. Plans to reconstruct nerve or artery should be in place. A case study is presented that involved a large bone mass of HO in hip joint which enclosed the sciatic nerve. Preoperative planning, microsurgical techniques, and equipment necessary for this complicated surgical procedure are reviewed.

Arthrodesis of the ankle and subtalar joints in patients with haemophilic arthropathy.

SUMMARY: There have been only a few studies in the literature that reported on the outcome of ankle arthrodesis in patients with haemophilia; furthermore, the number of patients was usually low and the operative technique has not been uniform. The aim of this study was to evaluate the outcome of surgery in haemophilic arthropathy of the ankle and subtalar joints, using internal fixation. From 1983 to 2006, 20 fusions were performed in 13 patients with advanced haemophilic arthropathy of the ankle and subtalar joints. There were 11 ankle fusions, one isolated subtalar fusion and eight combined ankle and subtalar fusions. Three of the latter had a subtalar fusion at a second operation. The mean age at operation was 38.7 years and the mean followup was 9.4 years. In the majority of the cases, the ankle fusion was achieved by two crossing screws. For the subtalar fusion, either staples were used or the tibiotalar screws were extended to the calcaneus. Arthrodesis of the ankle was successful in all but one patient, in whose case the procedure was revised and eventually his condition was progressed to fusion. There was also one case of painless non-union of the subtalar joint which was not revised. There was no recurrent bleeding, and no deep infection. Arthrodesis with cross screw fixation is an effective method for fusion of the ankle and subtalar joints in patients with haemophilia.

Distal tibial fractures treated with hybrid external fixation.

Management of distal tibia fractures remains challenging. The purpose of this study was to evaluate whether hybrid external fixation, as definite treatment, was associated with satisfactory results and low rate of complications. Between November 1999 and October 2006, 48 patients (33 men and 15 women) with a mean age of 45.6 years and a median ISS of 14.3 were admitted to our department with a distal tibia fracture and treated with the use of a hybrid external fixator. Eight patients had an open fracture. Mean follow-up was 14 months (range, 9-36 months). In 40 patients, radiographic evidence of union was observed at 3.6 months (range, 3-6 months). Delayed union was observed in three patients. There were five non-unions (10.4%) with three of them were septic. When compared to previously reported series, with conventional open reduction and internal fixation, the use of hybrid external fixation with or without open reduction and internal fixation of the fibula, was associated with satisfactory clinical and radiographic results and limited complications.