ABSTRACT
INTRODUCTION AND IMPORTANCE: Pure ankle dislocation is a rare injury, and this injury is an orthopedic emergency requiring immediate reduction. In more common circumstances, this injury is usually associated with malleolar fractures. The standardized treatment protocol is still deficient. CASE PRESENTATION: We report a case of a 33-year-old woman who presented with an open ankle dislocation without concomitant malleolar fractures. Early extensive wound debridement, immediate reduction, and immobilization of the ankle joint using an external fixator were performed during the first surgery. During the second surgery, which was performed 3 weeks later, the medial and lateral ankle ligaments were repaired, and a suture tape internal brace was added. A good functional outcome with the American Foot and Ankle Society score of 87 was achieved at 1-year follow-up. DISCUSSION: In an open dislocation with massive ligamentous injury, staged surgery could be performed to prevent deep infection, with extensive debridement and immobilization using an external fixator in the first stage and ligament repair in the second stage. An internal brace using a suture tape is an option for ligament repair if the remnant is not sufficient to be repaired, as in this case. Early range of motion exercises should be initiated after second-stage surgery to prevent stiffness. CONCLUSION: Staged surgery using an external fixator and ligament repair using a suture tape and internal brace augmentation can be an effective option for a pure ligamentous ankle dislocation with an open wound and a poor remnant of ankle ligaments.
ABSTRACT
INTRODUCTION AND IMPORTANCE: Femoral shaft fracture is one of the most frequent injuries encountered by an orthopedic surgeon. Surgical treatment is commonly needed. Intramedullary nailing remains the gold-standard in surgical treatment of femoral shaft fracture. One of the constant dilemmas in intramedullary nailing is whether to use a static or dynamic locking screw for treating femoral shaft fractures. CASE PRESENTATION: We reported three cases of simple femoral shaft fracture and surgically fixed with primary dynamic interlocking nail. Closed reduction with reamed nail was performed in 2 cases, and mini open reduction with un-reamed nail was performed to the other one. Early weight bearing was instructed at day 1 post-operative. Mean follow-up period was 12.6 months. A solid bony union was achieved by all patients, and no complications were observed at the final follow up. CLINICAL DISCUSSION: Intramedullary nailing can be made static or dynamic. It is thought that in static mode of the intramedullary nailing, the axial weight is transferred through the locking screws rather than the fracture site, thus altering the callus formation and delaying fracture healing. A prompt dynamization of the fragments allows the contact of both fragments during mobilization and promotes early callus formation. CONCLUSION: Primary dynamic interlocking nail is an effective option for surgical treatment in simple or short oblique femoral shaft fracture.
ABSTRACT
INTRODUCTION: The prevalence of osteoarticular tuberculosis is increasing. Tuberculous infection in midfoot is rare. Establishing the diagnosis is difficult, leading to delay in management and leave many complications. CASE PRESENTATION: An 18-year-old man presents to our clinic with pain on his foot for the last 1 year. No other remarkable signs and symptoms. X-ray of his foot shown destruction of the 1st tarsometatarsal joint, later confirmed with MRI that shown synovitis and bone edema. Mantoux test and biopsy were done and established the diagnosis of tuberculous infection. CLINICAL DISCUSSION: Intensive phase of anti-tuberculosis chemotherapy was given for 2 months, followed by continuation phase for 7 months. Surgical management of debridement and arthrodesis were performed as adjunctive treatment. At 10 months follow-up patient was pain free, fully weight-bearing and no signs of further destruction. CONCLUSION: Osteoarticular tuberculosis is difficult to diagnose, a high index of suspicion is required to avoid delay treatment and complications. Anti-TB chemotherapy is still the treatment of choice, with surgical management is reserved for advance case.
