Infected Tibial Plateau Open Reduction Internal Fixation Treated Using External Fixation and a Gastrocnemius Flap: A Case Report.

Here, we describe the case of an 80-year-old female patient with type II insulin-dependent diabetes mellitus with a left proximal tibia fracture. Open reduction internal fixation was performed using a locking plate. After the surgical site infection, the plate was removed and negative-pressure wound therapy was applied. The bone was covered with a vastus medialis muscle flap, and a split-thickness skin graft and external fixation using an Ilizarov device was performed as the definitive treatment.

Open Fracture Dislocation of the Talus With Partial Talar Extrusion: A Case Report.

We report a case of open talar fracture-dislocation (Gustilo-Anderson type IIIA) associated with a posterior tibial artery injury. The limb was aligned and splinted in the emergency department. In the operating theater, the posterior tibial artery was ligated, the talar neck fracture was reduced, and it was fixed with two Kirschner wires (K-wires). After K-wire removal, the patient underwent rehabilitation to regain function and resumed activities of daily living (ADL). At nine months of follow-up, the patient has a good ankle range of motion (ROM) and a congruent ankle joint but has developed avascular necrosis (AVN) of the talus. This case report highlights the high risk of talus AVN after open talar fracture dislocation. Preservation of the extruded talus and anatomical reduction can maintain ankle alignment, which is essential for arthrodesis in cases of AVN complications.

Irreducible Knee Dislocation With Vastus Medialis Muscle Interposition: A Case Report.

Irreducible knee dislocation (KD) is a rare high-velocity injury (determined by shear and/or rotational forces) that is associated with the interposition of capsule-ligamentous or muscle structures in the joint space. This condition often requires open reduction. To our knowledge, irreducible KD is not widely reported in the literature. Here, we report the case of a 69-year-old man with a right KD that occurred after falling from a height and entrapment of the leg between concrete blocks. The patient presented to the emergency department with a right knee deformity without distal neurovascular deficit. After two failed attempts of close reduction (under sedation and spinal anesthesia), open reduction was performed. Intraoperatively, there were cruciate ligament tears, wide capsule tears, and intra-articular vastus medialis interposition, preventing reduction. The decision to release the muscle from the notch, suture of the medial capsule, temporary K-wire stabilization, and cast immobilization were taken. After K-wire removal, the patient underwent rehabilitation to regain function and resume activities of daily living. This case report highlights the need for open reduction in some KD cases. Identifying possible soft-tissue interposition can accelerate surgical treatment and minimize the risk of complications.