Bilateral medial malleolus stress fractures due to osteoarthritis of knee: A case report and review of literature.

INTRODUCTION: Medial malleolar stress fracture is a relatively uncommon injury but it can occur in athletes participating in running and jumping activities. Stress fractures of pelvis, proximal tibia and metatarsals are well documented in the elderly population but medial malleolus involvement in this subgroup has never been reported. PRESENTATION OF CASE: We report a case of bilateral medial malleolus stress fractures secondary to bilateral knee osteoarthritis. DISCUSSION: Osteoporosis and mechanical malalignment have been postulated as the possible risk factors for stress fractures in the elderly population. The pathomechanics and management of the case are discussed here. CONCLUSION: A high index of suspicion is required to identify such fractures. Identification and treatment of the predisposing factors are a very important part of treatment.

Functional outcome of computer-assisted spinal pedicle screw placement: a systematic review and meta-analysis of 23 studies including 5,992 pedicle screws.

A number of studies have shown increased accuracy of pedicle screw placement in spine with the help of computer-assisted navigation. The literature is lacking in regard to functional benefit derived from this technique. The aim of this systematic review was to look at the functional outcomes following computer-assisted pedicle screw placement in spine. A 'Dialog Datastar' search was used using optimized search strategy covering the period from 1950 to July 2009; 23 papers were finally included which met our inclusion criteria. We report on a total of 1,288 patients with 5,992 pedicle screws. The comparison of neurological complications in two groups demonstrated an odds ratio of 0.25 (95% CI 0.06, 1.14) in favour of using navigation for pedicle screw insertion (p = 0.07). Comparative trials demonstrated a significant advantage in terms of accuracy of navigation over conventional pedicle screw insertion with a relative risk of 1.12 (95% CI 1.09, 1.15) (p < 0.00001). Navigation does not show statistically significant benefit in reducing neurological complications and there was insufficient data in the literature to infer a conclusion in terms of fusion rate, pain relief and health outcome scores.