[Knee gouty monoarthritis. An arthroscopic view]. / Monoartritis gotosa de rodilla "una vista artroscópica". Reporte de un caso clínico.

INTRODUCTION: Gout is the symptom caused by the response to monosodium urate crystals that develop due to hyperuricemia; it is the most frequent inflammatory arthropathy in males over age 40. OBJECTIVE: To demonstrate the diagnosis as an arthroscopic finding. MATERIAL AND METHODS: The case of a male, 39 year-old patient without a relevant medical history whose illness started with left knee trauma consisting of rotation and forced valgus. He initially had pain and inflammation and was treated with immobilization for two weeks. Pain and inflammation persisted so plain films and MRI were ordered and they showed a lesion of the medial meniscus. Arthroscopy of the left knee was performed. RESULTS: The nuclear MRI showed a lesion of the medial meniscus and a chondral lesion of the medial condyle. Preoperative tests showed a uric acid level within the upper normal limit. The arthroscopy showed a transverse lesion of the medial meniscus that was repaired as usual; lesions were found throughout the articular surface, with crystal deposits, as well as an important synovial inflammatory reaction and medial condyle chrondropathy. DISCUSSION: Arthroscopy of a gouty knee shows urate deposits that partially cover the synovial, the anterior cruciate ligament, the menisci and lesion zones in the articular surfaces. Removal of gouty collections and a thorough articular lavage improve the local symptoms of the disease. No synovectomy was performed, as is recommended in the literature.

[Total hip arthroplasty in Klippel-Trenaunay syndrome. Case report and literature review]. / Artroplastía total de cadera en el síndrome de Klippel-Trenaunay. Reporte de un caso y revisión de la literatura.

INTRODUCTION: Klippel-Tranaunay syndrome is a rare congenital condition characterized by skin angiomas with arteriovenous malformations and hypertrophy of the soft and bone tissues of one extremity. The clinical case presented herein involved total hip replacement due to arthrosis secondary to avascular necrosis of the femoral head, which resulted in the hypervascularity that occurs with this syndrome. A 37 year-old female was diagnosed with grade IV hip arthrosis and Klippel-Trenaunay syndrome. Laboratory and imaging tests were performed to determine the local conditions for the surgical approach to the hip. The preoperative MR angiography identified the arteriovenous malformation tract to determine the limits of the approach. DISCUSSION: The arteriovenous malformations that occur in this syndrome turn the approach into a challenging one due to the potential bleeding, thus extreme prophylactic and technical measures must be applied. There are very few reports in the literature on this treatment.

[Anterior enucleation of a talus with "triple loss of relations". Case report and literature review]. / Enucleación anterior del astrágalo "pérdida triple de su relación". Presentación de un caso.

INTRODUCTION: When the talus loses its triple connection with the ankle mortise, a rare injury occurs in 3-4% of the ankle dislocations; 75% of the injuries are open. A clinical case is presented herein, together with its clinical course and a review of the literature. CLINICAL CASE: The case of a male, 52-year-old patient with a left ankle inversion and extension injury is presented. At the time of admission to the emergency room he had triple closed anterior dislocation of the talus. Closed reduction was performed under anesthesia, an acrylic boot was placed and he was followed-up at the outpatient service. RESULTS: The patient did well and was immobilized initially with an acrylic foot-thigh brace for six weeks; he then wore an acrylic suropodalic brace for 4 weeks and started partial weight bearing with crutches at 10 weeks; total weight bearing with crutches at 12 weeks, and without crutches at 16 weeks. Shortly before this a bone scan was performed and no signs of avascular necrosis were found. CONCLUSIONS: Triple talar dislocation is a rare injury and its major complication is avascular necrosis and secondary arthrosis that could result in the need for panastragalodesis; the prognosis depends on the timeliness of care, it is a true emergency.