Current Issue : April - June Volume : 2021 Issue Number : 2 Articles : 6 Articles
Ankle fractures are one of the most common injuries treated by orthopaedic surgeons. A minority of patients with ankle fractures go on to develop persistent pain following anatomical reduction. These sequelae may arise as a result of untreated ligamentous or chondral injuries. This study aims to correlate acute arthroscopic ankle findings with the Lauge-Hansen fracture pattern classification. We further aim to compare subjective functional outcomes at least one year following surgery between patients who have received Open Reduction and Internal Fixation (ORIF) alone, versus ORIF plus arthroscopy. This is a retrospective case series of patients who have undergone ankle fracture ORIF +/− arthroscopy from July 2014 to July 2017 inclusive. Each patient’s presenting radiograph was classified according to the Lauge-Hansen ankle fracture classification with subsequent correlation to intra-operative arthroscopic findings. Functional outcome at a minimum of one year was evaluated with the American Academy of Orthopaedic Surgeons (AAOS) metric. Twenty two patients underwent ankle ORIF plus arthroscopy (Group A) with a further 26 patients receiving ORIF alone (Group B). 1 in 3 supination- external-rotation type II (SER II) injuries possessed a concomitant syndesmosis injury or osteochondral lesion (OCL) on arthroscopy. 1 in 3 patients with an SER IV injury had an osteochondral lesion. The mean AAOS score achieved for Group A was 89.6 (±7.9) with the mean score for Group B being 82.0 (±13.7). In conclusion, ankle arthroscopy aids the diagnosis and treatment of ligamentous and osteochondral injuries not evident on plain film with subsequent superior short-term outcomes....
Patients undergoing anterior cruciate ligament (ACL) reconstruction and patients suffering from knee osteoarthritis (KOA) have been shown to have quadriceps muscle weakness and/or atrophy in common. The physiological mechanisms of blood flow restriction (BFR) training could facilitate muscle hypertrophy. The purpose of this systematic review is to investigate the effects of BFR training on quadriceps cross-sectional area (CSA), pain perception, function and quality of life on these patients compared to a non-BFR training. A literature research was performed using Web of Science, PEDro, Scopus, MEDLINE, Dialnet, CINAHL and The Cochrane Library databases. The main inclusion criteria were that papers were English or Spanish language reports of randomized controlled trials involving patients with ACL reconstruction or suffering from KOA. The initial research identified 159 publications from all databases; 10 articles were finally included. The search was conducted from April to June 2020. Four of these studies found a significant improvement in strength. A significant increase in CSA was found in two studies. Pain significantly improved in four studies and only one study showed a significant improvement in functionality/quality of life. Low-load training with BFR may be an effective option treatment for increasing quadriceps strength and CSA, but more research is needed....
Congenital unilateral hypertrophy of the plantar musculature is a rare condition, and to our knowledge, reports of only 14 cases have been previously published. As only one describes a concomitant orthopedic toe deformity, we report our case of abductor hallucis, flexor digitorum brevis, and abductor digiti minimi muscle hypertrophy in combination with hallux valgus and claw toe deformity as well as a laterally abducted fifth toe. Thus, this report presents the rare case of congenital hypertrophy of the plantar musculature associated with complex toe deformities. Moreover, the present article contains a detailed description of our surgical technique as well as a review of the current literature....
Hypermobile meniscus is known as one of the causes of knee pain and locking or limitation of the range of motion during knee flexion, even when there is no evidence of meniscus tear on magnetic resonance imaging (MRI). Most such cases show excessive hypermobility of the posterior part of the lateral meniscus. This case report presented a rare case of a hypermobile anterior horn of the lateral meniscus. An 18-year-old woman visited our hospital for left knee pain without trauma. Her physical examination showed a limited range of motion and tenderness in the lateral joint space. However, her MRI did not show any abnormalities. After conservative treatment failed, we performed arthroscopic surgery. The arthroscopic evaluation showed no meniscus and no other intraarticular injury. However, the anterior horn of the lateral meniscus was easily translated beyond the lateral condyle by using a probe. Thus, hypermobile anterior horn of the lateral meniscus was diagnosed. The meniscus was stabilized by the outside-in technique. Immediately after surgery, the catching symptom and pain were alleviated. After three-and-a-half months, she returned to work. The Lysholm score improved from 55, preoperatively, to 100, 1-year postoperatively. In conclusion, careful arthroscopic evaluation is essential for the diagnosis of a hypermobile anterior horn of the lateral meniscus. Arthroscopic meniscus stabilization provides a good outcome for hypermobile meniscus....
Nerve conduction studies (NCS) are electrodiagnostic tests used to evaluate peripheral nerves functions and aid in the assessment of patients with neuromuscular complaints. There is contrasting evidence concerning the use of NCS in the assessment of patients with lumbosacral radiculopathy. Objectives. This study was conducted to evaluate nerve conduction studies abnormalities in patients with lumbosacral radiculopathy and to find out their relation to abnormal physical examination findings. Materials and Methods. Twenty-seven patients with lumbosacral radiculopathy caused by L4/5 or L5/S1 intervertebral disc prolapse confirmed by magnetic resonance imaging (MRI) were recruited in the study. Twenty-five healthy subjects matched in age and sex served as control. Motor nerve conduction study bilaterally for both common peroneal and tibial nerves, F-wave for both nerves, and H-reflex had been conducted. Results. No significant difference was found in the motor nerve conduction study parameters (latency, amplitude, and conduction velocity) between the patients group and the control group. There was significant prolongation in H-reflex latency of both symptomatic and asymptomatic side in the patients group compared to the control group (P < 0.05). Also, F-wave latencies (F minimum, F maximum, and F mean) of the tibial nerve were significantly prolonged (P < 0.05) compared to control. Conclusion. Prolonged H-reflex latency was the commonest encountered abnormality in our study followed by F-wave latencies of the tibial nerve....
A stress fracture of the second metatarsal base in soccer players is extremely rare. In this case study, we report a nonunion of a stress fracture at the base of the second metatarsal in a female soccer player who had persistent pain despite continued conservative treatment, who then was treated with the bridging plate fixation technique. Case Report. A 19-year-old female college soccer player complained of pain on the dorsum of her right midfoot during a game without history of trauma and was conservatively treated for 6 months. Radiographic examination showed an oblique fracture with small bone fragment at the proximal base of the second metatarsal and computed tomography demonstrated sclerotic change around the fracture site. We diagnosed her with nonunion of a stress fracture at the base of the second metatarsal and performed operative treatments using autogenous cancellous iliac bone grafting and plate fixation bridging a second metatarsal and medial cuneiform with a locking plate. At 4 months after the initial surgery, she was able to return to playing soccer at preinjury level without complications or pain. Conclusion. We report a rare case of nonunion of a stress fracture at the base of the second metatarsal in a female soccer player without underlying diseases. Surgical treatment was applied, because the conservative treatment was ineffective for 6 months and led to nonunion. The plate fixation technique bridging the second metatarsal and medial cuneiform was a useful option to attain the bone fusion for small fracture fragment for a treatment of nonunion of a stress fracture at the base of the second metatarsal....
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