Malleolar tips as reference points for positioning of syndesmotic screw: A preliminary CT based analysis

PURPOSE

The risk of malpositioning of the syndesmotic screws is very high. A lack of standard radiological or physical references for accurate syndesmotic screw placement is a potential contributing factor in syndesmotic screw malpositioning. Malleolar tips are clinically as well as radiologically appreciable bony references. The purpose of this preliminary CT based study was to investigate the axial relations of the central syndesmotic axis with the malleolar tips.

METHODS

CT based studies of uninjured adult ankle joints with intact syndesmosis, conducted over a six months period were analysed. The axial differences between the coronal plane along the malleolar tips and that along the central syndesmotic axis in the axial plane were measured. Gender-based variations were also analyzed.

RESULTS

A total of 70 CT studies were analyzed, and the axial difference between the malleolar tips based coronal plane and that along the central syndesmotic axis was observed to be 3.70 ± 5.61°. The male and female measurements were comparable.

CONCLUSION

Being in a static relation to the syndesmosis independent of the foot position and the limb rotation, the malleolar tips can be reliably used as references for directing syndesmotic screw in the axial plane. A knowledge of this axial difference between malleolar tips and central syndesmotic axis can help surgeons in an accurate syndesmotic screw placement.

In vivo comparison of a fixed loop (EndoButton CL) with an adjustable loop (TightRope RT) device for femoral fixation of the graft in ACL reconstruction: A prospective randomized study and a literature review

INTRODUCTION

There is a lack of in vivo studies comparing the functional outcome and knee stability after anterior cruciate ligament reconstruction (ACLR) using fixed loop (EndoButton (EB) CL) and adjustable loop (TightRope (TR) RT) devices for femoral fixation of soft tissue grafts.

MATERIALS AND METHODS

Functional outcomes were assessed in terms of the International Knee Documentation Committee (IKDC) and Lysholm scores, knee stability by anteroposterior laxity and side-to-side difference (SSD) using KT-1000 arthrometer. The evaluation was performed preoperatively and post-operatively at 6 months and 2 years.

RESULTS

Both groups were matched in terms of demographic, preoperative, intraoperative and post-operative covariates. EB ( n = 52) appeared to have better IKDC and Lysholm scores at 6 months post-operative when compared to TR ( n = 50). However, at a final follow-up of 2 years, the results were similar. The anterior tibial translation and SSD were statistically insignificant between the two groups at 6 months and 2 years.

CONCLUSION

ACLR using EB or TR for femoral fixation gives substantially equivalent functional results and knee stability at mid-term follow-up.

Bilateral Tubercular Dactylitis: Unusual presentation of an usual disease

INTRODUCTION

Bilateral Tubercular Dactylitis (TD) is an unusual presentation of tuberculosis and only handful numbers of cases are reported in the literature. Hence, very little is known about its clinical presentation, statistic, radiological features and its outcome.

METHODS

We have included seven male and two female patients of mean age 7.2 years, of the proven cases of bilateral TD by histopathological or microbiological or PCR analysis from core biopsy. Radiological features were recorded from plain radiograph. All patients were given Antitubercular drugs according to WHO 2010 recommendation (four drugs for 3-5 months, three drugs for next 3-5 months and finally two drugs for 6-8 months). Debridement was done whenever required.

RESULTS

Of total 26 lesions, the most common presentation was swelling with or without mild pain. Discharging sinus was present in four lesions. There were six phalanges, 18 metacarpal and two metatarsals. Radiographically, the most common type of lesion was soft tissue swelling followed by lytic lesion. Histopathologically tuberculosis was proven in 10 (55.6%) lesions, bacteria isolated in 5 (27.8%) lesions and PCR was done in 8 lesions and was positive in all. All lesions healed after giving ATT except one which developed psudo-arthrosis and one patient developed coronal plane deformity that was corrected by JESS.

CONCLUSION

A clinician should always suspect tuberculosis while dealing with a pathology of hand and feet even if it is bilateral. Suspected case can be diagnosed by histopathological, microbiological or PCR analysis and it can be treated by ATT with a good functional outcome.

Results of Supracondylar "V" Osteotomy for the Correction of Genu Valgum Deformity

BACKGROUND

Medial close wedge, lateral open wedge, dome and "V" osteotomies are the commonly to correct the genu valgum (GV) deformity. However, the ideal method for the correction of coronal plane deformity is controversial. This prospective study is to evaluate the functional and radiological result of supracodylar "V" osteotomy to correct GV deformity.

MATERIALS AND METHODS

"V" osteotomy was done in all patients with clinically significant GV deformity and was fixed with crossed K-wires. Weight-bearing mobilization was started after radiological union. Patients were evaluated for correction in different clinical and radiological parameters. The function of the knee was assessed by Bostman's score. The subjective score was used to assess the parent's satisfaction after the procedure.

RESULTS

187 limbs with genu valgum deformity (47 males and 71 females) were included in this study. We observed a significant improvement in the mean intermalleolar distance, clinical and radiological tibiofemoral angle and lateral distal femoral angle, from 17.3 to 3.9 cm, 23.8°to-4.5°, 25.6° to 6.1°, 76.6° to 88.4°, respectively. The mean Bostman score improved from 20.6 to 28.1. The parent's satisfaction assessed subjectively was 95.3 points.

CONCLUSION

This osteotomy along with the fixation with K-wires is a safe, effective, reproducible technique with a short learning curve and a procedure requiring no repeat surgery for implant removal, with good functional results, and without major complications.

Atraumatic Acute Compartment Syndrome of Forearm Following Artificial Mehndi (Henna) Dermatitis - A Rare Case Report

Atraumatic compartment syndrome of the forearm is a rare entity. There are several papers available in the literature on the adverse effects of mehndi application; however Acute Compartment Syndrome (ACS) following mehndi application has never been reported. We present the case of a 25-year-old female, who presented with sudden onset swelling and pain in the left forearm. The patient had applied mehndi all over her left palm and forearm just two days prior to presentation. The patient had stretch pain and other clinical features suggestive of compartment syndrome of forearm and was hence taken up for an emergency fasciotomy. The fasciotomy wound healed without skin grafting and the patient achieved near normal range of movement of the affected elbow, wrist and fingers.

Comparative study between staples and eight plate in the management of coronal plane deformities of the knee in skeletally immature children

PURPOSE

To compare two commonly used methods of temporary hemiepiphysiodesis (staples and figure of eight plate) in the management of coronal plane deformities of the knee in skeletally immature children.

METHODS

This prospective study was conducted between November 2012 and November 2015. A total of 40 patients with 67 affected knee joints, having at least 1 year of skeletal growth remaining, were included in the study. Angular correction was measured by recording the mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), and anatomical tibio-femoral angle (TFA) (for the overall alignment of lower limbs). Implant removal was done after 5° of overcorrection was achieved. The rate of correction (° per month) and complications related to each technique were recorded.

RESULTS

The most common diagnosis was idiopathic genu valgum. The overall rate of correction (TFA) was 1.2° for staples and 1.4° for eight plate (p = 0.70, not statistically significant). The correction in mLDFA was statistically better in the eight plate group, whereas an opposite trend was recorded in mMPTA. Implant-related complications were present in two cases of the staples group.

CONCLUSION

Although the overall correction rate was similar in both groups, implant-related complications were lower with figure of eight plate. In idiopathic genu valgum (the most common diagnosis), the correction was statistically better in the eight plate group. We recommend figure of eight plate over staples in managing these deformities.