Isolated talus dislocation: a case report

Medial ankle sprains have a very low incidence (5% of ankle ligament injuries), and most of the time, the first structure involved is the deltoid ligament complex. However, other structures, such as the spring ligament, posterior tibial tendon, and flexor retinaculum, can also get damaged. A 32-year-old man who had an ankle sprain while performing sports activities showed magnetic resonance imaging findings compatible with a detachment of the flexor retinaculum and medial dislocation of the posterior tibial tendon. Surgical intervention was suggested to this patient; deepening of the medial retromalleolar groove and reattaching of the retinaculum were performed. It is very important to consider this rare injury after a medial ankle sprain and to think out of the box, not always assuming a deltoid ligament lesion. Level of Evidence V; Therapeutic Studies; Expert Opinion.

A New Year

The Level of Evidence Pyramid: Indicating Levels of Evidence in Plastic and Reconstructive Surgery Articles

Multifocal fractures in a single upper extremity represent a significant clinical challenge, often resulting from high-energy impacts such as motor vehicle accidents or severe falls. These injuries require complex, multifaceted approaches in management, spanning initial acute care to long-term rehabilitation. This paper examines the complexities of diagnosing, treating, and rehabilitating multifocal upper extremity fractures, highlighting the importance of timely intervention and a multidisciplinary approach to maximize functional recovery, minimize long-term disability and the prognosis. A 25-year-old male was admitted to the emergency department after being struck by a vehicle, sustaining multiple fractures in his right upper extremity, including the scapula, proximal humerus, radius, and ulna. Initial management involved stabilizing the fractures with external fixation and performing a craniotomy for an associated epidural hematoma. After stabilization, definitive surgical repairs were performed, including ORIF for the humerus and radius ulna, followed by rehabilitation to address functional deficits. The management of multiple fractures in a single upper extremity requires timely surgical interventions, such as ORIF, to stabilize complex fracture patterns. Effective postoperative rehabilitation is essential for recovery and depends heavily on patient compliance and comprehensive care. Although advances in surgical techniques have improved outcomes, challenges remain in reducing soft tissue damage and preventing long-term complications like joint stiffness and chronic pain. Multiple fractures in a single upper extremity usually result from high-energy trauma, necessitating comprehensive management strategies.

Level of clinical evidence presented at the Society for Vascular Surgery Annual Meeting during a 5-year period (2012-2016)

Introduction: Segmental fractures of the tibia and fibula represent a severe form of long bone injury, often resulting from high-energy trauma such as road traffic accidents or falls from height. These fractures are frequently associated with significant soft tissue damage, bone loss, and infection risk, making their management particularly challenging. This study aims to evaluate the clinical and radiological outcomes of patients with segmental fractures of the tibia and fibula managed with the Ilizarov external fixator under C-arm guidance. Methods: This prospective observational study was conducted in the Department of Orthopaedics at Aichi Medical College, Dhaka, Bangladesh, from January 2023 to January 2024. A total of 40 patients were selected as study subjects. Data were collected and analyzed using SPSS version 25.0, with descriptive statistics, chisquare tests, and p-values <0.05 considered statistically significant. Result: In this study of 40 patients with open segmental fractures of the tibia and/or fibula managed using the Ilizarov method under C-arm guidance, fracture union was achieved in 95% of cases with a mean union time of 22.6 ± 3.5 weeks. According to ASAMI criteria, bone results were excellent in 35% and good in 52.5% of patients, while functional outcomes were excellent in 32.5% and good in 52.5%. Common complications included pin tract infection (30%), joint stiffness (17.5%), and malalignment (10%). Older age was significantly associated with delayed union (p = 0.042), and joint stiffness had a notable impact on functional outcome (p = 0.021). Conclusion: The Ilizarov method, applied under C-arm guidance, has proven to be a reliable and effective technique for managing open segmental fractures of the tibia and/or fibula. In this study, it facilitated high union rates, and satisfactory functional recovery, and allowed early weight-bearing, even in complex and highenergy injuries.

Introduction: The lumbar vertebrae facet joint dislocation is typically brought on by high-energy trauma. There is a paucity of literature on the dislocation of Lumbar vertebrae, with most published studies being infrequent case reports. Compared to the cervical spine, the lumbar spine's facet joints are more coronal in orientation, the coronal position increases stability and restricts the range of motion, which lowers the risk of dislocation. Additional stability is provided to the lumbar spine by huge, robust muscles and robust ligaments. These features cumulatively reduce the likelihood of dislocation Case Presentation: A 25-year-old male presented to the emergency room following a motor vehicle accident (MVA). An evaluation revealed bilateral L5-S1dislocation, Femur shaft closed fracture, Sacral fracture along with bilateral superior Pubic rami fractures. Owing to the injury's intricacy, a staged surgery was planned. Emergency surgery was performed on the day of admission involving the debridement and repair of the perianal wound along with closed intramedullary nailing of the Femur. On the second post-operative day, the second procedure was performed: percutaneous fixation of the Sacrum followed by posterior decompression of L5-S1, extraction of the sequestered disc, posterior stabilization of L4 to S1 + S2 AI screws, and interbody fusion of L5-S1 along with autologous bone grafting (using the decompressed bone) for 360-fusion using the posterior only approach. Conclusion: Bilateral facet dislocation of the L5-S1 is a rare injury, and therefore worth reporting. Multidisciplinary approach, timely diagnosis, can lead to successful management of such complicated injuries.

Unusual combination of femoral head dislocation associated acetabular fracture with multipart femoral fractures: Case report

Avascular necrosis of the talus is a rare condition that can lead to important functional sequelae. There are few therapeutic alternatives for more advanced stages of this disease, the majority of which sacrifice the ankle joint. We report the case of a 50-year-old patient with nontraumatic avascular necrosis that compromised a large part of the talar surface. After non-structural autograft failed, it was reconstructed using fresh structural talar allograft. At one year of follow-up, the patient reported a considerable decrease in pain. To our knowledge, this is the first reported case in which fresh structural allograft was used in the treatment of nontraumatic avascular necrosis of the talus. Level of Evidence V; Therapeutic Studies; Expert Opinion.

Reconstruction of extensive bone loss in the foot requires a set of strategies involving various surgical techniques and orthopedic devices. Semicircular Ilizarov external fixator combined with a structural homologous bone graft may be advantageous in pediatric patients. This case report describes the technique of reconstructing an extensive bone loss of the first metatarsal with osteodistraction and homologous graft in an immature skeleton. The combination of the external fixator and the homologous graft provided sufficient bone volume without recurrent infection, minimal complications, substantial length gain of the metatarsal bone, and improved soft tissue conditions. It is a viable treatment option for severe foot injuries in immature skeletons. Level of Evidence V, Therapeutic Studies, Expert Opinion.

Ankle fracture infection is a devastating complication that can lead to chronic pain, limited motion, post-infectious end-stage anklearthritis, osteomyelitis, and amputation. Treatment historically involves aggressive debridement, hardware removal, and long-termantibiotic therapy. We describe a case of post-infectious end-stage ankle arthritis treated with a custom, fixed-bearing, 3D printed totalankle replacement with antibiotic-impregnated cement. The provided treatment allows continued elution of high-dose local antibioticswhile preserving the ankle range of motion and allowing immediate weight bearing postoperatively. Level of evidence V; Therapeutic studies; Expert opinion.

Systematic review. We systematically reviewed the level of clinical evidence presented at Cervical Spine Research Society annual meetings from 2008 through 2017. The Cervical Spine Research Society is dedicated to advancing knowledge of the cervical spine to promote evidence-based care. Research presented at these meetings impacts clinical practice. A total of 774 paper abstracts presented at Cervical Spine Research Society (CSRS) annual meetings were independently assessed by two reviewers. Reviewers designated a clinical level of evidence (LOE) to each included abstract from level I to level IV based on criteria set forth by the Oxford Centre for Evidence-Based Medicine. Reviewer agreement was assessed using Cohens Kappa coefficient (k) and disagreements were discussed until a consensus was reached. Wilcoxon rank sum test was used to assess for differences in LOE grades. Chi-squared testing was used to assess nonrandom changes in level of evidence and in excluded studies. A total of 583 abstracts were included. Over the last 10 CSRS meetings, 5.15% of presentations were level I, 27.8% level II, 27.4% level III, and 39.6% level IV. The average LOE from 2008 to 2017 was 3.02 (median = 3). Additionally, 49.7% were therapeutic studies, 37.6% prognostic studies, and 12.7% diagnostic studies. When comparing the first 5 years (2008-2012) to the last 5 years (2013-2017), we observed a significant increase in Level II (P = 0.007) evidence and a corresponding decrease in level IV evidence (P < 0.001). The average LOE improved from 3.14 (2008-2012) to 2.91 (2013-2017); there was a significant improvement in LOE between the two periods (P = 0.001). Emphasis on evidence-based medicine within cervical spine research has positively influenced the clinical level of evidence disseminated at CSRS annual meetings between 2008 and 2017. Continued focus on higher quality Level I studies is warranted. 4.

Introduction:Hip joint fracture-dislocations are rare injuries and usually result from high energy trauma. Femoral head fractures account for only 7–16% of all hip fracture-dislocations. There is always a controversy regarding optimal surgical treatment modality and approach for the treatment of Pipkin type IV fractures. In a 60 years old individual, various reports favor primary hip arthroplasty as compared to open reduction and internal fixation (ORIF). The posterior approach is preferred because it provides adequate exposure of the acetabular fracture and an opportunity for simultaneous repair of the femoral head and acetabular fractures. Another benefit is that anterior vascular supply to the femoral head and abductor function can be preserved.Case Report:In this case report, we present a neglected 15 days old rare injury (Pipkin type IV femoral head fracture) in a 60 years old male patient that was given a trial of hip preservation surgery by ORIF through posterior (Kocher-Langenbeck) approach.Conclusion:A neglected case of Pipkin type IV injury with chances of avascular necrosis and arthritis can be given a trial of hip preservation surgery because in an Indian scenario sitting cross legged and squatting are indispensable activities of daily lifestyle and appropriate surgical technique, adequate exposure, anatomic reduction, and stable internal fixation of the fractures are critical to achieve satisfactory clinical results.

Isolated comminuted trapezium fracture: A case report and literature review

Understanding evidence-based arthroscopy