Acta Orthop Belg
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Total dislocation of the talus is caused by a high-energy trauma, that dislocates the talus from all its surrounding articulations. Most cases reported are open talus dislocations; closed dislocations are rarely seen. Complications include avascular necrosis, posttraumatic osteoarthritis and infection. ⋯ We describe the case of a 46-year old male patient who sustained a closed total dislocation of the right talus associated with small fractures of the lateral and medial malleolus. The talus could not be reduced by closed means. The malleolar fractures were treated by open reduction and internal fixation.
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The aim of this retrospective study was to evaluate the long-term effect of the Luque-Galveston spinal fusion in Duchenne muscular dystrophy (DMD) patients. Twenty patients had undergone this operation at a mean age of 153 years (surgical group, A). The correction of their scoliosis amounted to +/- 55.8%, after an average follow-up period of 3 years. ⋯ Patient satisfaction after surgery was relatively high, mainly because of an improved sitting balance, but only 60% of the questionnaires were available. Twenty-five other patients were not operated upon (non-surgical group, B). They had better results at ages 153 and 183, but this was mainly due to the fact that group B contained more benign cases according to the Oda classification.
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Case Reports
Periosteal entrapment in distal femoral physeal fractures: harbinger for premature physeal arrest ?
We report on two patients who sustained Salter-Harris II fractures of the distal femur with physeal widening after being tackled in football games. Preoperative MRI indicated entrapped periosteum at the physeal fracture site for both patients. Both patients underwent open reduction of the physeal fracture with removal of the entrapped periosteum and achieving an anatomic reduction. ⋯ This can result in injury to both the epiphyseal blood supply and to the physeal cartilage (germinal zone) resulting in physeal arrest despite anatomic reduction after removal of the entrapped periosteum. Upon literature review, pre-operative MRI demonstrating entrapped periosteum has not been previously reported. We hypothesize that the presence of entrapped periosteum following distal femoral physeal fractures may be associated with an increased risk for premature physeal arrest.
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Case Reports
Simultaneous bilateral tibial tubercle avulsion fracture in an adolescent: a case report.
Bilateral simultaneous avulsion fractures of the anterior tibial tubercle (ATT) are extremely rare. Since the first description in 1954, 15 similar cases have been reported. We report a further case in a 16-year-old boy who sustained simultaneous bilateral tibial tubercle avulsion fractures (Watson-Jones Type III) from jumping during a gymnastics session. ⋯ Both knees were treated successfully by open reduction and internal fixation with two cannulated screws. The recovery of the patient was complete; the screws were removed six months later. After one year follow-up, the patient had no complaint and had resumed his sporting activity.
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Tibial pilon fractures are challenging to treat, as they are typically intra-articular and associated with extensive soft tissue damage. We briefly review the anatomy of the distal tibia, as well as the pathophysiology of pilon fractures. ⋯ Finally, we propose a treatment algorithm (used in our institution), taking into account the level of associated soft tissue injuries. The use of a 2-phase treatment protocol is recommended; however, to date, no absolute treatment protocol exists for these injuries.