Extensor Retinaculum Flap and Fibular Periosteum Ligamentoplasty After Failed Surgery for Chronic Lateral Ankle Instability

BACKGROUND

The anterior talofibular ligament and the calcaneofibular ligament are 2 of the most frequently injured structures in sports, being damaged in 30% to 45% of all sports injuries. Most reconstructive procedures are successful but can deteriorate with time and can lead to low-grade radiographic degeneration.

METHODS

We operated on 26 consecutive patients from 2001 to 2008 who had failed previous surgical procedures for the lateral ligamentous complex of the ankle, with an average of 104 (range, 75-140) months.

RESULTS

The overall functional rating was excellent in 14 ankles, good in 10, fair in 1, and poor in 1. Twenty-four patients (92.3%) were satisfied with the procedure and 15 (57.7%) were able to return to their preinjury level of activity. Local complications were detected in 2 patients who presented with skin necrosis; 1 patient developed severe reflex sympathetic dystrophy.

CONCLUSION

Revision surgery for the management of failure after surgical treatment of chronic lateral ankle instability is under debate, and the literature is devoid of clinical studies with long-term follow-up. The technique described offers a high rate of long-term excellent and good results, with a low rate of complications and a good rate of return to preinjury level.

LEVEL OF EVIDENCE

Level IV, retrospective case series.

Ixodid ticks on wild donkeys in a Mediterranean nature reserve (Asinara National Park): diversity and risk factors

The Sardinian coloured donkey Equus asinus (Perissodactyla: Equidae) and its albino colour morph represent the wildlife species most typical of the island of Asinara. This Mediterranean island represents a favourable context for ticks and tick-borne diseases; however, knowledge of the tick fauna on Asinara is scarce. A total of 106 Sardinian donkeys were inspected for tick infestation from June to November 2015. All ticks found were collected, classified by stage and sex, and identified to species level. The level of infestation of each donkey was determined; both the overall tick infestation and infestations of each detected species were classified on a scale of 1-3 to give an infestation score (IS). Overall, 256 hard ticks were collected from 60 of 106 donkeys (56.6%). Rhipicephalus bursa, Haemaphysalis punctata and Hyalomma marginatum (all: Ixodida: Ixodidae) infested 26.4%, 28.3% and 6.6% of donkeys, respectively. Different variables affected the IS. With reference to overall tick infestation, a higher IS was observed in donkeys grazing on grassland and Mediterranean shrubland and in albino donkeys compared with coloured donkeys. The collected ticks included species involved in the transmission of pathogens to humans, which highlights the risks for public health in a tourist destination such as Asinara National Park.

Peroneus brevis tendon transfer for reconstruction of chronic tears of the Achilles tendon: a long-term follow-up study

BACKGROUND

Chronic tears of the Achilles tendon can result in substantial loss of function. Those tears with a tendon gap of up to 6.5 cm can be treated surgically with use of an autologous peroneus brevis tendon graft.

METHODS

At an average follow-up period of 15.5 years after the surgery, we examined sixteen of twenty-two patients who had undergone peroneus brevis tendon graft reconstruction for a chronic Achilles tendon tear. Clinical and functional assessment was performed.

RESULTS

All sixteen patients were able to walk on tiptoe, and no patient used a heel lift or walked with a visible limp. The maximum calf circumference of the involved limb remained significantly decreased. The involved limb was significantly less strong than the contralateral one. One patient had developed a tendinopathy of the opposite Achilles tendon, one had developed a tendinopathy of the reconstructed tendon, and one had ruptured the contralateral Achilles tendon five years after the original injury.

CONCLUSIONS

The long-term results of treatment of chronic tears of the Achilles tendon by means of autologous peroneus brevis tendon grafting are encouraging. Patients retain good functional results despite permanently impaired ankle plantar flexion strength and decreased calf circumference.

Peroneus brevis tendon transfer in neglected tears of the Achilles tendon

BACKGROUND

We present the results of a single-center, single-surgeon study in 59 patients with a fresh (4 women and 23 men; mean age, 43.6 +/- 8.8 years) or a neglected (1 woman and 21 men; mean age, 41.3 +/- 7.4 years) Achilles tendon rupture.

METHODS

Patients with a fresh rupture were operated on using end-to-end suture, and patients with a neglected rupture received the tendon of the peroneus brevis as an autologous graft. Patients were assessed during the sixth postoperative week, and during the sixth postoperative month. They were discharged within 1 year after the operation, and were reviewed at an average of 53 +/- 13 months after surgery.

RESULTS

Patients were generally satisfied with the procedure, but those with a neglected rupture tended to have a greater postoperative complication rate, greater loss of isokinetic strength variables at high speeds, and greater loss of calf circumference.

CONCLUSION

The management of acute and neglected subcutaneous tears of the Achilles tendon by peroneus tendon transfer is safe but technically demanding. It affords good recovery, even in patients with a neglected rupture of 6 weeks' to 9 months' duration. Patients with a neglected rupture are at a slightly greater risk of postoperative complications, and their ankle plantar flexion strength can be reduced.

Giant cell tumour of the hamate. Case report

We report the case of a 31-year-old woman who had had the distal end of the ulna resected for a giant cell tumour five years before presenting with a further one in the hamate. The medullary cavity of the hamate was curetted and cancellous bone grafted from the distal radius. Her symptoms resolved, and 26 months postoperatively the cortex of the hamate was fully restored.

Radiological measurements in patellofemoral disorders. A review

This paper analyzes some of the radiologic measurements used in the diagnosis and management of patellofemoral disorders. Measurements such as condylar width and height and patellar height from the true lateral view are helpful to determine the type and severity of intercondylar dysplasia. Skyline views provide information on the type and degree of patellar subluxation and dysplasia, especially of the medial aspect of the trochlear groove. In asymptomatic subjects, the trochlear angle does not exceed 140 degrees, and the lateral medial intercondylar ratio in dysplasia is > 1.7. Scanograms specifically assess the longitudinal axis of the lower limb. Computed tomography (CT) measurements for patellar subluxation do not provide significant additional information over that provided by skyline views. The average distance between the anterior tibial tuberosity and the trochlear groove is normally 13 mm, and a distance > 20 mm associated with knee pain should probably warrant surgery. Because of multiplanar facilities and exposure to nonionizing radiations, magnetic resonance imaging is progressively replacing CT scanning for quantitative and qualitative measurements, at least in a research environment. Its use in routine clinical practice is not yet warranted, given its high costs.

Biomechanics of radiotransparent circular external fixators

The mechanical and biomechanical characteristics of an external fixation system determine the biologic environment of the treated site. Traditionally, the Ilizarov system uses steel rings, which are heavy and can interfere with radiographic imaging. Biomechanical comparison of the traditional Ilizarov steel rings with rings made of oriented carbon fibers shows that the mechanical characteristics of the carbon fiber rings are comparable with those exhibited by traditional steel rings, being elastically rigid over the whole range of loads applied (147 N, 441 N, 735 N, 1029 N, 1110.34 N, 1192.7 N, 1274 N, 1355.3 N, 1437.7 N, 1519 N, and 1600.4 N). The plastic deformation exhibited by steel rings at high loads thus is avoided. In a clinical situation, such a deformation in response to loading would alter the biomechanics of the fracture site, possibly affecting the healing process.

Rectus sheath haematoma in a canoeist

A 26-year-old male canoeist was referred with a 10-day history of abdominal pain, and a palpable mass in the left upper quadrant. No history of direct trauma was given. He was not taking any medication, and malignancy and inflammatory conditions were considered in the differential diagnosis. Ultrasonographic scan identified a mass originating in the rectus abdominis sheath. Ultrasonographically guided aspiration yielded some partially clotted blood, confirming the clinical diagnosis of rectus sheath haematoma. After conservative treatment, the patient resumed training, and is fully asymptomatic 1 year after discharge.

Interlocking nailing for fractures of the femur and tibia

In 132 patients, fractures of the lower limb (71 femoral and 61 tibial fractures) were treated using interlocking nailing (ILN) according to Grosse and Kempf during the period 1986-1989. Of these, 118 were followed up for a median of 19 months (range 9-32 months). Inpatient stay averaged 9 days regardless of the fracture. Consolidation was achieved in approximately 3 or 4 months from the operation in tibial and femoral fractures, respectively. Tibial fractures were technically more demanding than femoral ones, and their average operating time was significantly longer (73 min versus 51 min). Only one patient had a malunion in malrotation. The most serious complication was in a closed upper tibial fracture with traumatic rupture of the popliteal artery. Although the nailing was technically successful, an above-knee amputation had to be carried out. In only one case did the nail fail, and tibial plating had to be performed. Given the present degree of expertise, ILN for fractures of the long bones of the lower limb is a safe and relatively easy procedure to perform.

Osteochondritis dissecans of the lateral humeral condyle in a table tennis player

The case of a table tennis player suffering from intra-articular loose bodies of the elbow is reported. The patient developed the first signs of osteochondritis dissecans of the right lateral humeral condyle at age 16 but underwent surgery only 6 yr later. He has now resumed training and competition, despite some residual stiffness due to early osteoarthritis. This is the first case of osteochondritis dissecans of the elbow ascribed to this sport. It was probably due to repetitive valgus compressive stresses at the radiocapitellar joint during the forced movements imposed by high-level table tennis in a young athlete.

Lateral meniscal cyst: arthroscopic management

Thirty-six patients underwent arthroscopic cystectomy and partial meniscectomy for a lateral meniscal cyst. In two other patients, an open cystectomy was performed following a diagnostic arthroscopy. The patients were reviewed at an average of 39 months (range 8-82) after the operation, and recurrence was found in four cases. Five patients, all keen sportsmen, were dissatisfied with the operation. Four patients, with arthroscopic signs of early degenerative arthritis, were still experiencing some pain, but were able to lead a normal working and social life. Arthroscopy is safe, giving low morbidity and recurrence. In the cases treated by arthroscopy, a horizontal meniscal tear was always found. The question whether this tear and the resulting meniscal changes are traumatic or degenerative in origin still remains; and, to some extent, neither hypothesis can be readily discarded. This study supports the use of arthroscopy alone in the treatment of lateral meniscal cysts.

Intensive training in young athletes

An increasing number of children take part in organized sporting activities, undergoing intensive training and high level competition from an early age. Although intensive training in children may foster health benefits, many are injured as a result of training, often quite seriously. This paper reviews some of the areas of research dealing with intensively trained young athletes, and focuses on physical, cardiovascular and muscular effects, sports injuries and psychological effects of intensive training. It is concluded that measures should be taken to modify present training and competition schemes to avoid the deleterious effects of intensive physical activity on these children.

Stress fracture of the sixth rib in a canoeist

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Tumours mimicking sports injury in two young athletes

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