Anterior ulnohumeral compression plate arthrodesis for revision complex elbow injury: a case report

Elbow arthrodesis can be used for complex elbow injuries that are complicated or fail other conventional treatment methods. We present a case report of an anterior ulnohumeral compressive plate elbow arthrodesis for a patient with a complex elbow injury from a gunshot wound that failed initial open reduction and internal fixation and posterior ulnohumeral arthrodesis secondary to numerous complications.     

Arthrodesis for ankle osteoarthritis after harvesting of free vascularized fibular bone: a case report

Introduction Although free vascularized fibular bone grafting is a good method for the reconstruction of large bone defects, it might cause morbidity of the donor leg. Progression of ankle osteoarthritis, valgus deformity and instability of the donor leg subsequently leading to arthrodesis has rarely been reported. Materials and methods A 53-year-old man suffered from a left tibial comminuted and Gustilo type IIIb open fracture. A folded free vascularized osteoseptocutaneous flap was harvested from the right fibula and transferred to the left tibial bone defect. After the reconstructive surgery, the patient obtained a solid union of the left tibial shaft uneventfully. Ten years later, he suffered intermittent pain on his right ankle. Plain radiographs revealed progressive tibiotalar osteoarthritis. Right ankle arthrodesis with crossed cannulated screws fixation and osteosynthesis of the fibula to the tibia and talus were performed. However, this procedure failed due to a deep infection and osteomyelitis. A revision of the failed ankle fusion was performed by using a vascularized iliac bone flap to strut the anterolateral aspect of the tibiotalar bone defect. A ventral plate fixation and supplementary onlay bone grafting were applied across the anterior aspect of the tibiotalar joint. At the 2-year follow-up, the patient had no pain and resumed his regular daily activities. Conclusions Harvesting of the fibula may cause longterm ankle osteoarthritis that requires ankle arthrodesis. In revision arthrodesis a ventral plate fixation and vascularized iliac bone flap may be the treatment of choice, neutralizing the large moment due to the long lever arms.     

Pisotriquetral arthrodesis for pisotriquetral instability: case report

A 22-year-old professional downhill mountain bike rider developed increasing posttraumatic pisotriquetral instability. To preserve full function of the pisiform bone, we performed pisotriquetral arthrodesis using a Herbert screw. Ten months after the splint was removed, the patient was free of symptoms and returned to professional downhill mountain biking without limitations. This uncommon method seems to be a feasible treatment strategy and can be recommended in high-demand patients.     

Computer aided designed neo-clavicle out of osteotomized free fibula: case report.

Total clavicle reconstruction is a challenging task. We performed a reconstruction of the ventral shoulder girdle by calculating a 3D DICOM representation of the left clavicle to create a right neo-clavicle. Two cuts in correct position and angle leads to a natural 3D shape of the new clavicle. The data were used with a thermo-jet procedure to form model slices of thermoplastic wax. Subsequently, the double titanium osteotomy template with correct cut-angulation was constructed. A 40-year old patient presented with symptoms of progressive pain and instability in the shoulder girdle resulting from complete right clavicle resection due to desmoid tumour 23 years earlier. During the operative procedure, dissection, guided double osteotomy, microvascular anastomoses and acromioclavicular-sternoclavicular fixation were performed. The computer-assisted planning resulted in the exact calculation of the two osteotomy cuts, hence, the 3D appearance of the neo-clavicle. Two years postoperatively, patient showed slightly improved elevation and complete recovery from pain. Our operative procedure demonstrates that the computer-assisted planning with construction of a wax model and an osteotomy template is a useful approach to plan the two precise cuts leading to a predictable shape of the clavicle.     

Enhancement of the fibula free flap by alveolar distraction for dental implant restoration: report of a case

We describe the utilization of distraction osteogenesis in the free fibular microvascular bone graft to the mandible for increasing bone height for future osseointegrated dental implants. Successful reconstruction of a resected mandible requires restoration of both function and esthetic form. Although current reconstructive techniques restore anterior-posterior and lateral projection, often the graft's vertical height is not sufficient for the placement of osseointegrated dental implants and subsequent oral prosthesis. The patient was a sixteen-year-old male who was found to have a large desmoplastic fibroma of the left mandible, which was resected. The defect was successfully restored with a free fibular microvascular bone graft and reconstruction plate. Nevertheless, the patient had persistent problems with mastication and it was decided to perform a segmental osteotomy of the neomandible. Two internal vertical distraction devices were then placed in the mandible. The appliances were then activated five days postoperative, twice a day, for a total of 14 days. At that time 1.5 cm of distraction had occurred and the patient was placed in a consolidation phase for four months. The patient then had sufficient bone height and was restored with 8 osseointegrated dental implants.     

Primary angiosarcoma of the fibula : a case report

Primary vascular neoplasms of bone are rare and have a poor prognosis. Angiosarcoma of bone originates in vascular endothelial cells within bone tissue. Patients may present with unifocal or multifocal osseous disease. The most commonly involved bones are femur and tibia, followed by pelvis, vertebral column and bones of the upper limb. Here we present a 72-year-old male patient who had primary angiosarcoma of the fibula. He was treated with amputation, and the metastases that later emerged were successfully managed with chemotherapy.     

Primary ankle arthrodesis in trauma: report of three cases

This is a review of three patients who underwent primary ankle arthrodesis for severe ankle trauma. Arthrodesis was performed within the first 3 weeks after injury. The procedure resulted in a functional lower extremity in all cases. We recommend primary or delayed primary ankle fusion when extensive bone loss or comminution and severe soft tissue injury are present.     

先天性双侧近排腕骨融合一例

患者女,62岁.因右腕部畸形、疼痛、活动受限40 min急诊入院.临床检查:一般情况可,生命体征平稳;右腕部轻度肿胀,呈"锅铲"状畸形,局部有明显的压痛,叩击痛,右腕关节生理功能基本消失,右手各手指感觉、血运正常;无明显的既往病史.     

Revision of malaligned triple arthrodesis: a case report

Malalignment of a triple arthrodesis can pose significant challenges to the foot and ankle surgeon. Lack of a plantigrade foot will not be well tolerated by the patient and will often require revision of the original surgery. This article presents a review of the treatment algorithm used to address this unique problem. A case study based on this approach is also presented.     

The use of fibular autograft and ankle arthrodesis for aggressive giant cell tumor in the distal tibia: a case report

The case describes successful distal tibial resection, fibular autograft, and ankle arthrodesis in two patients who had giant cell tumor in the distal tibia. At long-term followup, the patients had no pain and no limitation in daily or low-impact recreational activities. In conclusion, due to the large resection that is often necessary for aggressive tumors, fibular autograft and ankle arthrodesis may be a useful method in the distal tibia.     

Distal fibula reconstruction using a frozen allograft: a case report

We report the case of a 25-year-old woman who developed recurrent chondromyxoid fibroma involving the distal portion of the right fibula. This patient had been treated two years earlier with curettage without grafting. The treatment associated en bloc resection of the distal 12 cm of the fibula and reconstruction with a cryopreserved allograft fixed with a lateral plate and pin associated with a syndesmodesis screw for six weeks. The lateral collateral ligament and the tibiofibular ligaments were also repaired. At two years, the patient has no sign of recurrence and the ankle motion is satisfactory. The ankle is stable and pain free with an esthetic aspect similar to the healthy side. Allograft reconstruction is a novel alternative for reconstruction of the distal fibula. We have found only one other case reported in the literature.     

Supercharged dorsoulnar island flap: a case report and review of the literature

Complicated hand and wrist defects require durable and pliable tissues which are offered by flaps, instead of skin grafts. Various dorsoulnar flap options have been used in the regional flap armamentarium of the upper limb. Poor venous drainage may be a considerable handicap when moderate to large skin paddle dorsoulnar flaps are used. In the present case, we aimed to reduce the risk of necrosis by supercharging the dorsoulnar island flap. The current literature regarding dorsoulnar island flap has also been reviewed with focus on this flap. This technique has successfully been used for a complex wrist defect in a 48-year-old man. Postoperative follow up was one year. The flap survived completely with perfect hand function. We think this modification can prevent possible venous stress in the pedicled and free dorsoulnar flaps by obtaining extraveneous drainage. The method is simple, does not need sophisticated microsurgical procedure and longer operative time.     

Isolated lateral tarsometatarsal joint arthrodesis: a case report.

There are few references in the literature to an isolated lateral tarsometatarsal joint arthrodesis. Most references include it as a component of a Lisfranc's joint arthrodesis, which usually involves arthrodesis of at least the intermediate tarsometatarsal joint. A case report involving the treatment of an isolated lateral tarsometatarsal joint arthrosis is presented. Dowel grafting of the fourth and fifth metatarsocuboid joints was initially attempted but resulted in nonunion. Revisional inlay bone grafting afforded solid arthrodesis in this case. Although there are some detrimental biomechanical effects of the procedure, they do not outweigh the need to alleviate the debilitating symptoms that can be associated with degenerative arthritis of the lateral tarsometatarsal joint.