Ankle fracture following hip arthroscopy

This article describes a case of an ankle fracture following hip arthroscopy. A 58-year-old woman underwent hip arthroscopy for a labral tear. She was placed in a lateral decubitus position with her foot in a padded boot. Traction was maintained for approximately 30 minutes. She was instructed to bear weight as tolerated with crutches postoperatively. At 2-week follow-up, she reported ipsilateral ankle pain. Radiographs revealed a minimally displaced medial malleolus fracture. She was treated with a cast followed by a cam walker boot and successfully went on to complete union and resolution of her symptoms.The following risk factors exist for ankle fracture after hip arthroscopy: history of ankle sprains, ligamentous laxity (more common in women), and small feet with large calves (more likely to become plantarflexed during traction). Distraction performed with the ankle rotated is also likely to place added stress on the medial or lateral ligamentous structures.It is important to counsel patients preoperatively about the risk of ankle pain after hip arthroscopy, to be aware of the possibility of ankle pathology postoperatively, and to have a low threshold for ordering radiographs. Radiographs are warranted if patients continue to have ankle pain after 72 hours postoperatively.     

Peripheral versus central compartment starting point in hip arthroscopy for femoroacetabular impingement

The purpose of this study was to compare the perioperative complications and traction times in femoroacetabular impingement hip arthroscopy with either a peripheral or central compartment starting point. Sixty patients with femoroacetabular impingement were treated with hip arthroscopy. Thirty patients had a peripheral compartment starting point and 30 had a central compartment starting point. Intra- and postoperative complications were documented along with traction times. The peripheral compartment starting group experienced 6 minor chondral injuries and 1 case of postoperative paresthesias. The central compartment starting group experienced 8 minor and 3 moderate chondral injuries, 2 labral penetrations, and 3 cases of postoperative paresthesias. Traction time averaged 46 minutes in the peripheral compartment starting group and 73 minutes in the central compartment starting group. Iatrogenic injury and traction times are decreased with peripheral vs central compartment starting in hip arthroscopy for femoroacetabular impingement. Consideration should be given for peripheral compartment starting in hip arthroscopy for the treatment of femoroacetabular impingement.     

Anterior Tibial Artery Pseudoaneurysm in a Patient with Hemophilia: A Complication of Ankle Arthroscopy

Arterial pseudoaneurysm formation as a complication of ankle arthroscopy is extremely rare. We present a case of anterior tibial artery pseudoaneurysm identified 10 days after ankle arthroscopy in a patient with hemophilia. The diagnosis was confirmed with a duplex ultrasound scan. The patient was referred to the vascular surgeon and underwent evacuation of the hematoma, resection of the damaged segment of the artery, and reconstruction with a reversed long saphenous vein interposition graft. The patient had an uneventful recovery after the second surgery. The prevention of this complication in patients with hemophilia is discussed, as well as diagnosis and management. Preventative measures include careful dissection while making the portals, preoperative mapping of the artery with a duplex or a handheld Doppler in patients with coagulopathy, and performance of open rather than arthroscopic surgery to excise large osteophytes.     

Pseudoaneurysm of the Anterior Tibial Artery: A Complication of Ankle Arthroscopy

The authors describe a case of pseudoaneurysm of the anterior tibial artery after ankle arthroscopy that was undiagnosed for more then 10 weeks. The pseudoaneurysm was resected and postoperative recovery was uneventful. Anterior tibial artery pseudoaneurysm is a rare complication of ankle arthroscopy and should be considered when a patient presents with a local swelling of the anterolateral ankle joint.     

Pseudoaneurysm of the anterior tibial artery: a complication of ankle arthroscopy

The authors describe a case of pseudoaneurysm of the anterior tibial artery after ankle arthroscopy that was undiagnosed for more then 10 weeks. The pseudoaneurysm was resected and postoperative recovery was uneventful. Anterior tibial artery pseudoaneurysm is a rare complication of ankle arthroscopy and should be considered when a patient presents with a local swelling of the anterolateral ankle joint.     

Hüftarthroskopie

Arthroscopy of the hip joint can be performed in the supine or lateral position. The decision whether to use the supine or lateral position appears to be more a matter of individual training or habit. Both positions have specific pros and cons. The operative experience with arthroscopy of the central and peripheral compartment shows that a combined procedure with and without traction is beneficial. Whereas arthroscopy of the central compartment in normal joints of adults is feasible only with traction, the peripheral compartment can be better scoped without traction. The combination of both techniques however is technically demanding. Particularly for arthroscopy of the central compartment with traction, the success of the operative procedure is strongly correlated with a correct technique of positioning and distraction. Precise positioning and thick padding of the counterpost, secure fixation and thick padding of the foot, and the limitation of magnitude and duration of traction are important features in order to avoid soft tissue and nerve damage. Good relaxation, joint position, and distension of the joint to break the joint vacuum significantly improve distraction of the femoral head from the socket. In combination with fluoroscopy, scope trauma to the acetabular labrum and hyaline cartilage can be minimized. For arthroscopy of the peripheral compartment without traction, the counterpost is removed and the foot taken out of the traction module for free range of motion of the leg and hip joint. This allows dynamic testing of the hip and access to different parts of the peripheral labrum, proximal femur, and soft tissues.     

Acute compartment syndrome of the foot following fixation of a pilon variant ankle fracture

Acute traumatic compartment syndrome of the foot is a serious potential complication after fractures, crush injuries, or reperfusion injury after vascular repair. Foot compartment syndrome in association with injuries to the ankle is rare. This article presents a case of acute compartment syndrome of the foot following open reduction and internal fixation of an ankle fracture. A 16-year-old girl presented after sustaining a left ankle injury. Radiographs demonstrated a length-stable posterior and lateral malleolar ankle fracture. Initial treatment consisted of a bulky splint and crutches pending the improvement of her swelling. Over the course of a week, the soft tissue environment of the distal lower extremity improved, and the patient underwent open reduction and internal fixation of both her fibula and distal tibia through 2 approaches. Approximately 2 hours from the completion of surgery, the patient reported worsening pain over the medial aspect of her foot and into her calcaneus. Physical examination of the foot demonstrated a swollen and tense abductor hallicus and heel pad. Posterior tibial and dorsalis pedis pulses were palpable and her sensation was intact throughout her foot. Emergently, fasciotomy of both compartments was performed through a medial incision. Postoperatively, the patient reported immediate pain relief. At 18-month follow-up, she reported no pain and had returned to all of her preinjury athletic activities.     

Infection after arthroscopic treatment of symptomatic total knee arthroplasty

Arthroscopy for failed total knee arthroplasty (TKA) is a well-documented and accepted procedure for diagnosis of component and soft tissue problems. Fortunately, infection is a rare complication of arthroscopy. To our knowledge, we present the second report of acutely infected TKA after arthroscopy. Two days after arthroscopic treatment because of painful TKA, a 72-year-old woman developed an acutely infected TKA. The patient underwent immediate arthroscopic irrigation and debridement, and treatment with intravenous antibiotics. The cultures from knee joint aspirates were positive for infection with the organism Staphylococcus aureus. Three days later, repeat open debridement with exchange of the tibial polyethylene insert was performed because of persistent fever and fluctuation. The patient was treated with antibiotics for 6 weeks postoperatively. At the latest follow-up evaluation, 26 months after revision, the patient was pain free, had full activities of daily living, and had no clinical or radiographic signs of infection. However, despite the success of arthroscopy in treating and evaluating painful TKA, this potential complication should be considered when performing arthroscopy of symptomatic TKA.     

Complications in foot and ankle arthroscopy

Arthroscopy of the foot and ankle has become an important diagnostic and therapeutic tool for the orthopaedic surgeon. A thorough knowledge of foot and ankle anatomy and intraarticular anatomy is critical to avoid complications in foot and ankle arthroscopy. Numerous complications can occur in foot and ankle arthroscopy, such as neurologic, tendon, and ligament injuries, wound complications, infections, and instrument breakage. The most common complication is neurologic injury. The overall complication rate is 9%. Most complications associated with foot and ankle arthroscopy are transient and tend to resolve within 6 months. The only complication that persisted at 10 years followup was a neurologic injury, specifically, numbness at the incision site. Because the difficulty of procedures has increased, so has the complication rate. Knowledge of the more common complications in foot and ankle arthroscopy and improved techniques and instruments may reduce the overall complication rate.     

Abdominal compartment syndrome during hip arthroscopy

Hip arthroscopy is recognised as a highly effective means of treating joint disorders. The majority of complications associated with hip arthroscopy involve neurovascular traction injury. We report a relatively unusual complication of hip arthroscopy, extravasation of irrigation fluid into the retroperitoneal and intraperitoneal cavities, resulting in abdominal compartment syndrome.     

Isolated medial foot compartment syndrome after ankle sprain

Foot compartment syndrome is a serious potential complication of foot crush injury, fractures, surgery, and vascular injury. An acute compartment syndrome isolated to the medial compartment of the foot after suffering an ankle sprain is a rare complication.We report the case of a 31-year-old man who developed a medial foot compartment syndrome after suffering a deltoid ligament rupture at ankle while playing football. The patient underwent a medial compartment fasciotomy with resolution of symptoms.Compartment syndromes of the foot are rare and have been reported to occur after severe trauma. But, there are some reports in the literature of acute exertional compartment syndrome. In our case, the compartment syndrome appeared after an ankle sprain without vascular injuries associated.     

Ankle arthroscopy with patient in prone position

Anterior ankle arthroscopy is the most commonly performed foot and ankle arthroscopy. By means of the anterolateral and anteromedial portals, the anterior compartment of the ankle joint can be approached easily. Different posterior portals had been described to reach the posterior ankle compartment. With the patient in prone position and the combination of anterior and posterior portals, the medial and lateral gutters of the ankle joint can be reached together with the anterior and posterior compartment. This is useful for complete synovectomy of the ankle joint.     

Double Posteromedial Portals for Posterior Ankle Arthroscopy in Supine Position

Both posterior and anterior arthroscopy of the ankle may be indicated in the same patient. With the patient supine, it is possible to reach most intraarticular structures of the ankle through the standard anterior portals, but difficult to examine the posterior compartments and to perform hindfoot endoscopy. In most patients following the anterior procedure the patient is positioned prone to operate on the posterior compartment. We describe a two-portal posteromedial hindfoot procedure that allows the surgeon to reach both the posterior joint space and the extraarticular compartment of the hindfoot with the scope and instruments, regardless of diagnosis, with the patient supine. After arthroscopy on the anterior portion of the foot using standard anterior portals, the two posteromedial portals allow endoscopic inspection and management of abnormalities in this region without repositioning the patient and without any remarkable local complication.     

Abdominal Compartment Syndrome After Hip Arthroscopy

As hip arthroscopy becomes a more common procedure, more complications may occur. We present a case of abdominal compartment syndrome resulting from fluid extravasation in a 42-year-old man who underwent routine hip arthroscopy for femoral acetabular impingement. He had not had previous surgeries to that hip, and arthroscopy was performed in the supine position. After adequate distraction, arthroscopy was performed with an automated pressure- and flow-controlled pump with the pressure maintained between 40 and 60 mm Hg. We performed debridement of a degenerative tear of the anterosuperior labrum, removal of a pincer lesion, and a psoas tenotomy through a capsular window. A distended abdomen was noted on drape removal, and the patient required decompressive laparotomy for abdominal compartment syndrome. Extravasation of arthroscopy fluid is a potentially devastating complication during hip arthroscopy, and there should be careful monitoring by the surgeons, anesthesiologists, and operating room staff.     

Distal tibial fracture post syndesmotic screw removal: an adverse complication

Fractures of the ankle are common injuries. Some ankle fractures have an associated injury to the syndesmosis, necessitating fixation with one or more screws. Generally, the overall outcome post ankle fracture is good. However, several complications have also been described. The current authors describe a distal tibial fracture following syndesmotic screw removal. A 77-year-old woman was admitted with a bimaleollar right ankle fracture. The patient underwent an emergency operation with open reduction and internal fixation. Six weeks after the surgery, the syndesmotic screw was removed without complication. The patient presented 4 weeks after removal of the screw complaining of persistent swelling and tenderness of the right ankle without a history of trauma. Radiographs showed a non-displaced distal tibial fracture around the site at which the syndesmotic screw was inserted. The distal tibial fracture was treated conservatively with a toe-to-knee cast for 6 weeks. In summary, the authors present a rare case of distal tibial fracture. Surgeons should bear this additional complication in mind.     

Complications following hip arthroscopy: a retrospective review of the McMaster experience (2009–2012)

Background

The use of hip arthroscopy has been steadily rising as technology, experience and surgical education continue to advance. Previous reports of the complication rate associated with hip arthroscopy have varied. The purpose of this study was to report our experience with hip arthroscopy complications at a single Canadian institution (McMaster University).

Methods

We performed a retrospective chart review of 2 hip arthroscopists at the same institution to identify patients who had undergone the index surgery and had been followed for a minimum of 6 months postoperatively. We used a standard data entry form to collect information on patient demographic and clinical characteristics, including age, sex, surgical indication and type of complication if any.

Results

A total of 211 patients underwent 236 hip arthroscopies. The mean age at time of surgery was 37 ± 13 years and mean follow-up was 394 ± 216.5 days. The overall complication rate associated with hip arthroscopy was 4.2% (95% confidence interval 2.3%–7.6%). We identified 4 major and 6 minor complications.

Conclusion

Overall, hip arthroscopy appears to be safe, with minor complications occurring more frequently than major ones. However, surgeons should recognize the possibility of serious complications associated with this procedure. Future research should focus on prospective designs looking for potential prognostic factors associated with hip arthroscopy complications.     

Contralateral deep venous thrombosis after hip arthroscopy

Since the 1980s, hip arthroscopy has become an accepted treatment modality for a variety of hip conditions. It is generally considered a low-risk procedure with a low rate of complications. The risk of developing a deep venous thrombosis (DVT) or venous thromboembolism following these procedures is also thought to be low, and most patients undergoing these procedures receive no pharmacologic prophylaxis postoperatively. This article presents a case of a 33-year-old woman with a history of oral contraceptive use who presented 13 days after a routine hip arthroscopy with pain and swelling in the contralateral thigh. Ultrasonography revealed acute DVTs in the left common femoral, superficial femoral, and popliteal veins. She was admitted to the hospital and treated accordingly. A workup for thrombophilic disorders was negative. We believe that her history of oral contraceptive use, the use of axial traction, and asymmetric forces about the pelvis during the procedure contributed to this postoperative complication. Although this complication is rare and the use of pharmacologic prophylaxis is not common, physicians must be aware of this potential complication following hip arthroscopy.     

Ruptured Pseudoaneurysm of the Lateral Plantar Artery After Tibiotalocalcaneal Fusion With Retrograde Nail—A Rare Complication

We report a rare presentation of a ruptured pseudoaneurysm of the lateral plantar artery following tibiotalocalcaneal fusion with a retrograde nail at 1 month after the index surgery. Although case reports of pseudoaneurysms of larger arteries such as the anterior tibial artery and posterior tibial artery after ankle surgery (e.g., ankle arthroscopy, implant removal, Ilizarov application) have been reported, we report a rare complication of a pseudoaneurysm of the lateral plantar artery. We discuss the anatomic considerations of the lateral plantar artery in the foot and the entry point of the retrograde nail to avoid this unusual complication.     

Leg Anterior Compartment Syndrome Following Ankle Arthroscopy After Maisonneuve Fracture

We report a case of leg anterior compartment syndrome following ankle arthroscopy after Maisonneuve fracture. A 21-year-old football player sprained his left ankle. Plain radiography of his left ankle showed a lateral dislocation of the talus without obvious fractures. Plain radiography of his left lower extremity showed a spiral fracture of the proximal fibula approximately one third distal to the fibular head. According to these findings, we diagnosed this fracture as a Maisonneuve fracture and treated it by ankle arthroscopy and drilling of the talar osteochondral injury followed by arthroscopic ankle visualization during syndesmosis screw fixation. Six hours after surgery, the patient complained of pain in the lower extremity. We diagnosed acute compartment syndrome and performed emergent fasciotomy. One year after surgery, he was able to fully participate in athletic activities. We consider ankle arthroscopy to be available for the treatment of ankle fracture with the suspected complication of an intra-articular disorder such as a Maisonneuve fracture. However, with this type of ankle fracture, there is a higher potential risk of acute compartment syndrome developing than with other types of ankle fractures. Therefore we suggest that surgeons guard against this complication.     

Pseudoaneurysm as a complication of ankle arthroscopy

We describe a case of pseudoaneurysm of the anterior tibial artery as a complication after arthroscopic ankle synovectomy, in which standard anterolateral and anteromedial portals were used. Pseudoaneurysm has been previously reported as a complication in ankle arthroscopy with the use of the anterocentral portal. Previously described anatomic variations of the tibial artery and its close relationship with the anterior ankle capsule may complicate arthroscopic surgery, especially when aggressive synovectomy is performed. Anterior tibial artery aneurysm is a rare complication of ankle arthroscopy, but its potential catastrophic sequelae must not be underestimated.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 4 (April), 2001: pp 400–402