Nonvascularized autogenous bone graft for extensive phalangeal bone loss: case report

A 47-year-old man, a fine woodworker, sustained extensive phalangeal and soft tissue loss of his dominant left long and index fingers in a table saw injury. We report the long-term clinical and radiographic outcomes of the patient following reconstruction with corticocancellous iliac crest bone grafts. Rarely described in recent literature, we believe that primary nonvascularized autogenous bone grafting for phalangeal reconstruction is a worthwhile alternative to amputation when the soft tissue envelope is satisfactory.     

Reconstruction of the columella using the prefabricated reverse flow submental flap: A case report

BACKGROUND: The reconstruction of columellar defects is still a challenging procedure because of limited local and regional flap options and the characteristics of the anatomy of this site. Although a number of methods are available to repair nasal columella defects, no treatment of choice ensuring an excellent texture- and color-matched tissue in one stage has been determined to date. METHOD: In this case, we used a reverse-flow submental island flap prefabricated with the costal cartilage for the reconstruction of a complex columellar defect. RESULT: The flap survived completely with reversible venous congestion. The cosmetic result and nasal respiratory function were acceptable during the follow-up time of 6 months. CONCLUSION: We propose that the prefabricated reverse submental flap may be an alternative among the surgical options for columellar defects. This flap may also be considered in the reconstructive repertoire of other composite defects of the head and neck region.     

Pigmented villonodular synovitis of 1st metatarsophalangeal joint: A case report and literature review

Pigmented villonodular synovitis is a common disease entity particularly in the knee joint but its incidence in the foot is quite rare. A case of first metatarsophalangeal (MTP) joint pigmented villonodular synovitis (PVNS), presented to us with recurrence of symptoms after surgical excision done outside our institute. After histological confirmation of recurrence of the disease, repeat open surgical excision was performed. After being asymptomatic for two months she presented to us with recurrence of symptoms for which hyperkeratotic plaque at the ventral aspect of the first MTP joint was found to be responsible on physical examination. It was treated surgically by pairing it and now patient is symptom free for last 1 year. It signifies the importance of the histopathology in the diagnosis and recurrence of the PVNS and thorough physical examination in the management of the foot pathologies.     

Reconstruction of an extensive soft tissue and bone defect of the first metatarsal with the use of Masquelet technique: A case report

The literature regarding reconstruction of foot bone defects is limited. The purpose of this study is to present a case report with an extensive bone defect of the first metatarsal bone which was treated with the use of the induced membrane technique.A 53-year-old man, with comminuted foot grade IIIb open fracture was treated with the Masquelet procedure. At 14 months follow-up, clinical and radiological assessment of the foot revealed osseous healing and no signs of infection, osteolysis or hardware failure. At 18 months follow-up, the patient had no pain and returned to his usual daily activities. The Masquelet procedure provides an effective method of treatment of extensive bone defects of the foot. It can restore the normal length and metatarsal arch minimizing the risk of complications that occurs with other surgical procedures.Level of evidenceLevel V, case report.     

Reconstruction of closed rupture of thumb flexor tendon pulleys with a single free palmaris longus tendon graft: A case report and review of literature

Closed rupture of thumb flexor tendon pulleys is extremely rare. Several techniques have already been described for finger pulley reconstruction. Various techniques based on prior anatomic and biomedical studies have been proposed for thumb pulley reconstruction, in which one or two of the three pulleys are replaced. In the present study, we describe an original technique using a single, free palmaris longus (PL) autograft for thumb pulley reconstruction.     

A cat model for the evaluation of mechanisms of bone resorption: Induction of bone loss by simulated immune complexes and inhibition by indomethacin

Summary When simulated immune complexes (SIC) (heat-aggregated IgG) possessing many of the properties of true antigen-antibody complexes were injected via the root canal into the periapical tissues of cat maxillary cuspids, radiographically and histologically evident bone resorption occurred at these sites within 7 days. Bone loss was accompanied in all cases by inflammation of the surrounding collagenous connective tissues and was characterized by the presence of osteoclasts. Bone resorption, but not the accumulation of inflammatory cells, was blocked by the systemic administration of indomethacin, an inhibitor of prostaglandin synthetase. The most likely explanation is that SIC-activated mechanisms such as the complement cascade, prostaglandin synthesis, and neutrophil degranulation were responsible for the bone loss. The minor inflammation and bone loss that followed the repeated injections of BSA and of monomeric IgG can best be explained as a response to trauma. The data presented establish that the cat maxillary cuspid is a useful model in which to explore the mechanism underlying pathological bone resorption.     

A case of midgut volvulus related to adult intestinal malrotation found with weight loss after streptococcus infection: A case report and literature review

Introduction and importanceThe incidence of intestinal malrotation is 1 in 6000 births, and 90% of cases occur within the first year of life. Adult cases are rare, with a reported incidence of 0.2%–0.5% of all cases. The significance of reporting this case is to recognize that some adult-onset cases require surgery even in the absence of intestinal necrosis.Case presentationA 36-year-old man was infected with streptococcus and treated with antibiotics. He developed appetite loss and his weight decreased 12 kg in 4 months. His abdomen was flat and soft with no tenderness. A computed tomography scan showed that the horizontal duodenal leg was not anchored to the retroperitoneum. Rotation of the mesentery, which was wrapped around the superior mesenteric artery in a clockwise direction, was observed, suggesting midgut volvulus. We performed emergency surgery and Ladd’s procedure.Clinical discussionA previous study reported that the most common symptom in the chronic course of intestinal malrotation was abdominal pain in 41.2% of cases, and weight loss was observed in only 2.6% of patients. The high degree of intestinal adhesion suggests that repeated torsion and release and the development of collateral vessels may have contributed to the asymptomatic course.ConclusionAdult-onset intestinal malrotation should be considered as a differential diagnosis in the presence of weight loss and gastrointestinal symptoms. The timing of surgery is still controversial. In chronic cases, severe adhesion might be expected and laparoscopic surgery should be considered carefully.     

Surgical treatment of osteochondroma on the first rib by double clavicle osteotomy and internal fixation with a reconstruction plate: A case report and literature review

IntroductionThe accepted indication for surgical removal of osteochondroma is when a lesion becomes symptomatic. There have been no established standard surgical approaches to remove osteochondroma on the first rib and no report on management after that. This report aims to present a novel approach by double clavicle osteotomy followed with internal fixation.Case presentationA 17-year-old female presented with a gradually enlarged bony mass with tenderness at the supraclavicular area. Radiographic images revealed a bony mass attached to the first rib. The provisional diagnosis is osteochondroma. The tumor was approached by osteotomy at the proximal and distal shaft of the clavicle. After removing the entire tumor, the direct reduction and internal fixation of the clavicle were performed.DiscussionBoth, size of the mass and mobilization of the clavicle are factors in determining the surgical approach. Clavicular osteotomy, especially two sites, is considered when the lesion is extremely large. A possible complication after the clavicular osteotomy is nonunion or malunion. A proper technique of reduction and method of fixation contributes to reducing complications.ConclusionThe double clavicle osteotomy is an effective route for removing a large tumor at the first rib. Plate fixation following clavicular osteotomy contributes to bone union and excellent functional outcomes postoperatively.     

Closure of a tracheocutaneous fistula by two hinged turnover skin flaps and a muscle flap: A case report

INTRODUCTIONTracheocutaneous fistula is a complication of tracheostomy. Tracheocutaneous fistulectomy followed by primary closure carries a high possibility of complications.PRESENTATION OF CASEAn 11-year-old boy underwent surgery to repair a tracheocutaneous fistula, using skin and muscle flaps. A vertical incision was made around the fistula and 3 skin flaps were prepared: 2 hinge flaps, and 1 to cover the skin defect (advanced flap). The 2 hinged turnover flaps were invaginated by multiple layered sutures, and a strap muscle flap was placed over the resulting tracheal closure. An advanced skin flap was used to cover the area of the previous defect. The patient was extubated immediately after surgery. He was discharged on the sixth postoperative day without tracheal leakage or subcutaneous emphysema. The patient is currently doing well, with no respiratory symptoms and no recurrence at the postoperative 5 months.DISCUSSIONOur technique is minimally invasive and has a low risk of lumen stenosis, other complications, or recurrence.CONCLUSIONThis technique demonstrates the multiple-layered closure of a tracheocutaneous fistula, using skin flaps and a muscle flap.     

Emergency decompression and stabilization of 1st thoracic spinal cord injury and sacral fracture in a Covid-19 patient: A case report

Introduction and importanceSpinal cord injury is mostly caused by traumatic accident and usually associated with several injuries. The ideal treatment of orthopaedic injury is to perform surgical decompression and stabilization early.Case presentationA 24-year-old-male patient came in emergency department with history of severe pain in his thoracic vertebrae after fell from 10 m height. His buttock was hit the ground first and patient was alert. He felt hypoesthesia below the injured level and dysfunctional motor and sensory of both lower extremities. We put pedicle screw at the C7, Th1, Th2 and Th 3. Then we put rods and nuts. After that, we did decompression by laminectomy of the C7 and Th1 and we put vacuumed drain for the wound.Clinical discussionThis patient was diagnosed with traumatic spinal cord injury of 1st thoracic vertebra ASIA Impairment Scale (AIS) C and sacral fracture Denis classification zone II of right side with confirmed Covid-19 case. First patient treated with 1000 mg methyl prednisolone. An early surgical treatment was open reduction and internal fixation (ORIF) sacral fracture. We put a two-hole 4.5 narrow dynamic compression plate (DCP) at the lateral side of posterior ridge of iliac bone, between posterior superior iliac spine (PSIS) and posterior inferior iliac spine (PIIS).ConclusionImmediate surgical decompression and stabilization for spinal cord injury give significant improvement in motor and sensory function. Appropriate management for Covid-19 patient with Favipiravir and some supplements, had been proved control the virus and give patient good quality of life.     

Impending spontaneous head neck dissociation caused by anteverted cup: A case report on reverse bottle opener effect and review of literature

Modularity in total hip arthroplasty (THA) not only allows adjustments of leg length and offset but also simplifies the revision. It allows limited revision of various components and decreases surgical morbidity of complete revision. Despite benefits, modularity is associated with risks like corrosion and component dissociation. Dissociation between head and neck taper is rare and the cause is attributed to taper corrosion, revision, stem subsidence, pumping phenomenon, injury and closed reduction of dislocated THA. We report a case of late-onset impending head-neck dissociation in a THA caused by a well-fixed anteverted cup with polyethylene liner wear by “reverse bottle opener effect.” To our knowledge, this is the most late-onset reported case of head-neck dissociation, occurring after 13yrs of index surgery.     

Surgical treatment of the severe thoracic gastrocutaneous fistula by pedicled muscle flap filling and thoracoplasty after oesophagectomy for oesophageal squamous cell carcinoma: A case report

Background: Thoracic anastomotic fistula (TAF) is a severe postoperative complication of oesophagectomy, and its occurrence coupled with a thoracic gastrocutaneous fistula (TGCF) and tracheostenosis is very unusual and may lead to a fatal consequence.Case presentation: We describe a case of an old female diagnosed with mid-oesophageal carcinoma, who presented with a TAF after oesophagectomy, which was healed by an effective treatment, while a severe TGCF and tracheostenosis appeared one month postoperation. The complications were detected by gastroscopy, barium oesophagogram and thoracic computed tomography (CT). Through surgical treatments, including pedicled muscle flap filling and thoracoplasty, and a correlated corrective procedure, the patient completely recovered and was discharged six months after the admission.Conclusion: Treatment by pedicled muscle flap filling and thoracoplasty after oesophagectomy for oesophageal squamous cell carcinoma can be a curative alternative for the severe thoracic gastrocutaneous fistula.     

Central fracture dislocation of the hip associated with fracture of femoral neck treated by femoral head autograft and total hip arthroplasty: A rare case report

Central Fracture Dislocation of the Hip is a rare condition requiring more attention in its management, caused by high-energy trauma and is often associated with other injuries. This case report presents a 57-years old female who was injured in a traffic accident and diagnosed with polytrauma, abdominal blunt trauma with 7th zone liver laceration, central fracture dislocation of the left hip associated with closed fracture left acetabulum anterior column and closed fracture left neck femur. Until now, there is no mandatory management to treat this kind of injury. Several surgical techniques were explained in previous literatures to treat this condition such as Open Reduction and Internal Fixation (ORIF) procedure and Total Hip Arthroplasty (THA). Some studies chose THA as a treatment for similar condition in older population due to high risk of nonunion and avascular necrosis of the femoral head, especially in cases of significant displacement and devitalization of the femoral head. In this case, we performed femoral head autograft and total hip arthroplasty as a definitive treatment.     

A rare complication of pelvic perforation by an excessive medial slide of the helical blade after treatment of an intertrochanteric fracture with proximal femoral nail anti-rotation: A case report and literature review

Intertrochanteric fractures have become a severe public health problem in elderly patients. Proximal femoral nail anti-rotation (PFNA) is a commonly used intram...