Isolated slipped-retroverted osteochondral fracture of second metatarsal head

Although metatarsal fractures are common, isolated intraarticular metatarsal head fractures are rare, and retroversion of the fracture segment is even rarer. Herein, a retroverted fracture of the second metatarsal head, which happened with a direct trauma from jumping from a height, was discussed with treatment options and finally a simple surgical trick was advised. There are only a few cases of isolated osteochondral and retroverted fractures of the metatarsal head in literature. The following is a rare case report of such an injury in a 19-year-old male.     

Autogenous osteochondral transplantation of the second metatarsal head

A case of an osteochondral defect of the second metatarsal head treated with autogenous osteochondral transplantation from the talonavicular joint is presented. At 6-months follow-up, the patient had returned to previous activities with no complaints. MRI evaluation showed good congruency of the joint surface and complete incorporation of the osteochondral autograft.     

Traumatic osteochondral defect of the first metatarsal head: a case report.

Osteochondral injury of the first metatarsophalangeal joint is described in most literature as "osteochondritis dissecans" and an early stage of hallux rigidus. Traumatic osteochondral lesions of the knee and ankle are relatively common and well described. A case of a traumatic osteochondral defect of the first metatarsal head is presented.     

Surgical management of osteochondral lesions of the first metatarsal head: A systematic review

BackgroundTreating osteochondral lesions of the first metatarsal head can help reducing pain and preventing end-stage arthritic cartilage degeneration and hallux rigidus. Several surgical techniques have been described, but no clear indications are reported. This systematic review aims to offer an overview of the current surgical treatments for focal osteochondral lesions of the first metatarsal head.MethodsThe selected articles were examined to extract data about population, surgical technique, and clinical outcomes.ResultsEleven articles were included. Mean age at surgery was 38,2 years. Osteochondral autograft was the most used technique. After surgery, an improvement was achieved in AOFAS, VAS, and hallux dorsiflexion but not in plantarflexion.ConclusionThere is limited evidence and knowledge regarding the surgical management of the first metatarsal head osteochondral lesions. Various surgical techniques have been proposed, drawn from other districts. Good clinical results have been reported. Further high-level comparative studies are necessary to design an evidence-based treatment algorithm.     

Femoral head autograft in simultaneous primary and revision total hip arthroplasty

Bilateral total hip arthroplasty during one anesthetic procedure can be beneficial in properly selected patients. For patients who have a failed hip arthroplasty requiring revision and a contralateral arthritic hip requiring primary arthroplasty, bilateral surgery permits the resected femoral head from the primary procedure to be used as a fresh autogenous bone—graft during the revision procedure. Four patients underwent combined primary hip arthroplasty and contralateral revision hip arthroplasty during one anesthetic procedure. The femoral head obtained during the primary procedure was used as a structural acetabular bone—graft in three patients, and bone slurry was used to fill cavitary acetabular defects in one patient. A femoral neck autograft was used to reconstruct a calcar defect in one of the patients. After an average follow-up period of 27 months, all hips were functioning well with healed bone—grafts and stable prosthetic components.     

Acetabular reconstruction using a free fibular autograft in total hip arthroplasty revisions

Purpose

Acetabular reconstruction for segmentary bone loss aims for primary stability and long-lasting integration. The use of a fibular autograft has been described after tumour resection and in traumatology. The hypothesis of this study is that it offers a mechanically reliable solution with good functional results and acceptable morbidity.

Methods

This is a two center retrospective study of 26 operated hips. Indication was mechanical loosening in every case. The operative technique included fibular grafting of a segmental bone loss associated with an acetabular metal reinforcement.

Results

Mean follow up was 88 months (three to 165). The PMA score increased from 8.5 (five to 12) to 15 (six to 18) (p <0.001). Acetabular migration was 2 mm (0–4) vertically and 1 mm (0–2) medially. Three graft failures were observed. No major morbidity was observed.

Conclusion

Fibular autograft after mechanical loosening and segmentary bone loss in total hip arthroplasty revisions offers a mechanically reliable solution for acetabular reconstruction. The results seem to be at least equivalent to other techniques.     

Osteochondral autogenous transplantation for an osteochondral defect of the first metatarsal head: A case report

A case of an isolated, traumatic, osteochondral injury to the articular surface of the first metatarsal head, which was successfully treated with an autogenous transplant of an osteochondral plug from the ipsilateral knee, is reported. After a 2-year follow-up, the patient reported no persistent symptoms, full resumption of preinjury activities, and was satisfied with her outcome.     

Donor-site morbidity after osteochondral autograft transfer procedures

We report on 2 patients who had donor-site morbidity after an autogenous osteochondral grafting was performed. Both patients had fibrocartilage hypertrophy at the donor sites that contributed to knee pain and occasional locking; the second patient also had a lack of fibrocartilaginous regrowth with symptomatic residual osteocartilaginous defects. Additional arthroscopic surgery was required in both cases to trim the fibrocartilage. In addition, for the second case, a fresh osteoarticular allograft was used to transfer osteocartilaginous plugs back into the original knee donor sites due to continued knee pain. When performing an osteochondral autograft transfer, the benefits provided at the recipient site must be weighed against the possible donor-site morbidity that may result.     

Cementless total hip arthroplasty using an autograft of the femoral head for marked acetabular dysplasia: case series

PURPOSE: To assess the short-term outcome of cementless total hip arthroplasty involving an autograft of the femoral head in Japanese patients. METHODS: Cementless total hip arthroplasty with autogenous bone block grafting was performed on 18 hips in 15 patients with marked acetabular dysplasia. The resected femoral head was used as a graft for the superior-lateral region of the true acetabulum. Clinical outcome was correlated with the placement of the acetabular component, as revealed in radiographs. RESULTS: The 13 women and 2 men had a mean age of 60.2 years (range, 37.0-73.0 years) at primary surgery and a mean follow-up duration of 3.3 years (range, 2.0-5.3 years). According to the classification of Crowe, 4 hips were in group I, 3 were in group II, one in group III, and 10 in group IV. The mean Harris Hip Score preoperatively was 45.7 (range, 19-69) and that at follow-up was 82.5 (range, 44-100). All 15 cases showed a good clinical outcome. There were no major intra-operative complications in this series. The grafted bones united in all patients. Two patients need surgical revision because the lateral insertion of the acetabular component resulted in loosening of it. CONCLUSION: Medial insertion of the acetabular component provides satisfactory short-term outcomes. Lateral insertion of the acetabular component during total hip arthroplasty should be avoided in patients with marked acetabular dysplasia.     

Tibial plateu "Kissing Lesion" from a proud osteochondral autograft

Knee osteochondral lesions can be debilitating. Multiple procedures have been used to manage these defects. Osteochondral autograft transplantation is one such option. Reported complications include donor-site morbidity, failed osteointegration, size mismatch, and incongruency. In this article, we report a case of graft incongruency of the medial femoral condyle that resulted in a full-thickness "kissing lesion" groove on the opposing medial tibial plateau. In an osteochondral autograft transplantation procedure, proper surgical technique is paramount to prevent placement of a proud autograft and avoid the difficult complication of associated tibial chondral defects.     

Proximal row carpectomy with capitate osteochondral autograft transplantation

Proximal row carpectomy (PRC) is an effective treatment option for degenerative or posttraumatic osteoarthritis of the wrist in conditions such as scapholunate advanced collapse, scaphoid nonunion advanced collapse, Kienbock disease, and chronic fracture dislocations of the carpus. PRC involves excision of the scaphoid, lunate, and triquetrum, and relies on the articulation of the remaining capitate from the distal row to articulate with the lunate fossa. PRC offers the potential advantage of greater range of motion, technical ease, and decreased immobilization, and eliminates specific complications found with other motion-preserving procedures such as nonunion, hardware irritation, and impingement. An established relative contraindication for PRC is the presence of advanced capitolunate arthritis. Many authors have offered modifications of the traditional PRC procedure to account for the presence of capitate arthritis. A PRC technique utilizing an osteochondral autograft, from the carpal bank of excised bones, for transfer to the capitate defect is described.     

Radial head arthroplasty with a modular metal spacer to treat acute traumatic elbow instability

BACKGROUND: The use of a metal radial head prosthesis to help stabilize an elbow with traumatic instability is appealing because internal fixation of multifragment, displaced fractures of the radial head is susceptible to either early or late failure. The newer modular prostheses are easier to size and implant, but their effectiveness has not been investigated, to our knowledge. METHODS: Twenty-seven patients in whom a radial head replacement with a modular metal spacer prosthesis had been performed to treat traumatic elbow instability were evaluated with use of the Mayo Elbow Performance Index (MEPI), the American Shoulder and Elbow Surgeons Elbow Evaluation Instrument (ASES), and the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH). Radiographs were evaluated for arthrosis, periprosthetic radiolucency, and heterotopic ossification. RESULTS: Seven patients underwent one or more subsequent operations to treat residual instability, heterotopic ossification and elbow contracture, ulnar neuropathy, or a misplaced screw. In two of these patients, the prosthesis was removed as part of an elbow contracture release or to treat infection. At an average of forty months postoperatively, elbow motion in the entire group of twenty-seven patients averaged 131 degrees of flexion with a 20 degrees flexion contracture, 73 degrees of pronation, and 57 degrees of supination. Stability was restored to all twenty-seven elbows, and twenty-two patients had a good or excellent result according to the MEPI. Seventeen patients had radiographic evidence of lucency around the neck of the prosthesis that was not associated with increased pain, thirteen patients had clinically inconsequential heterotopic ossification anterior to the radial neck, and nine patients had radiographic changes in the capitellum. CONCLUSIONS: An intentionally loosely placed modular metal radial head prosthesis can help to restore stability in conjunction with repair of other fractures and reattachment of the lateral collateral ligament to the epicondyle in the setting of traumatic elbow instability with a comminuted fracture of the radial head. While a prosthesis that is too large can cause problems, lucencies around the stem of the intentionally loose prosthesis and most changes in the capitellum do not appear to cause problems, at least in the short term.     

Outcome of osteochondral autograft transplantation for type-V cystic osteochondral lesions of the talus

The treatment of osteochondral lesions of the talus has evolved with the development of improved imaging and arthroscopic techniques. However, the outcome of treatment for large cystic type-V lesions is poor, using conventional grafting, debridement or microfracture techniques. This retrospective study examined the outcomes of 50 patients with a cystic talar defect who were treated with arthroscopically harvested, cored osteochondral graft taken from the ipsilateral knee. Of the 50 patients, 45 (90%) had a mean good to excellent score of 80.3 (52 to 90) in the Karlsson-Peterson Ankle Score, at a mean follow-up of 36 months (24 to 83). A malleolar osteotomy for exposure was needed in 26 patients and there were no malleolar mal- or nonunions. One patient had symptoms at the donor site three months after surgery; these resolved after arthroscopic release of scar tissue. This technique is demanding with or without a malleolar osteotomy, but if properly performed has a high likelihood of success.     

Swanson人工跖趾关节置换术治疗晚期跖骨头骨软骨病

背景：第二跖骨头骨软骨病的基本病理改变是跖骨头关节软骨和髓软骨内骨化障碍。对中晚期患者,大部分学者主张早期手术干预。而目前采用的手术方法多种多样,且各有利弊。目的：观察Swanson人工跖趾关节置换术治疗晚期跖骨头骨软骨病的疗效。方法：2007年5月至2011年3月,利用Swanson人工跖趾关节置换治疗且有完整随访资料的晚期跖骨头骨软骨病患者19例（36足）,男7例（14足）,女12例（22足）;年龄43-76岁,平均57．8岁。单侧2例,双侧17例;病变于第二跖趾关节16例,第三跖趾关节3例;合并躅外翻畸形13例,趾间神经瘤2例。负重位X线片参照Smillie分期：Ⅲ期1例,Ⅳ期11例,Ⅴ期7例。测量并记录术前、术后跖趾关节背伸、跖屈角度。结果：随访时间最长5年,最短14个月,平均3．6年。术后患者跖趾关节处疼痛消失,活动自如,术前跖趾关节活动度：背伸10．6°±2．87°,跖屈18．3°±1．96°;术后：背伸32．9°±1．67°,跖屈36．7°±1．17°,术后与术前关节活动度比较,差异有统计学意义（P〈0．05）。根据美国足踝外科协会Maryland跖趾关节百分评分法对本组患者进行评定,优为90～100分,26足,占72．2％;良为80-89分,8足,占22．2％;可为70-79分,2足,占5．6％。优良率为94．4％。结论：对于年龄较大且处于Smillie分期晚期的跖骨头骨软骨病患者,Swanson人工跖趾关节置换术是一个较好的治疗方法。     

Radial head prosthesis with a mobile head

Radial head replacement is a useful method in the treatment of comminuted radial head fractures. Because such injuries are a common clinical problem and many complications have been reported after radial head replacements, a new radial head prosthesis is proposed. This new design, based on the shape-dimensional identification of the radial head, consists of two parts. The head, made of ultra-high molecular weight polyethylene, is articulated with a Vitallium stem. A series of functional quality and strength tests were conducted on this new prosthetic design. The implant was also examined via the finite element method. General preclinical investigations of clinical cases show that this prosthesis is a very promising design.     

Simultaneous primary total hip arthroplasty and contralateral revision hip arthroplasty: role for use of femoral head autograft

We report the outcome of revision hip arthroplasty for patients with acetabular bone loss in whom the femoral head retrieved from arthritic contralateral hip during the same anesthesia was used as autograft for acetabular reconstruction. Thirty-two hips in 16 patients with a mean age of 63.8 years (range, 43-79 years) were followed for an average of 3.5 years. All primary arthroplasties were successful. Evidence of autograft incorporation was found in all except 2 patients. The acetabular component failed and required revision in the latter 2 patients. The use of femoral head autograft in a select group of patients with symptomatic arthritis of hip and a failed prosthetic hip with severe bone loss in the contralateral side is a viable option. However, this technique should not be applied to acetabular reconstructions in which protected weight-bearing in the postoperative period may be necessary.