SOTA Foot and Ankle, Conservative Treatment & Resident‘s Sessions Free Papers
Tracks
MR 7
Thursday, September 26, 2024 |
9:00 - 10:00 |
MR 7 |
Speaker
Mohd Yazid Bajuri
National Delegates For Malaysia, Sicot Education Commitee
Universiti Kebangsaan Malaysia, Medical Centre
The Diagnostic Puzzle: Midfoot Fracture, Malunion, or Charcot Neuroarthropathy
Abstract
The Diagnostic Puzzle: Midfoot Fracture, Malunion, or Charcot Neuroarthropathy
INTRODUCTION:
Injuries to the midfoot are uncommon and their diagnosis can be challenging. Consequently, overlooked midfoot fractures can result in significant repercussions for both the patient and the surgeon.
REPORT:
Here, we present a case of a 39-year-old woman recently diagnosed with diabetes, hypertension, and dyslipidemia. She experienced left foot pain and deformity for five months after spraining her ankle. Initially diagnosed with a soft tissue injury, her condition worsened despite bearing weight on her foot. Four months later, she sought medical attention, showing signs of foot deformity. Laboratory results revealed elevated HbA1c at 12.3%. Diagnosis: neglected midfoot fracture with malunion secondary to charcot neuroarthropathy. Treatment: left midfoot fusion surgery corrected deformity and relieved pain.
DISCUSSION:
The case presented a diagnostic challenge due to severe midfoot deformity following a minor ankle sprain. Differential diagnoses included midfoot charcot neuroarthropathy, osteomyelitis, and malunited midfoot fracture. With the patient newly diagnosed with diabetes mellitus (HbA1c: 12.3%), charcot neuroarthropathy was identified as a causative factor. Rapid progression of the condition further suggested charcot neuroarthropathy. Managing neglected midfoot malunion secondary to charcot neuroarthropathy poses challenges, with literature recommending corrective surgery focusing on salvaging the tarsometatarsal joint and reconstructing the foot arch through osteotomy, fusion, and stabilization.
CONCLUSION:
Surgical intervention is imperative for neglected malunion of midfoot charcot neuroarthropaty. Effective treatment, which focuses on stabilizing the affected joints, correcting alignment, and restoring the foot arch, can lead to outstanding outcomes.
INTRODUCTION:
Injuries to the midfoot are uncommon and their diagnosis can be challenging. Consequently, overlooked midfoot fractures can result in significant repercussions for both the patient and the surgeon.
REPORT:
Here, we present a case of a 39-year-old woman recently diagnosed with diabetes, hypertension, and dyslipidemia. She experienced left foot pain and deformity for five months after spraining her ankle. Initially diagnosed with a soft tissue injury, her condition worsened despite bearing weight on her foot. Four months later, she sought medical attention, showing signs of foot deformity. Laboratory results revealed elevated HbA1c at 12.3%. Diagnosis: neglected midfoot fracture with malunion secondary to charcot neuroarthropathy. Treatment: left midfoot fusion surgery corrected deformity and relieved pain.
DISCUSSION:
The case presented a diagnostic challenge due to severe midfoot deformity following a minor ankle sprain. Differential diagnoses included midfoot charcot neuroarthropathy, osteomyelitis, and malunited midfoot fracture. With the patient newly diagnosed with diabetes mellitus (HbA1c: 12.3%), charcot neuroarthropathy was identified as a causative factor. Rapid progression of the condition further suggested charcot neuroarthropathy. Managing neglected midfoot malunion secondary to charcot neuroarthropathy poses challenges, with literature recommending corrective surgery focusing on salvaging the tarsometatarsal joint and reconstructing the foot arch through osteotomy, fusion, and stabilization.
CONCLUSION:
Surgical intervention is imperative for neglected malunion of midfoot charcot neuroarthropaty. Effective treatment, which focuses on stabilizing the affected joints, correcting alignment, and restoring the foot arch, can lead to outstanding outcomes.
Mohd Yazid Bajuri
National Delegates For Malaysia, Sicot Education Commitee
Universiti Kebangsaan Malaysia, Medical Centre
Diagnostic Dilemma: Late-stage Ankle Gouty Arthritis Simulating Infection and Malignancy
Abstract
Diagnostic Dilemma: Late-stage Ankle Gouty Arthritis Simulating Infection and Malignancy
INTRODUCTION :
Gouty arthritis poses a frequent challenge in orthopedic-endocrinology realms. Nonetheless, occurrences of erosive gouty tophi leading to ankle joint deterioration are seldom encountered. Herein, we present a case involving the late manifestation of tibio-talar joint gouty arthritis.
REPORT:
A 53-year-old man with a history of gout presented with worsening pain and swelling in his right ankle over five months, hindering weight-bearing. No night pain, constitutional symptoms, or tuberculosis contact reported. Examination revealed diffuse swelling around the right ankle joint. Blood tests showed leukocytosis (24.5 x 10^9/L), elevated ESR (77mm/hr), CRP (4.42 mg/dL), and hyperuricemia (503umol/L). Ultrasound and bone scan indicated active infection, confirmed by contrast MRI. Treatment involved arthrotomy washout, external fixation, and antibiotic cement spacer insertion. Intraoperatively, chalky material, flattening of the talar dome, and complete loss of articular cartilage were observed, with inflamed synovial tissue. Cultures for fungi, TB, and tissue were negative. Histopathological examination confirmed gouty tophi.
DISCUSSION :
Due to elevated inflammatory markers and MRI evidence of tibio-talar joint erosion with talar dome flattening, investigating for osteomyelitis or tuberculosis is crucial. Ankle joint involvement and signs of joint erosion typically manifest in the late stages of gouty arthritis (19% versus 5% in early stages).
CONCLUSION :
Diagnosing ankle gouty arthritis can be complex, but management focuses on thorough debridement, restoring limb functionality, pain relief, and joint stabilization. Definitive procedures like ankle joint arthrodesis or replacement surgery may be considered in later stages of treatment.
INTRODUCTION :
Gouty arthritis poses a frequent challenge in orthopedic-endocrinology realms. Nonetheless, occurrences of erosive gouty tophi leading to ankle joint deterioration are seldom encountered. Herein, we present a case involving the late manifestation of tibio-talar joint gouty arthritis.
REPORT:
A 53-year-old man with a history of gout presented with worsening pain and swelling in his right ankle over five months, hindering weight-bearing. No night pain, constitutional symptoms, or tuberculosis contact reported. Examination revealed diffuse swelling around the right ankle joint. Blood tests showed leukocytosis (24.5 x 10^9/L), elevated ESR (77mm/hr), CRP (4.42 mg/dL), and hyperuricemia (503umol/L). Ultrasound and bone scan indicated active infection, confirmed by contrast MRI. Treatment involved arthrotomy washout, external fixation, and antibiotic cement spacer insertion. Intraoperatively, chalky material, flattening of the talar dome, and complete loss of articular cartilage were observed, with inflamed synovial tissue. Cultures for fungi, TB, and tissue were negative. Histopathological examination confirmed gouty tophi.
DISCUSSION :
Due to elevated inflammatory markers and MRI evidence of tibio-talar joint erosion with talar dome flattening, investigating for osteomyelitis or tuberculosis is crucial. Ankle joint involvement and signs of joint erosion typically manifest in the late stages of gouty arthritis (19% versus 5% in early stages).
CONCLUSION :
Diagnosing ankle gouty arthritis can be complex, but management focuses on thorough debridement, restoring limb functionality, pain relief, and joint stabilization. Definitive procedures like ankle joint arthrodesis or replacement surgery may be considered in later stages of treatment.
Draško Vasović
Banjica Institute of Orthopedics
Hirurško lečenje povrede Lisfrankovog zgloba stopala
Abstract
Uprkos tome što je Lisfrankova povreda tarzo-metatarzalnog zgloba stopala poznata unazad dva veka, lečenje ove povrede i dalje predstavlja veliki problem u ortopediji i traumatologiji. Od postavljanja dijagnoze i operativne indikacije, preko odabira adekvatne operativne tehnike i na kraju pravilne rehabilitacije postoji dosta prostora za grešku, a u literaturi se ne izdvaja ni jedan algoritam lečenja koji bi se mogao okarakterisati kao superioran.
Autori žele da predstave studiju slučajeva od 14 pacijenata sa povredom Lisfrankovog zgloba, koji su lečeni operativno na Institutu za ortopediju Banjica, u periodu od četiti godine (od 2020. do 2024 godine), od strane istog hirurga. Operativna tehnika koja je bila korišćena je otvorena anatomska repozicija tarzometatarzalnog zgloba sa različitim tehnikama unutrašnje fiksacijom. Period praćenja pacijenata je bio u intervalu od 6 do 30 meseci nakon operacije.
Cilj ove studije slučajeva je prikazivanje rezultata nakon operativnog lečenja Lisfrankove povrede tarzo-metatarzalnog zgloba. Takođe razmatra se najadevatniji načinin fiksacije, kao i funkcionalni rezultati nakon operativnog lečenja. Na kraju iznećemo preporuke i smernice za lečenje povrede Lisfrakovog zloba koja, ako se previdi ili zanemari može dovesti do ozbiljnih komplikacija u smislu pojave deformiteta stopala i rane pojave osteoartitičnih promena, kao i posledice po svakodnevni život pacijenata.
Autori žele da predstave studiju slučajeva od 14 pacijenata sa povredom Lisfrankovog zgloba, koji su lečeni operativno na Institutu za ortopediju Banjica, u periodu od četiti godine (od 2020. do 2024 godine), od strane istog hirurga. Operativna tehnika koja je bila korišćena je otvorena anatomska repozicija tarzometatarzalnog zgloba sa različitim tehnikama unutrašnje fiksacijom. Period praćenja pacijenata je bio u intervalu od 6 do 30 meseci nakon operacije.
Cilj ove studije slučajeva je prikazivanje rezultata nakon operativnog lečenja Lisfrankove povrede tarzo-metatarzalnog zgloba. Takođe razmatra se najadevatniji načinin fiksacije, kao i funkcionalni rezultati nakon operativnog lečenja. Na kraju iznećemo preporuke i smernice za lečenje povrede Lisfrakovog zloba koja, ako se previdi ili zanemari može dovesti do ozbiljnih komplikacija u smislu pojave deformiteta stopala i rane pojave osteoartitičnih promena, kao i posledice po svakodnevni život pacijenata.
Ivica Lalić
Assoc. Prof. Md Phd
University Business Academy In Novi Sad Faculty Of Pharmacy, Novi Sad
Treatment of open extruded fracture neck of the talus using the combined method of external fixation modified for dynamic ankle joint fixation and Kirschner wires - case report
Abstract
Abstract
Introduction: Open extruded fracture of the talus is present in 2% of talar fractures. Because of numerous complications (infection, nonunions, arthritis), it represents a great challenge for the surgeon. The most commonly used method of treatment is reimplantation of the talus and osteosynthesis.
Case presentation: A 19-year-old patient suffered an open extruded fracture of the talus type Hawkins II after falling from a height. The emergency operative technique that we performed was debridement of the wound, reimplantation of the talus bone, osteosynthesis with external fixation modified for dynamic external fixation of the ankle joint (Mitkovic-type), and two Kirschner wires. Reposition of fragments we controlled with C-Arm fluoroscopy. The patient was prescribed 14 days antibiotic therapy (cephalosporin, aminoglycoside, mebendazole) and thromboembolic prophylaxis for 35 days. After 6 weeks we allowed movements in the ankle joint with physical therapy. Gradual weight-bearing in the injured leg was allowed after 8 weeks. The osteosynthetic material was removed after 18 weeks, and the treatment continued with physical therapy with a full weight bearing on the leg after 6 months. X-ray follow-up of the talus was done for 2 months until the 24th month postoperatively. An excellent result was obtained with a healed talus and minimal restriction of dorsiflexion of the foot.
Conclusion: Treatment of this injury represents a huge challenge for the surgeon. External fixation can be chosen as a treatment method for an open luxation fracture of the talus.
Keywords: case report, open extruded talar fracture, external fixation, Kirschner wires.
Introduction: Open extruded fracture of the talus is present in 2% of talar fractures. Because of numerous complications (infection, nonunions, arthritis), it represents a great challenge for the surgeon. The most commonly used method of treatment is reimplantation of the talus and osteosynthesis.
Case presentation: A 19-year-old patient suffered an open extruded fracture of the talus type Hawkins II after falling from a height. The emergency operative technique that we performed was debridement of the wound, reimplantation of the talus bone, osteosynthesis with external fixation modified for dynamic external fixation of the ankle joint (Mitkovic-type), and two Kirschner wires. Reposition of fragments we controlled with C-Arm fluoroscopy. The patient was prescribed 14 days antibiotic therapy (cephalosporin, aminoglycoside, mebendazole) and thromboembolic prophylaxis for 35 days. After 6 weeks we allowed movements in the ankle joint with physical therapy. Gradual weight-bearing in the injured leg was allowed after 8 weeks. The osteosynthetic material was removed after 18 weeks, and the treatment continued with physical therapy with a full weight bearing on the leg after 6 months. X-ray follow-up of the talus was done for 2 months until the 24th month postoperatively. An excellent result was obtained with a healed talus and minimal restriction of dorsiflexion of the foot.
Conclusion: Treatment of this injury represents a huge challenge for the surgeon. External fixation can be chosen as a treatment method for an open luxation fracture of the talus.
Keywords: case report, open extruded talar fracture, external fixation, Kirschner wires.
Luka Čvorović
Resident Of Orthopedic Surgery And Traumatology
Klinički centar Srbije
Complications of Surgical Treatment of Achilles Tendon Rupture
Abstract
The Achilles tendon, significant for stabilizing the ankle joint and crucial for walking, is often prone to injury, especially in physically active individuals. Surgical intervention is often necessary for a certain portion of the population, but it carries certain risks that affect the final outcome. This study aims to analyze complications after surgical treatment of the Achilles tendon. Complications of Surgical Treatment: Wound Complications: Issues such as wound dehiscence and infection are possible and have a certain percentage influenced by factors such as diabetes and surgical technique. Reported rates vary from 3% to 25%. Nerve Injuries: Rare but serious intraoperative nerve injuries can cause sensory problems. Reported rates vary from 0.5% to 6%. Achilles Tendon Healing Complications: Poor healing can lead to re-rupture or adhesions. Reported rates of re-rupture vary from 1% to 5%. Functional Results and Limitations: Complications often result in reduced strength and mobility of the ankle joint, along with decreased dorsiflexion, deformity, swelling, with reported percentages ranging from 10% to 30%. Deep Vein Thrombosis and Pulmonary Embolism:
Prolonged immobilization increases the risk of blood clots, with reported rates ranging from 0.5% to 3%. Conclusion: Although surgical intervention restores function, the complications are significant. A multidisciplinary approach is crucial for effective management.
Prolonged immobilization increases the risk of blood clots, with reported rates ranging from 0.5% to 3%. Conclusion: Although surgical intervention restores function, the complications are significant. A multidisciplinary approach is crucial for effective management.
Divya Bhanu
Senior Resident
Sanjay Gandhi Postgraduate Institute Of Medical Sciences,Lucknow,uttar Pradesh,india
Subjective Global Assessment and Serum Biomarkers as a Screening Tool for The Evaluation of Nutrition Status and Its Impact on Bone Healing in Patients with Limb Injuries
Abstract
Background: Hospitalized patients' malnutrition is a serious issue. In patients with limb injuries, this study sought to determine the usefulness of the Subjective Global Assessment (SGA) in forecasting the relationship between serum biomarkers and malnutrition, as well as the effect of malnutrition on clinical and radiographic bone repair. Methodology: There were ninety-three individuals with limb injuries in this prospective trial. Along with the secondary outcomes, basic demographic information, serum biomarker levels, nutritional status as determined by the SGA, and the relationship between nutrition status and the Radiological Union Shaft Tibia (RUST) score were evaluated. Results: Patients were categorized into three groups based on the SGA: well-nourished Group A, moderately malnourished Group B, and severely malnourished Group C. Albumin, hemoglobin, platelets, and total leucocyte count were the serum indicators that were substantially increased in Group A compared to Group B + C (p < 0.0001). When compared to Group B + C, the nutritional status of patients in Group A was significantly greater (p < 0.0001) from the time of admission up to six months later. At six months, the RUST score for radiological healing showed a negative connection with C-reactive protein and a positive correlation with a number of other indicators. Conclusions: There was a positive link observed between the nutritional status of the patients and the serum biomarker levels as well as the clinical and radiographic bone repair as determined by the RUST grading system.
Uros Moljevic
Clinic for Orthopedic Surgery and Traumatology UCCS
Lečenje aseptične pseudoartroze dijafize tibije intramedularnim klinom - prikaz slučaja
Abstract
Uvod: Brojne tehnike se koriste za lečenje pseudoartroza preloma dijafize tibije, od kojih fiksacija intramedularnim klinom može biti najpovoljnija po pacijenta, obzirom da omogućava oslonac od prvog postoperativnog dana, uz minimalan rizik od postoperativnih komplikacija.
Slučaj: Pacijentkinja starosti 66 godina, hipertoničar, loše regulisana glikemija, povređena padom na ravnom, zadobila prelom tibije AO42A2, otvoren Gustillo-Anderson tip II. Lečena spoljašnjim fiksatorom u regionalnoj ustanovi. Zbog inicijalno prihvatljive pozicije fragmenata, odlučeno da se lečenje započetom metodom. Nakon 6 meseci, uklonjen fiksator, bez jasnih znakova zarastanja preloma, postavljena gipsana imobilizacija, koja je uklonjena nakon 6 nedelja, kada je pacijentkinji dozvoljen oslonac, i započet rehabilitacioni tretman. Na narednim kontroloma radiografski se uočava progresivno povećanje varus deformiteta na mestu pseudoartroze. Nakon 15 meseci od povrede, pacijentkinja operativno lečena na našoj Klinici, učinjen debridman mesta preloma, intramedularna fiksacija uz osteoplastiku koštanom pastom. Dobijena anatomska konfiguracija potkolenice. Brisevi mesta preloma pristigli sterilni. Pacijentkinji dozvoljen oslonac prvog postoperativnog dana. Radiografski verifikovano zarastanje posle 3 meseca.
Diskusija: Pseudoartroze tibije predstavljaju čest problem u ortopedskoj hirurgiji, najčešće kao posledica loše procene u metodi lečenja ili korišćenjem neadekvatne tehnike. Potrebno je odabrati implantat s kojim se ostvaruje zadovoljavajuća stabilnost, uz što manje narušavanje mekotkivnog pokrivača potkolenice, i smanjen rizik od nastanka postoperativnih komplikacija.
Zaključak: Indramedularna fiksacija se može uspešno koristiti kao metoda lečenja aseptičnih pseudoartroza dijafize tibije.
Slučaj: Pacijentkinja starosti 66 godina, hipertoničar, loše regulisana glikemija, povređena padom na ravnom, zadobila prelom tibije AO42A2, otvoren Gustillo-Anderson tip II. Lečena spoljašnjim fiksatorom u regionalnoj ustanovi. Zbog inicijalno prihvatljive pozicije fragmenata, odlučeno da se lečenje započetom metodom. Nakon 6 meseci, uklonjen fiksator, bez jasnih znakova zarastanja preloma, postavljena gipsana imobilizacija, koja je uklonjena nakon 6 nedelja, kada je pacijentkinji dozvoljen oslonac, i započet rehabilitacioni tretman. Na narednim kontroloma radiografski se uočava progresivno povećanje varus deformiteta na mestu pseudoartroze. Nakon 15 meseci od povrede, pacijentkinja operativno lečena na našoj Klinici, učinjen debridman mesta preloma, intramedularna fiksacija uz osteoplastiku koštanom pastom. Dobijena anatomska konfiguracija potkolenice. Brisevi mesta preloma pristigli sterilni. Pacijentkinji dozvoljen oslonac prvog postoperativnog dana. Radiografski verifikovano zarastanje posle 3 meseca.
Diskusija: Pseudoartroze tibije predstavljaju čest problem u ortopedskoj hirurgiji, najčešće kao posledica loše procene u metodi lečenja ili korišćenjem neadekvatne tehnike. Potrebno je odabrati implantat s kojim se ostvaruje zadovoljavajuća stabilnost, uz što manje narušavanje mekotkivnog pokrivača potkolenice, i smanjen rizik od nastanka postoperativnih komplikacija.
Zaključak: Indramedularna fiksacija se može uspešno koristiti kao metoda lečenja aseptičnih pseudoartroza dijafize tibije.
Moderator
Ivana Glisovic Jovanovic
MD, ortopaedic and traumatology surgeon
UNIVERSITY CLINICAL CENTRE OF SERBIA, Clinic for ortopaedic surgery and traumatology
Goran Lekić
Predrag Rasovic
Clinical Center Of Vojvodina