Search

Plantar reconstruction is often challenging for plastic surgeons because of the peculiar anatomical features of this region. A large variety of reconstructive techniques for the plantar aspect of the foot have been described previously, including skin grafts, local flaps, fasciocutaneous flaps, perforator flaps, cross-limb flaps, and free flaps. This article presents a case of a 64-year-old patient with insulin-dependent diabetes who was involved in a traffic accident that resulted in a large plantar tissue defect (9×4 cm) extending to the base of the toes. After debridement of the wound, a subcutaneous flap was raised from the medial aspect of the lower leg in a sovrafascial plane. The flap was based on a double vascularization given by the great saphenous vein and by the perforator vessels from the posterior tibial artery, located anteriorly and inferiorly to the medial malleolus. The flap showed excellent vitality and long-term result with reduced donor site morbidity. We believe this flap represents a reliable surgical option in superficial plantar defects due to easy harvesting, short operative time, and minimal donor site morbidity. The subcutaneous flap of the distal medial fourth of the leg is a safe technique because of the vascular components of the pedicle. It provides durable coverage, mechanical resistance to pressure and shear stresses and, in selected cases (superficial defects, thin patients), is an interesting option to avoid major free flap procedures.

The anteroposterior (AP) stability of standard anterior cruciate ligament (ACL) reconstruction, referred to as “vertical,” was compared with that of a modified femoral position, referred to as “horizontal,” which is lower than and anterior to an operative knee at 90° flexion. Two consecutive series of 50 patients underwent vertical and horizontal arthroscopic single-bundle ACL reconstruction, respectively. For vertical reconstruction, the clock position was chosen, placing the graft at 10:30 in right knees and 1:30 in left knees, 1 to 2 mm anterior to the posterior femoral cortical cortex and at the back of the resident ridge. In the horizontal reconstruction, the transplant replaced the original ligament insertion at approximately the 9:30 o’clock position in right knees and the 2:30 o’clock position in left knees, approximately 2 mm in front of the posterior femoral cortical cortex. One year after surgery, the results of stabilometric evaluation revealed good performance after horizontal transplant. The mean clinical results changed from 1.0 (±1.3) mm for vertical to 0.7 (±1.3) mm for horizontal reconstruction. [ Orthopedics. 2014; 37(5):321–324.]

Loose bodies are common findings in hip arthroscopy. Loose body removal can be challenging because of the inner position of the acetabulum in which the loose bodies tend to accumulate. Moreover, the standard removal procedure of a considerable number of loose bodies may need a long time under limb traction, thereby increasing the risk of complications. This article describes a new easy method for intra-articular loose body removal. A flexible endotracheal catheter, connected with suction system, is inserted via the anterior or midanterior portal. The catheter can easily be directed toward the inner parts of the joint in proximity of loose bodies. The suction system allows the loose body to be captured in contact with the tip of the catheter, which is then retrieved carrying the loose body outside the cannula. We performed this technique on 4 consecutive patients with synovial chondromatosis. Patients were evaluated preoperatively and 1 month postoperatively by completing self-administered questionnaires. The technique effectiveness was evaluated in terms of overall surgery time, traction time, radiographic appearance of loose bodies left in situ, and postoperative complications. Mean overall surgery time and central time was 175 and 78 minutes, respectively. All patients showed improvement in the operated hip. All radiographs showed hip joint space free of osteochondral loose bodies. No patients reported paraesthesia, nerve palsy, or other postoperative complications. This technique allows for retrieval of a greater amount of loose bodies in a short time, reducing the possibility of undesirable complications.

The capsulolabral advancement procedure performed for glenoid articular defects resulted in a significant decrease in pain and improved UCLA scores, and postoperative range of motion was not significantly diminished.

Several series report patients homogeneously treated using arthroscopic Bankart repair exclusively, or in some cases arthroscopic Bankart repair with rotator interval closure. Current international literature has few reports on arthroscopic Bankart repair with rotator interval closure procedures undertaken on a homogeneous series of patients. The purpose of this study was to evaluate the residual active range of motion (ROM) and clinical outcome in this patient population. Fourteen patients affected by recurrent anterior instability were consecutively treated. Rowe, Walch-Duplay, and UCLA scores, as well as differences in active ROM of both shoulders (treated and contralateral), were recorded. A significant reduction in active external rotation was noted along the side of the arm (P

The relationship between a longstanding cubitus varus deformity and the delayed onset of posterolateral rotatory instability has casually been reported as being caused by abnormal repetitive varus and external rotation torques with progressive failure of the lateral collateral ligament. This article presents a case of longstanding cubitus varus in a young man, following a supracondylar fracture sustained during childhood. Posterolateral rotatory instability with lateral collateral ligament deficiency was discovered after a corrective distal humeral realignment osteotomy. The scenario was worsened by medial olecranon overgrowth that predicated symptomatic medial snapping triceps during terminal extension and secondary ulnar neuropathy. Lateral collateral ligament reconstruction as well as an extra-articular olecranon osteotomy was performed. The ligament was reconstructed with a free graft harvested from the central portion of the distal triceps and secured with 2 bioabsorbable screws. The patient returned to work with no residual symptoms at final follow-up. This case highlights the possibility of posterolateral rotatory instability even with no clinical evidence at presentation. It suggests the importance of laterally redirecting the triceps vector and reconstructing the lateral collateral ligament as additional procedures at the time of supracondylar osteotomy.

The relationship between a longstanding cubitus varus deformity and the delayed onset of posterolateral rotatory instability has casually been reported as being caused by abnormal repetitive varus and external rotation torques with progressive failure of the lateral collateral ligament. This article presents a case of longstanding cubitus varus in a young man, following a supracondylar fracture sustained during childhood. Posterolateral rotatory instability with lateral collateral ligament deficiency was discovered after a corrective distal humeral realignment osteotomy. The scenario was worsened by medial olecranon overgrowth that predicated symptomatic medial snapping triceps during terminal extension and secondary ulnar neuropathy. Lateral collateral ligament reconstruction as well as an extra-articular olecranon osteotomy was performed. The ligament was reconstructed with a free graft harvested from the central portion of the distal triceps and secured with 2 bioabsorbable screws. The patient returned to work with no residual symptoms at final follow-up. This case highlights the possibility of posterolateral rotatory instability even with no clinical evidence at presentation. It suggests the importance of laterally redirecting the triceps vector and reconstructing the lateral collateral ligament as additional procedures at the time of supracondylar osteotomy.