Traumatic carotid cavernous fistulas. Rare and life threatening.

Purpose: Carotid-cavernous fistulas (CCFs) are often underdiagnosed or misdiagnosed. In polytraumatized patients, the focus is primarily on treating potentially life-threatening conditions such as increased intracranial pressure and hemorrhages. This case report aims to identify common diagnostic mistakes in rare pathologies.

Arthroscopically-assisted mini open partial synovectomy for the treatment of localized pigmented villonodular synovitis of the knee. A retrospective comparative study with long-term follow up.

Purpose: The purpose of this study was to present the long-term results of treatment of localized pigmented villonodular synovitis (LPVNS) comparing two operative procedures of excision of the lesion-the arthroscopic and the arthroscopically assisted mini-open. We hypothesized that the latter approach allowed for treatment of LPVNS with acceptable recurrence rates, complication rates and functional outcomes.

Methods: Between 1990 and 2006, 21 patients with LPVNS were treated with partial synovectomy through an arthroscopically-assisted mini open technique (group A), and 23 patients were treated with an arthroscopic excision of the lesion (group B).

Distal Locking Screws for Intramedullary Nailing of Tibial Fractures.

Recently introduced tibial intramedullary nails allow a number of distal screws to be used to reduce the incidence of malalignment and loss of fixation of distal metaphyseal fractures. However, the number of screws and the type of screw configuration to be used remains obscure. This biomechanical study was performed to address this question.

Arthroscopic 4-point suture fixation of anterior cruciate ligament tibial avulsion fractures.

Tibial eminence avulsion fractures are rare injuries occurring mainly in adolescents and young adults. When necessary, regardless of patient age, anatomic reduction and stable internal fixation are mandatory for fracture healing and accurate restoration of normal knee biomechanics. Various arthroscopically assisted fixation methods with sutures, anchors, wires, or screws have been described but can be technically demanding, thus elongating operative times.

Concomitant acromioclavicular and miliary tuberculosis.

A 48-year-old man was being treated unsuccessfully for miliary tuberculosis for 5 months until he presented with acromioclavicular joint swelling. Imaging of the shoulder revealed destruction of the acromioclavicular joint and the patient was brought to the operating theatre and underwent the excision of the distal end of the clavicle, synovectomy and drainage of the abscess. Surgery was followed by prompt clinical, functional and radiological improvement.

Reverse cutting guidewire for intramedullary nailing: a solution for a common yet undocumented and unresolved complication.

In 6 of the 81 patients who were treated with intramedullary nailing for a femoral or tibial fracture the ball-tipped guidewire was impossible to remove manually after nail implantation. In four cases we had to remove the implant and to re-insert the nail. While this is a relatively common complication well known to orthopaedic and trauma surgeons, it has not been previously reported.

Floating elbow injuries in adults: prognostic factors affecting clinical outcomes.

Background: Floating elbow fractures in adults are rare and complex injuries with unpredictable outcomes. The present study was designed to assess our experience, analyze possible compilations and illustrate prognostic factors of the final outcome.

Methods: Between 2002 and 2009, 19 patients with floating elbow fractures were treated in our department (mean follow-up, 26 months).

Long head of the biceps pathology combined with rotator cuff tears.

The long head of the biceps tendon (LHBT) is an anatomic structure commonly involved in painful shoulder conditions as a result of trauma, degeneration, or overuse. Recent studies have pointed out the close correlation between LHBT lesions and rotator cuff (RCT) tears. Clinicians need to take into account the importance of the LHBT in the presence of other shoulder pathologies.

Hemiarthroplasty for pigmented villonodular synovitis of the shoulder: a report of two cases.

Pigmented villonodular synovitis is a reactive condition characterised by exuberant proliferation of synovial villi and nodules. It may be localised or diffuse and can cause severe articular damage. This report is of 2 patients with pigmented villonodular synovitis of the shoulder causing extensive arthritic changes.

Autologous bone marrow grafting combined with demineralized bone matrix improves consolidation of docking site after distraction osteogenesis.

Background: Distraction osteogenesis is used for the reconstruction of extensive osseous defects. Delay in docking site consolidation results in significant prolongation of this surgical procedure. The primary aim of the present study was to retrospectively compare three different treatment options, all aimed at improving and accelerating docking site consolidation.

New trends in fixation of proximal humeral fractures: a review.

Surgical treatment of proximal humeral fractures continues to be a challenge especially in osteoporotic patients. Locking plates and intramedullary nails have been used with satisfactory results but the previous reported complications have not been substantially reduced. Most of the existing studies involve a small number of patients followed up for a rather short period of time.

Functional outcome and structural integrity following mini-open repair of large and massive rotator cuff tears: a 3-5 year follow-up study.

Background: Mini-open approach has been considered for years the gold standard for rotator cuff repairs. Nevertheless, the rate of tendon-to-bone healing, and that of cuff re-tear, still remains unclear.

Methods: Between 2001 and 2004, 37 shoulders (32 patients) with a mean age of 54.

Surgical treatment of a twice recurrent chondrosarcoma of the pubic symphysis: a case report and review of the literature.

The case of a patient with a second recurrence of a chondrosarcoma of the pelvis and pubic symphysis is presented, in order to show the difficulties of the surgical treatment and the long course of the tumor.A 56-year-old woman having already been operated upon twice within two decades, presented with a large, mass of the pubic symphysis, extending into the left proximal thigh.Preoperative imaging revealed a large tumor occupying the pubic symphysis and the pubic bones up to the ischial tuberosities, extending into the soft tissues of the inner surface of the left thigh and displacing the urinary bladder, the urethra and the vagina.

Mid-term results of internal fixation of proximal humeral fractures with the Philos plate.

Objective: To report our experience from the use of the Philos plate for the treatment of three- and four-part proximal humeral fractures and to investigate factors influencing the final outcome.

Materials And Methods: Between April 2005 and September 2007, 29 Philos plates were implanted in 17 women and 12 men, with a mean age of 62.3 years (range: 28-80 years).

Suction during orthopaedic surgery. How safe is the suction tip?

The use of a suction system is mandatory in most orthopaedic procedures. In the unlikely event of contamination of the system, deep wound infection could occur, jeopardising the operation. We have prospectively studied 50 patients who underwent elective and orthopaedic trauma procedures during which a suction system was used.

Ultrasonography of symptomatic rotator cuff tears compared with MR imaging and surgery.

Purpose: To compare the accuracy of ultrasonography and magnetic resonance imaging in the detection of rotator cuff tears.

Materials And Methods: Ninety-six patients with clinically suspected rotator cuff pathology underwent ultrasonography and magnetic resonance imaging of the shoulder. The findings in 88 patients were compared with arthroscopy or open surgery.

Atraumatic haemarthrosis following total knee replacement treated with selective embolisation.

Spontaneous haemarthrosis in the absence of anticoagulant medication or a bleeding disorder is a very rare complication after total knee arthroplasty. A case of recurrent spontaneous haemarthrosis following total knee replacement in a 69-year-old patient is reported. Angiography was used to aid the diagnosis.

Reduction of postoperative spinal infections based on an etiologic protocol.

Unlabelled: Acute postoperative spinal infections are serious complications. We saw a sudden increase in the infection rate in our unit during a 6-month period. This led us to construct an assessment protocol combining risk factors into a mnemonic we named the "Nine Ps Protocol" (patient-related factors, personnel, place, preoperative length of stay, procedure, prosthetics, prophylaxis, packed red blood cells, and pus cultures).

Treatment of tuberculous spondylitis with anterior stabilization and titanium cage.

Unlabelled: We retrospectively reviewed 12 patients with spinal tuberculosis of the thoracic and lumbar spine who had radical débridement, anterior decompression, interbody arthrodesis with an anterior interbody titanium cage, and autologous bone grafts, combined with a standardized perioperative antituberculous regimen. Their mean age was 55.1 years and they were observed for a mean of 65.

Primary total-hip arthroplasty with the autophor 900-s fully porous coated stem in young patients seven to seventeen years of follow-up.

A total of 233 Autophor 900-S fully porous coated stems were implanted in 220 patients with an average age of 47.5 years and an average follow-up of 13.5 years.

Open traumatic avulsion of the flexor pollicis longus tendon from the musculotendinous area: a case report.

A traumatic avulsion of the flexor tendon at the musculotendinous junction in nonamputated digits is a very rare injury. We present a 14-year-old girl who sustained a longitudinal, tensile, injurious force directly to the flexor pollicis longus tendon after an open thenar injury resulting in its avulsion at the musculotendinous junction. In an effort to minimize soft-tissue damage and preserve the transverse ligament of the carpus the tendon was retrieved through a separate forearm incision.

Laceration of tibialis anterior tendon complicating a closed tibial fracture: a case report.

Traumatic laceration of the tibialis anterior tendon complicating a closed tibial shaft fracture is a rare injury pattern. Only 3 such cases have been reported to date in the English literature and all were missed on initial examination. A case of a 17-year-old motorcyclist with an acute laceration of the tibialis anterior tendon resulting from a closed oblique tibial shaft fracture is presented.

Antegrade interlocking nailing of humeral shaft fractures.

The results of 39 humeral shaft fractures (37 patients) treated with antegrade locked nailing using a Russell-Taylor nail were reviewed. There were 30 acute fractures, 6 fractures malaligned in a hanging cast or brace, and 3 pathological fractures. Patient age ranged from 26 to 80 years (average, 59.

Wilson osteotomy stabilised by means of internal fixation for the treatment of hallux valgus.

The results achieved in 20 patients (32 feet) who underwent Wilson's osteotomy of the first metatarsal for the treatment of hallux valgus were reviewed. In all cases the osteotomy site was stabilised with one or two cortical screws. The patients' average age was 50.