Surgical Approaches and Leg Positions for Tibial Plateau Fractures

Tibial plateau fractures are a common orthopedic injury. Epidemiological studies have shown that these injuries appear in younger or older patients with different mechanisms of injury. For better long-term results, it is crucial to achieve successful fracture reduction, thus avoiding the main complication, which is post-traumatic arthritis. Reduction can be achieved by choosing the proper surgical approach. Many approaches that address the fractures of the tibial plateau have been described in international literature. In the past, the direct anterior midline approach was used, which required a large detachment of the soft tissues. Nowadays, the percutaneous approach, the anterolateral approach, the medial approach, the posteromedial approach, the posterolateral approach, and the direct posterior approach are used by orthopedic surgeons to treat these kinds of fractures. In this chapter, we will describe the surgical approaches available for tibial plateau fractures and the possible positions of the affected leg

One-stage thumb lengthening with use of an osteocutaneous 2nd metacarpal flap

Traumatic thumb amputation represents an extremely disabling entity, thus rendering its reconstruction a procedure of paramount importance. A case of a patient, who sustained a traumatic amputation of his left index finger at the metacarpophalangeal joint and of his left thumb in the middle of the proximal phalanx 4 months ago and was initially treated elsewhere, is described. For the thumb reconstruction, an osteocutaneous flap of the radial side of the 2nd metacarpal, which consisted of a 3, 5-cm bony segment with the overlying skin and its blood and nerve supply was used. The flap was transferred and fixed with a plate and screws to the palmar-medial side of the stump of the thumb, while the 1st web space was deepened by removing the rest of the second metacarpal, while a partial skin graft was used to cover a remaining gap. Thumb functionality was restored immediately postoperatively, and the overall result was satisfactory

Combined Bone Transportation and Lengthening Techniques for the Treatment of Septic Nonunion of the Forearm Followed by Tendon Transfer

Infected nonunion of a forearm fracture complicated by a considerable skin-muscle defect poses a great challenge to orthopaedic surgeons. The treatment strategy comprises eradication of the infection, ensuring bony union and soft tissue coverage along with functional restoration. We report a case of a 23-year-old man with an open Gustilo-Anderson IIIb fracture complicated by infected nonunion after internal fixation. After thorough surgical debridement, a considerable soft tissue defect, extensor muscle loss, and posterior interosseous nerve laceration had to be addressed. He was finally treated with bone transportation and bone lengthening followed by tendon transfers

A Case of Trapezium Avascular Necrosis Treated Conservatively

Introduction. Avascular necrosis (AVN) of the bones of the wrist most commonly involves the lunate followed by the proximal pole of the scaphoid and the capitate. Trapezium avascular necrosis is extremely rare with only two cases reported in the literature, both of which were treated surgically. In this article, we report a unique case of trapezium avascular necrosis treated conservatively. Case Presentation. A 38-year-old man complaining of a 4-month history of mild pain on the base of his right thumb. MRI scan was performed. The clinical presentation and the imaging findings indicated avascular osteonecrosis of the trapezium. The patient was treated with immobilization of the wrist joint for a period of six weeks. Three months later, the patient was free of symptoms and the MRI scan revealed a normal trapezium. Conclusion. AVN of trapezium is extremely rare. Our case shows that immobilization of an early stage avascular necrosis of the trapezium might be a treatment option

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. This paper provides an up-to-date overview of recent publications on anatomy, pathophysiology, diagnosis, classification, and current treatment strategies

A Misguiding Osteoid Osteoma in the Bicipital Tuberosity of the Radius

Osteoid osteoma is a benign bone tumor that appears most frequently in young patients. It is more common in males and it concerns mostly the long bones of the lower limb. A 20-year-old young woman presented to our outpatient department with pain in her left elbow. The symptoms began four years ago. At first, her symptoms were attributed to ulnar neuritis, confirmed by nerve conduction studies. In the following two years, she had undergone two surgical operations for decompression of the ulnar nerve. As a result, she reported poor results, which forced her to take frequently anti-inflammatory drugs for some years. When the patient presented to us, we planned a three-phase bone scan and an elbow MRI, which revealed the lesion. Based on the image findings of osteoid osteoma, we proceeded to the surgical removal of the tumor. Since then, the patient is pain-free and has a full range of motion of the affected elbow. Osteoid osteoma usually mimics multiple pathologies in the upper limb especially joint disease posing a challenge for the physician. The diagnosis requires high index of suspicion and a prompt diagnostic and surgical management

Relationship between Surface Loading, Depth and Effluent Suspended Solids at a Rectangular, Horizontal Pilot-Scale Secondary Clarifier

This paper deals with the selection of depth necessary for final clarifiers depending on hydraulic surface loading qA (m3.m−2.h−1), on settled sludge volume VSV (ml.l−1, dilution method, see W. Merkel, 1971), on the return sludge ratio (RV, percent) and on TSe (mg.l−1), the total filterable residue in the effluent.</jats:p