Measurement of Medial Tibial Eminence Dimensions for the Clinical Evaluation of ACL-Injured Knees: A Comparison between CT and MRI

Anterior cruciate ligament (ACL) injuries commonly lead to translational and rotational tibiofemoral instability. The morphology of the medial tibial eminence (MTE) has received increased attention regarding its role in tibiofemoral stability in ACL-injured knees. Therefore, quantification of MTE dimensions on clinical imaging may help clinicians predict knee stability after ACL injury. Although magnetic resonance imaging (MRI) is routinely obtained in patients with ACL injuries, whether the dimensions of the MTE can be accurate quantified on MRI is unknown. The purpose of this study was to assess the degree of correlation between measurements of MTE height and width on computed tomography (CT) versus MRI. An institutional picture archiving and communication system imaging database was used to identify patients aged between 15 and 60 years who received concurrent MRI and CT of the same knee within a 1-year interval. Knees with significant arthrosis, deformity, intraarticular fracture, or hardware-related artifact that obscured visualization of the MTE were excluded. Mean differences and interstudy agreement between CT and MRI MTE measurements were compared using concordance correlation coefficient (r c) and Bland–Altman analysis. A total of 41 knees in 38 patients (mean age, 37 years; 82% male) were analyzed. Interrater reliability for CT and MRI measurements was high (intraclass correlation coefficient = 0.740–0.954). On coronal CT and MRI, mean MTE height measurements were 10.4 ± 1.9 and 10.4 ± 1.8 mm, respectively; mean MTE width measurements were 14.6 ± 3.6 and 14.2 ± 3.0 mm, respectively. On sagittal CT and MRI, mean MTE height measurements were 11.6 ± 1.7 and 11.7 ± 1.7 mm, respectively; mean MTE width measurements were 36.5 ± 4.8 and 36.2 ± 5.0 mm, respectively. Good agreement was observed between CT and MRI measurements of MTE height and width on coronal and sagittal planes (r c = 0.947–0.969). Measurements of MTE height and width were similar on MRI relative to CT on both coronal and sagittal planes. MRI may be suitable for characterizing the dimensions of the MTE when clinically evaluating patients with ACL injuries, potentially allowing for individualized patient care.

MIPO For Complex Comminuted Bone Fractures in the Floating Knee IIC According Fraser: a Case Report

Objective:Floating knee type IIC according to Fraser’s classification is an uncommon severe injury that typically occurs in polytrauma. In this case, mainly due to both intraarticular fracture and the high degree of comminution and malformation on the femoral mid-distal segments, fixation was challenging. The purpose of this study was to prove that minimally invasive plate osteosynthesis (MIPO) technology can simplify complex problems and improve prognosis. Case Presentation:A 38-year-old man injured his left leg in a car accident, causing pain, swelling, deformity, and limited mobility on his left knee and thigh, and two small open wounds were noted mainly on the anterior aspect of the mid-distal thigh. Physical examination and lower limb computed tomography angiography (CTA) confirmed that the neurovascular status was normal. The clinical diagnosis were closed intraarticular fracture of the proximal tibia, open intraarticular fracture of the distal femur with extension to the diaphysis, and a patellar fracture on the ipsilateral knee.In this case, a locking plate system characterized by minimally invasive plate osteosynthesis (MIPO) technology was used as the treatment. Results and Conclusion:Postoperative evolution was satisfactory, with immediate functional exercise, full weight bearing after three months, and return to daily activity without pain. Final follow-up taken at 3 years showed good lower limb alignment and complete plasticity of the bone structure, by which time the patient showed good limb function. Minimally invasive techniques can provide a simple and effective treatment for some complex fractures.

Talo-calcaneal distraction Ilizarov frame: an ergonomic method to manage intra-articular fractures of calcaneum

Background: Principle of distraction and an indirect reduction was used to promote healing of fractures and adequate regeneration of cartilage at the subtalar joint. Aims and Objectives: The study was aimed to elaborate and develop role of Ilizarov as an alternative biologicalmethod to manage intraarticular fracture calcaneum with minimal chances of infection. Materials and Methods: Twenty-one patients were studied and the mean age of patients was 40.7 years (span: 20 to 65 years). Sanders CT classification was used to divide into type II, 11 (52.38%); type III, 7 (33.33%) and type IV, 3 (14.28%). The average followup was 17.2 months (range: 6 to 24 months). AOFAS scale for ankle and hindfoot was used for assessment of patients- 7 (33.33%) excellent, 7 (33.33%) good, 3 (14.28%) fair, and 4 (19.04%) poor results. The average score was 81.5 ±12.1. The mean period of treatment was 12 weeks (10 to 14 weeks). Results: On radiological assessment, Bohler’s angle change was 19.7±4.4 degrees to 33.51± 5.7 degrees; angle of Gissane changed from 126.4 ± 6.7 degrees preoperatively to 124.9 ± 6.9 degrees postoperatively; calcanealheight changed 40.14 ± 1.98 mm preoperatively to 43.33 ± 1.87 mm and width changed 45.09 ±3.65 mm preoperatively to 43.09 ±3.16 mm postoperatively and reduction malalignment >10 degrees in 5 patients. Superficial skin infection at wire insertion sites was the most common complication encountered in our cases. Conclusion: Our results with this ergonomic technique in a small number of 21 non-randomised cases with a mean followup of 17.2 years attribute towards an alternate surgical substitute to conventional open reduction techniques in the treatment of intra-articular fractures of calcaneum having lesser rate of complications.

Evaluation of open reduction and internal fixation of displaced intra-articular fracture of calcaneum- A short term study

Introduction: Management of displaced intraarticular fracture of calcaneum is controversial. Non-operative management often have unsatisfactory result due to subtalar arthritis and abnormal foot morphology. Objective: The objective of the study was to evaluate clinical and radiological outcome of patients with displaced intra-articular fracture of calcaneum treated by open reduction and internal fixation(ORIF) with plates and screws through extensile lateral approach. Methodology: This was prospective clinical study conducted in Nobel Medical College between November 2016 to December 2019. The patients were treated by ORIF with calcaneal plates and screws through extensile lateral approach. Patients were followed up for minimal one year. Patients were evaluated clinically by using AOFAS hind foot score and radiologically by measuring Bohler’s and Gissane angle and calcaneal height and width. Results: Out of total 26 cases, fifteen were sander’s type II, eight were type III and three were type IV. The mean age of patients was 33.92 years. The mean delay of surgery due to swelling was 8.65±1.95 days. The averagefollow-up period was 17 months. The mean AOFAS hind foot score was85.08±7.67. Tenpatients (38.46%) had excellent, twelve patients(48.61%) had good and four patients(15.38%) had fair outcome.There were significant association between improvement in Bohler’s and Gissane angle and functional outcome measured by AOFAS hind foot score. Conclusion : Open reduction and internal fixation of displaced intraarticular fracture of calcaneum with calcaneal plates and screws through extensile lateral approach produce good clinical and radiological result.

Nascent Malunion of an Isolated Intraarticular Fracture of the Ulnar Head

Background Isolated fractures of the ulnar head are rare. Only few cases have been reported in literature. Case Description We report a case of a 16-year-old student who was treated for an ulnar styloid fracture conservatively. An associated displaced intraarticular fracture of the ulnar head has been overlooked. He presented late in our clinic with a symptomatic nascent malunion of the ulnar head fracture. A corrective osteotomy by a palmar approach was performed. Fixation by screws was used with an excellent result at 7-year follow-up. Literature Review The rare cases of isolated ulnar head fractures reported in literature were treated by open reduction and internal fixation only in case of fracture dislocation. Clinical Relevance The authors highlight the fact that even a nascent malunion of an isolated intraarticular fracture of the ulnar head may be treated successfully by open reduction and internal fixation.