A unique case of a double intra-conal cavernous hemangioma

Background Cavernous hemangiomas are benign vascular malformations, probably representing the most common intraorbital and intraconal tumors in the adult population. Case presentation We report the case of a 49-year-old female with two intra-conal lesions. We performed a total resection using Ulivieri's extended lateral approach. The postoperative course was uneventful and the patient was discharged three days after surgery. Conclusions To the best of our knowledge, we report here the first case in the literature of a double intra-conal lesion.

3D printing-assisted extended lateral approach for displaced intra-articular calcaneal fractures: a systematic review and meta-analysis

Background Three-dimensional (3D) printing technology has developed rapidly in orthopaedic surgery and effectively achieves precise and personalized surgery. The purpose of this meta-analysis was to assess the efficacy of 3D printing technology in the management of displaced intra-articular calcaneal fractures (DICFs) by extended lateral approach (ELA). Methods We searched PubMed, Web of Science, Embase, Cochrane Library, CNKI, VIP, and VANFUN databases were searched up to October 2020. All clinical studies comparing traditional surgery and 3D printing-assisted surgery in the management of DICFs were obtained, evaluating the quality of the included studies and extracting data. For each study, we assessed odds ratios (ORs), standard mean difference (SMD), and 95% confidence interval (95% CI) to assess and synthesize the outcomes. Results Three RCTs and nine retrospective studies involving 732 patients were included met our inclusion criteria with 366 patients in the 3D group and 366 patients in the conventional group. The meta-analysis showed that there were significant differences of the operative time in the 3D group [SMD = − 1.86, 95% CI (− 2.23, − 1.40), P < 0.001], intraoperative blood loss [SMD = − 1.26, 95% CI (− 1.82, − 0.69), P < 0.001], the number of intraoperative X-ray exposures [SMD = − 0.66, 95% CI (− 1.20, − 0.12), P < 0.001], postoperative complications [OR = 0.49, 95% CI (0.31, 0.79), P < 0.001], excellent and good rate of calcaneal fracture outcome [OR = 4.09, 95% CI (2.03, 8.22), P < 0.001]. Conclusion The current study indicates that 3D printing-assisted ELA surgery showed a better rate of excellent and good outcome, shorter operation time, less intraoperative blood loss, fewer intraoperative fluoroscopies, fewer complications. Besides, there is still a need for large-sample, high-quality, long-term randomized controlled trials to confirm the conclusion.

Anatomical Study of Sinus Tarsi–Based Lateral Lengthening Calcaneal Osteotomy

Background: Lateral lengthening calcaneal osteotomy (LL-CO) is commonly performed as a treatment for an abducted midfoot in pes planovalgus deformity. The purpose of this study is to investigate potential damage to medial structures with a sinus tarsi LL-CO. Methods: Sixteen cadaver feet were used. Eight feet had an extended lateral approach, and 8 had a limited lateral (sinus tarsi) approach. All underwent a sinus tarsi LL-CO. Specimens were then dissected to identify inadvertent injury to medial structures. Results: Sinus tarsi LL-CO was associated with damage to the sustentaculum tali and medial articular facets in 56% and 62.5% of specimens, respectively. No anterior or posterior facet injuries were found, although 56% of specimens had a confluent medial and anterior facet. Conclusion: Damage to the medial articular facet and sustentaculum is possible with a flat cut sinus tarsi LL-CO due to the curved nature of the relevant sinus tarsi and canal anatomy. Clinical Relevance: Sinus tarsi LL-CO needs to be performed with caution since damage to the subtalar joint is possible. Level of Evidence: Level II, prospective cohort study.

Extended approach to the lateral tibial plateau with central meniscal subluxation in fracture repair: feasibility and first clinical and radiographic results

Purpose Anatomic reduction in tibial plateau fractures remains to be demanding. For further visualisation of and approach to the joint surface an extended lateral approach using a lateral femoral epicondyle osteotomy and subluxation of the lateral meniscus was recently described. First clinical and radiographic mid-term results of this technique are presented in this feasibility study. Method Ten complex tibial plateau fractures treated with extended lateral approach and lateral meniscal subluxation were prospectively analysed. Clinical and radiographic results were objectified according to the Rasmussen scores. Results After a median follow-up of 8.6 (IQR 4.3) months good to excellent clinical and radiographic results were noted. The clinical Rasmussen Score showed a median of 25 (IQR 2.8) and radiographic a median of 17 (IQR 2.0) points. Conclusion Good to excellent clinical and radiological scores were obtained after using an extended lateral approach with lateral femoral epicondyle osteotomy and central meniscus subluxation. No approach specific complications could be observed.

A Modified Sinus Tarsi Approach for Treatment of Displaced Intra-articular Calcaneal Fractures Sanders type Ⅱ or Ⅲ Compared to Extended Lateral Approach

Background: We have designed a modified sinus tarsi approach (MSTA) to treat sanders type Ⅱ or Ⅲ intra-articular calcaneal fractures, providing sufficient surgical field exposure and operation space, and significantly reducing the rate of wound complications. We compared the radiologic results, clinical outcomes, and complications of patients operated on via the MSTA and the extended lateral approach (ELA) for treatment of displaced intraarticular calcaneal fractures Sanders type Ⅱ or Ⅲ.Methods: We retrospectively studied the utility of the ELA (32 patients, 34 feet) and the MSTA (33 patients, 36 feet) operated on from January 2013 to January 2018. The average follow-up time of the two groups was 58 months. We assessed the preoperative and final x-rays, clinical outcomes and complications at the last follow-up. Clinical outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analog scale (VAS).Results: In both groups, the average final width, height, Bohler angle were significantly restored compared with the preoperative width, height, and Bohler. The last follow-up calcaneal length, width, height, Bohler angle, Gissane angle did not differ significantly between the 2 groups. In terms of the clinical outcomes, the average AOFAS score of the ELA group checked to 82.1 points, yielding a 77.8% excellent or good rating, and the average VAS score was 1.76 points. In contrast, the average AOFAS score of the MSTA group checked to 81.0 points, yielding a 79.4% excellent or good rating, and the average VAS score was 1.68 points. There was no significant difference in AOFAS score and VAS score between the 2 groups. The wound-healing complication rate was 2.9% in MSTA group and 22.2% in ELA group (p = .040). 4 cases of sural nerve injury occurred in ELA group, and 2 in MSTA group. 1 cases of peroneal tendon complication only occurred in ELA group.Conclusion: Compared with ELA, MSTA provides similar and favorable radiological and clinical results, and is associated with fewer wound complications. We believe the MSTA is more appropriate in the treatment of Sanders II and III calcaneal intra-articular fractures.

Improved Visualization by Central Subluxation of the Lateral Meniscus in Comminuted Lateral Tibial Plateau Fractures

The goal of surgical reconstruction of comminuted tibial plateau fractures is an anatomical reconstruction and stable fixation of the articular surface. This can be difficult due to poor visualization of the posterolateral and central segments of the articular surface of the proximal tibia. To improve visualization, the lateral approach can be extended with an osteotomy of the femoral epicondyle. In most cases, use of the extended lateral approach allows the whole lateral plateau to be visualized. Nevertheless, in some cases, an osteotomy alone is not enough to expose the entire fracture, especially the central segments of the tibial plateau. For these specific cases, we developed an additional technical trick that significantly improves articular visualization; the lateral meniscocapsular fibers are dissected allowing for central subluxation of the lateral meniscus, while leaving the anterior and posterior roots intact. With central subluxation of the lateral meniscus in comminuted tibial plateau fractures, the joint surface can be completely visualized, allowing an anatomical reduction even in highly complex fractures.