A Novel Percutaneous Screw Fixation of Postero-lateral Tibial Plateau Fracture using Posterior Cruciate Ligament Reconstruction Femoral Template: Technical Note 使用後交叉韌帶重建股骨模板重建後外側脛骨平台骨折的一種新的經皮螺釘固定法:技術說明

AbstractPercutaneous fixation method has been applied in Schatzker type III joint depressed-type lateral tibial plateau fracture. We report a 76-year-old man suffering from a small joint depressed-type posterolateral tibial plateau fracture with surgical reduction and fixation with a novel guidance of posterior cruciate ligament (PCL) reconstruction femoral template under X-ray and arthroscopic assistance. The concept of sequential tunnel drilling in ligament reconstruction has been applied in bone impaction tunnel creation beneath the articular step with the PCL jig. Avoidance of multiple bone guide pin drilling and accurate guide pin insertion and hence screw fixation was also achieved by use of the PCL template. As illustrated, we believe that the PCL jig is a good armamentarium and adjunct equipment to achieve a more precise minimally invasive operation in special anatomical positions such as the postero-lateral tibial plateau under careful surgical planning

Rare ligamentum flavum cyst causing incapacitating lumbar spinal stenosis: Experience with 3 Chinese patients

Three Chinese patients suffered from severe lumbar spinal stenosis with debilitating symptoms due to a rare condition of ligamentum flavum cysts in the midline of the lumbar spine. This disease is distinct from synovial cyst of the facet joints or ganglion cysts, both intraoperatively and histopathologically. Magnetic Resonance imaging features of the ligamentum flavum cyst are also demonstrated. We share our surgical experiences of identification of the ligamentum flavum cysts, decompression and excision for two of the patients with demonstrably good recovery. This disease should be considered in the differential diagnosis of an extradural instraspinal mass in patients with lumbar spinal stenosis

Clinical and biomechanical outcome of minimal invasive and open repair of the Achilles tendon

Introduction: With evolutions in surgical techniques, minimally invasive surgical (MIS) repair with Achillon applicator has been introduced. However, there is still a lack of literature to investigate into the clinical merits of MIS over open surgery. This study aims to investigate the correlation between clinical outcome, gait analysis and biomechanical properties comparing both surgical methods.Materials and methods: A single centre retrospective review on all the consecutive operated patients between January 2004 and December 2008 was performed. Twenty-six patients (19 male and 7 female; age 40.4 ± 9.2 years) had experienced a complete Achilles tendon rupture with operative repair. Nineteen of the patients, 10 MIS versus 9 open repairs (13 men with a mean age of 40.54 ± 10.43 (range 23-62 yrs) and 6 women with a mean age of 45.33 ± 7.71 (range 35-57 yrs) were further invited to attend a thorough clinical assessment using Holz's scale and biomechanical evaluation at a mean of 25.3 months after operation. This study utilized the Cybex II isokinetic dynamometer to assess the isokinetic peak force of plantar-flexion and dorsiflexion of both ankles. The patients were also invited to return to our Gait Laboratory for analysis. The eight-infrared camera motion capture system (VICON, UK) was utilized for the acquisition of kinematic variables. Their anthropometric data was measured according to the Davis and coworkers' standard.Results: The mean operative time and length of hospital stay were shorter in the MIS group. The operative time was 54.55 ± 15.15 minutes versus 68.80 ± 18.23 minutes of the MIS group and Open group respectively (p = 0.045), whereas length of stay was 3.36 ± 1.21 days versus 6.40 ± 3.70 days respectively (p = 0.039). There is statistically significant decrease (p = 0.005) in incision length in MIS group than the open surgery group, 3.23 ± 1.10 cm versus 9.64 ± 2.55 cm respectively. Both groups attained similar Holz's scores, 11.70 ± 0.95 versus 12.0 ± 1.50 respectively (p = 0.262). The mean percentage stance time of the injured leg for MIS patient was 58.44% while the mean percentage stance time of the injured leg for patients with open repair was 56.57%. T-test has shown there were no significance differences between the results of the two groups of patients. The loss of peak torque and total work done with respect to the injured side were similar between the MIS and open group.Discussion and conclusion: MIS using Achillon method can achieve smaller incisions, shorter operative time and hospital stay. There is no statistical significance difference in clinical outcome, the stance time to strike time ratio and biomechanical properties on the leg receiving Achilles tendon repair using MIS method and open surgery. © 2011 Chan et al; licensee BioMed Central Ltd

Clinical and biomechanical outcome of minimal invasive and open repair of the Achilles tendon

Introduction: With evolutions in surgical techniques, minimally invasive surgical (MIS) repair with Achillon applicator has been introduced. However, there is still a lack of literature to investigate into the clinical merits of MIS over open surgery. This study aims to investigate the correlation between clinical outcome, gait analysis and biomechanical properties comparing both surgical methods.Materials and methods: A single centre retrospective review on all the consecutive operated patients between January 2004 and December 2008 was performed. Twenty-six patients (19 male and 7 female; age 40.4 ± 9.2 years) had experienced a complete Achilles tendon rupture with operative repair. Nineteen of the patients, 10 MIS versus 9 open repairs (13 men with a mean age of 40.54 ± 10.43 (range 23-62 yrs) and 6 women with a mean age of 45.33 ± 7.71 (range 35-57 yrs) were further invited to attend a thorough clinical assessment using Holz's scale and biomechanical evaluation at a mean of 25.3 months after operation. This study utilized the Cybex II isokinetic dynamometer to assess the isokinetic peak force of plantar-flexion and dorsiflexion of both ankles. The patients were also invited to return to our Gait Laboratory for analysis. The eight-infrared camera motion capture system (VICON, UK) was utilized for the acquisition of kinematic variables. Their anthropometric data was measured according to the Davis and coworkers' standard.Results: The mean operative time and length of hospital stay were shorter in the MIS group. The operative time was 54.55 ± 15.15 minutes versus 68.80 ± 18.23 minutes of the MIS group and Open group respectively (p = 0.045), whereas length of stay was 3.36 ± 1.21 days versus 6.40 ± 3.70 days respectively (p = 0.039). There is statistically significant decrease (p = 0.005) in incision length in MIS group than the open surgery group, 3.23 ± 1.10 cm versus 9.64 ± 2.55 cm respectively. Both groups attained similar Holz's scores, 11.70 ± 0.95 versus 12.0 ± 1.50 respectively (p = 0.262). The mean percentage stance time of the injured leg for MIS patient was 58.44% while the mean percentage stance time of the injured leg for patients with open repair was 56.57%. T-test has shown there were no significance differences between the results of the two groups of patients. The loss of peak torque and total work done with respect to the injured side were similar between the MIS and open group.Discussion and conclusion: MIS using Achillon method can achieve smaller incisions, shorter operative time and hospital stay. There is no statistical significance difference in clinical outcome, the stance time to strike time ratio and biomechanical properties on the leg receiving Achilles tendon repair using MIS method and open surgery. © 2011 Chan et al; licensee BioMed Central Ltd

A Novel Closed Method to Retrieve Broken Teflon Tube During Intramedullary Nailing in Proximal Humeral Fracture

Broken medullary tubes have been used for intramedullary (IM) nailing of femoral and tibial fractures. In these reported cases, fragments of the medullary tube were retrieved by opening the fracture sites or left in situ, which might jeopardize periosteal blood supply. We herein present the case of a 58-year-old woman who underwent IM nailing for proximal humeral fracture, which was complicated by breakage of the medullary tube intraoperatively. Different instruments including guide rods, straight forceps, and cement extract hook were used to retrieve the retained fragments from the medullary canal, but these attempts were unsuccessful. Finally, the fragments were successfully removed using an anterior cruciate ligament (ACL) ENDOBUTTON depth gauge. This case highlights that medullary tubes can break during humeral IM nailing, which could be minimized by ensuring integrity of the medullary tube prior to surgery and disposing medullary tubes with more than 100 exposures. A novel method of using ACL ENDOBUTTON depth gauge to retrieve retained tube fragments is recommended because of its long and slim design