The management of intra-articular lateral femoral condyle (Hoffa) fracture of the knee using arthroscopy-assisted fixation: a case report

A Hoffa fracture is a type of supracondylar distal femoral fracture with fracture line located in the coronal plane. It is a rare injury consisting of tangential (coronal shear) fracture of distal femoral condyles. Unicondylar knee fractures are rare and present some diagnostic difficulties due to poor visibility on standard X-ray and are especially harder to identify in non-displaced fracture. A fifty-four-year-old male presented to our emergency room with a chief complaint of pain over his right knee that started 10 months prior. He previously was involved in a motor vehicle accident and underwent open reduction and internal fixation with plate and screws. Physical examination revealed swelling and tenderness over the right knee with limited range of motion. Plain X-ray showed union of tibia plateau fracture with plate and screws and no evidence of distal femoral fracture. A magnetic resonance imaging of the right knee was performed and revealed an intraarticular lateral condyle femur fracture with transverse configuration that was previously missed on plain X-ray. Arthroscopy-assisted reduction and internal fixation using antero-posterior and postero-anterior oriented screws were performed and good reduction was achieved. Diagnosis of this type of fracture is challenging and require some experience. Awareness of such entity and strong clinical suspicion are essential for diagnosis because most of the time the standard X-rays may appear normal. Arthroscopy-assisted fracture fixation using antero-posterior and postero-anterior oriented screws for Hoffa fracture offers many advantages and allows for early mobilization postoperatively without any loss of reduction

Latarjet procedure for failed arthroscopic Bankart repair: a case report

Arthroscopic Bankart Repair (ABR) provides acceptable results for recurrent anterior shoulder dislocation. However, recent studies have shown recurrent rates of 4-19% or even up to 35-40% in patients aged <25 years, and the results tend to get worse after long-term follow-up. The Latarjet procedure can improve anterior stability by multiple mechanisms, not only can the Bankart lesion be repaired and provide stability, but the transfer of the coracoid process extends the bony articular arc of the glenoid, and the addition of the conjoint tendon may provide dynamic stability as well. The Latarjet procedure for correcting recurrent anterior shoulder dislocation led to good and excellent results in 82.7% of the cases. The Latarjet procedure had the lowest re-dislocation rate, which was significantly lower than the arthroscopic Bankart repair. Latarjet procedure is effective in terms of restoring anteroinferior glenohumeral stability and good option for failed arthroscopic Bankart repair. Recurrence rates of instability are acceptable and re-operation rates were low

Medial patellofemoral ligament reconstruction with gracilis autograft for recurrent patellar instability: a case report

The medial patellofemoral ligament (MPFL) is the primary passive restraint in pathologic lateral translation of the patella. Recurrent patellar instability is com­mon, and multiple procedures have been described for its treatment. Chronic instability of the patellofemoral joint and recurrent dislocation may lead to progres­sive cartilage damage and severe arthritis if not treated adequately. A 17-years-old female presented with a one-year history of knee pain in his left knee. The apprehension test is positive; there is pain and muscle defensive contraction of lateral patellar dislocation with 20°-30° of knee flexion. MRI revealed flattened trochlear joint surface proximally and the concavity is less pronounced distally. The inclination angle is less than 11 degrees and trochlear facet asymmetry can be seen on axial view. Patient undergone medial patellofemoral ligament reconstruction with gracilis autograft and six months postoperatively, the patient was followed up using WOMAC score and showed good result. WOMAC score was 96.2% indicating no significant pain, joint stiffness, or any difficulty on physical activity. After the operation, the patient is able to perform regular daily activities without any complaints. This study has shown that treatment of recurrent patellar instability with medial patellofemoral ligament reconstruction using gracilis autograft resulted in satisfactory functional outcome based on WOMAC score

Arthroscopic pull-through suture for tibial eminence avulsion fracture: a case series

Fractures of the tibial eminence is commonly reported in adolescents and adults, due to traffic accident, sports injury, or any other mechanism. Case 1: a 12-year-old male complained knee pain after a traffic accident 2 months prior to visit. Case 2: a 31-year-old female complained knee pain which worsened with long-distance walking and sitting, after falling on her knees one month prior to visit. Case 3: a 27-year-old female complained a worsening knee pain after traffic accident 12 years ago. Although it has been extensively studied, controversies regarding the best fixation method still exist. Open technique was once popular, but some morbidity has been associated with this method. Therefore, a new approach using arthroscopic pull-through suture technique, albeit technically challenging, is currently being advocated as a treatment option for such fractures. The result in our series confirm that all of 3 patients have a good result based on international knee documentation committee (IKDC) scoring for evaluation the treatment, hence support the use of this novel technique for the patients with tibial eminence avulsion fracture

The correlation of Singh index and cortical thickness index toward bone mineral density in women older than 60 years old with femoral neck fracture

Background: Femoral neck fracture is one of the most common fractures in elderly. Proximal femur fracture in elderly patients is considered a severe morbidity which has a negative impact on the life expectancy and quality of life. Aim of this study was to find the correlation of cortical thickness index (CTI) and SI toward bone density (BMD) in female patients over 60 years of age with femoral neck fracture.Methods: This is an observational cross-sectional study. Subjects were selected from Sanglah general hospital outpatient department, Denpasar, Bali during the period October 2020 to January 2021 by inclusion requirements and then randomized into two groups. Data were taken through history taking, physical examination as well as supporting investigations such as contralateral hip joint radiograph and BMD measurements. Statistical analysis was done from those data.Results: It has been obtained that there was a positive correlation of Singh index (SI) and CTI toward BMD. The correlation coefficient (r) between SI and BMD was 0.874 (p=0.000). The r between CTI and BMD was 0.854 (p=0.000). Both variables were significant.Conclusions: There were significantly strong correlations between SI and BMD (r=0.874, p=0.00), also CTI and BMD (r=0.854, p=0.00) in female patients over 60 years of age with femoral neck fracture

Arthroscopic posterior-inferior capsular release in the treatment of overhead athlete with GHIRD: a case report

Glenohumeral internal rotation deficit (GHIRD) is one of most controversial joint diseases in terms of diagnosis and treatment. The use of arthroscopy has improved the recognition of pathologic findings in glenohumeral internal rotation deficit (GHIRD) and allowed a better understanding of the etiology of it and the correlation between symptoms and lesion patterns. We present our technique for arthroscopic posterior-inferior capsular release in athlete with symptomatic glenohumeral internal rotation deficit (GIRD) that was unresponsive to nonoperative treatment and was preventing him from returning to sport. By this technique resulted in a successful outcome. We evaluate a 28 years old male with right shoulder pain and limitation in abduction internanal rotation after 3 months conservative treatment. We performed Arthrospcopic posterior-inferior capsular release. After 2 months correspondingly, we performed follow-up assessments on shoulder function (using the ases and rowe score) and pain (using a visual analogue scale) were made. Arthroscopic posterior-inferior capsular release can be recommended as a reasonable operative solution for overhead athletes with symptomatic GIRD that has not responden to conservative management. Evaluation of patient in whom we performed arthroscopic repair base on ases and rowe score. Arthroscopic posterior-inferior capsular release showed satisfactory shoulder function after 2 months follow up correspondingly