Arthroscopy pull through for management of eminentia tibia fracture in 15 years old adolescent: a case report

Tibial eminence fractures are rare injuries. Multiple treatment techniques are described and there is a lack of consensus with regard to the choice of treatment. In this case, we present the left eminentia tibia fracture which stabilized using arthroscopy pull through technique in a 15 years old male adolescent. A male 15 years old adolescent complained of pain on his left knee after climbing a tree and jumped with his left knee in hyperextention. On physical examination, tenderness was felt around the apex of patella. Left knee X-Ray confirmed a fracture of eminentia tibia. On arthroscopic evaluation, there was a fracture of medial eminentia tibia meyers and mckeever IIIA. The fractures were treated by using 1 mm ethibond which was inserted through the anterior cruciate ligament and pull through the tibia plateau. 10 weeks evaluation after the procedure, patient was able to walk independently with full weight bearing and was able to flex his knee in 130˚ and full extension without any pain. Management of displaced fracture of eminentia tibia is somewhat controversial and the ideal method of fixation has not been defined. In this patient, there were perfect anatomic and functional outcome without any serious complication. Arthroscopic reduction and internal fixation by pull through suture provide perfect anatomic and functional outcome for displaced type II and type III tibial eminence fracture

Pathological fracture of subtrochanter femur, soft tissue infection along the fracture site, shaft femur bone cortex thickening and blastic lession on contralateral shaft femur due to renal osteodystrophy on the end stage renal disease patient: a case report

Renal osteodystrophy (ROD) is a skeletal complication resulting from pathologic alterations in calcium, phosphate, and bone metabolism. The potential link between bone turnover and bone quality is an important question meriting study because of the relatively high incidence of fractures reported. In this case presents a pathological fracture on a routinely hemodialyzed woman. She complained pain on her left subtrochanteric area after low energy trauma accident. A thickening of the shaft femoral bone cortex was also found, reflecting the osteosclerosis event due to imbalance of proliferation and differentiation of osteoblast with increase bone formation. She also had a blastic lesion on her contralateral shaft femoral during the bone survey, but this finding remains asymptomatic. Decreased osteoclastic activity may contribute to cortical thickening, resulting in overall bone mass increase, which may lead to decreased elasticity of the bone or impaired repair capabilities, therefore increasing the risk of fracture. The blastic lesion that occurred on contralateral side may indicated effect of ROD or primary bone lesion. Careful assessment and holistic management of patients with kidney disease is necessary to achieve optimal outcome. The prevention of falls is also an important strategy to prevent pathological fractures. End stage renal disease (ESRD) have reduced bone mineral density, a risk factor for fracture incidence. Careful anamnesis and clinical examination are needed for diagnosis and management

Medial swivel type dislocation of the talonavicular joint with associated cuboid fracture: a case report

Medial Swivel-type dislocation are dislocation of talonavicular joint (TNJ) medially and the calcaneus swivels under the talus, with the calcaneocuboid joint intact. This is a rare injury due to the strong network of ligament and tendinous structures. An 11-year-old girl presented after 1 week of injury to the left foot. She had pain, swelling on the mid-foot and inability to weight bearing. X-ray and computerized tomography (CT) scan showed medial dislocation of TNJ, with fracture of cuboid body. A closed reduction was attempted but it failed. Patient then underwent open reduction with K-wire fixation and immobilization by below knee cast for 3 weeks. After K-wire removal, the foot was stable with near normal ankle and sub-talar joint range of motion and patient started to partial weight bearing Midtarsal dislocations of the foot are rare injuries. In this case dislocation is resulted from high-energy medial forces to the forefoot. The associated cuboid fracture possibly as a result of tensile forces through the lateral structure of midfoot with adduction. ‘Swivel dislocation’ in which the TNJ dislocates, usually medially, and the calcaneus swivels under the talus, with the calcaneocuboid joint intact. A careful assessment of initial radiograph and CT scan should be done to determine type of dislocation and associated fracture. An open reduction K-wire fixation bring a stable reduction. Talonavicular dislocations are rare injuries, occur as a result of high-energy trauma. A stable reduction and good outcome are anticipated