Pseudoaneurysm as a complication of ankle arthroscopy

We present a case of a pseudoaneurysm of the anterior tibial artery following ankle arthroscopy with synovectomy, an extremely rare complication when standard anteromedial and anterolateral portals are used. The patient was diagnosed and treated with appropriate interventions which led to an uneventful recovery. Nevertheless, the potential sequelae of delayed diagnosis or misdiagnosis of the complication are dangerous; therefore, a high index of suspicion for a pseudoaneurysm must be maintained in the postoperative period

Respuesta a la carta al editor sobre 'El uso de rivaroxabán para la tromboprofilaxis está asociado con la infección temprana de la articulación periprotésica'

To the Editor: We would like to thank the authors for their input regarding our article entitled “Rivaroxaban Use for Thrombosis Prophylaxis Is Associated With Early Periprosthetic Joint Infection” [1]. As the authors noted, in the RECORD randomized controlled trials, no statistical differences in safety were reported [2, 3, 4, 5]. However, the adverse events that were well described in the methodology were primarily limited to bleeding events. There was no description of postoperative wound infection, how this was defined, or for what time point this was measured. In the absence of these details, we assumed that these data were reported for the treatment period, which was 14 days postoperative. This is a diversion from the methodology used in our study, in which patients were followed postoperatively for 30 days. In summary, although we agree with the authors that these trials did not show any statistical differences in terms of infection, we feel that this may have been a cursory look at the wrong time point for this outcome. In response to the comment regarding potential confounders contributing to our results (eg, steroid use, comorbidities, history of smoking, and so forth), we were not able to statistically adjust for these factors owing to the low incidence of early deep surgical site infections in our cohort as we noted in our limitations. However, we did perform univariate comparisons of the 2 treatment groups, and no statistically significant differences were observed between the 2 groups. We have discontinued the use of rivaroxaban at our institution, as it is our opinion that its benefits do not outweigh its risks

Computed tomography guided radio-frequency ablation of osteoid osteomas in atypical locations

Purpose: Percutaneous radio-frequency ablation is a minimally invasive treatment option for osteoid osteomas. The ablation process is straightforward in the more common locations like the femur/tibia. Surgery has historically been the gold standard, but is currently used in lesions, that may not be effectively and safely ablated, i.e. close to skin/nerve. Radio-frequency ablation can still be used in such cases along with additional techniques/strategies to protect the sensitive structures and hence improve the outcomes. The authors describe their experience with four challenging osteoid osteoma ablation cases. Methods: We retrospectively reviewed radio-frequency ablations of four osteoid osteomas in rather atypical locations, the protective techniques/strategies employed, the adequacy and safety of the radio-frequency ablation with the use of these techniques. Results: All patients had complete resolution of pain with no recurrence in the follow-up period. No complications were reported. Conclusion: RFA has been proven to be an effective and safe option for treatment of OOs in the common locations. It is generally recommended to have a 1 cm safety margin between the RF probe and any critical structures in the vicinity. However, with OOs in atypical locations this may not be always possible and hence additional techniques may be needed to ensure protection of the surrounding sensitive structures and also allow for effective ablation