Nonunion of ulnar diaphysis after Monteggia fracture of a right forearm in a 55-year-old patient - Are all methods effective? Case report

Fractures of the forearm make up about 10-14% of all fractures. Monteggia lesions account for 1-6% of the forearm fractures. The eponym “Monteggia fracture” is a term used for fracture of ulnar proximal shaft with concomitant dislocation of the radial head in the proximal radioulnar joint [1]. Its clinical symptoms are: pain, edema, local sensitivity, friction between bone fragments, deformation of the limb, loss of function in elbow joint and the forearm. Radiographs in AP and lateral views of the entire forearm, with wrist and elbow joint, are mandatory for successful diagnosis [2]. There are four types of fractures in the Bado classification system of the Monteggia lesion [3]. All Monteggia fractures in adults require surgical procedure of open reduction and internal fixation as a method of choice [4]. Delayed bone adhesion, nonunion, synostosis, instability of the radial head, nerve damage and restriction of movement are main complications of surgical intervention. We present a case of a 55-year-old patient with Monteggia fracture of a right forearm with a complication of a nonunion of the ulnar shaft, despite undergoing surgical procedure of open reduction and internal fixation. We describe consecutive methods of treatment that resulted in complete bone adhesion. Nonunion typically occurs due to technical mistakes in initial surgical intervention. Application of the correct reparative technique with autogenous bone graft and compression plates allows to fully heal nonunion of the bone

Early, posttraumatic, frontal instability of the knee joint deriving from injured medial collateral ligament, after total knee arthroplasty, complicated by wound dehiscence and Clostridium difficile infection in a 70-year-old patient

Gonarthrosis is a joint disease in which a balance between regenerative and degenerative processes of articular cartilage is impaired. Its main symptoms are: pain, swelling, rigidity, function restraint as well as articular deformation [1]. It is estimated that about 40% of the knee joint degeneration is a consequence of ageing of the body. 60% of remaining cases of gonarthrosis is a result of excessive strain, contusion and injury. Patients with advanced arthrosis are qualified for total arthroplasty of the knee. Medial collateral ligament (MCL) is responsible for the medial stability of the knee joint, it prevents from valgus deformity and restraints external rotation of tibia relative to the femur. Injury, most often distorting the knee, may lead to straining as well as complete rupture of the MCL [2,3]. We present a case of a 70-year-old patient with MCL injury that happened three weeks after total knee arthroplasty, complicated by wound dehiscence. Insufficiency of the medial collateral ligament in our patient had an effect in longer healing process and rehabilitation. Main treatment options are: revision surgery with use of constrained implants and injured medial collateral ligament reconstruction. Constrained implants may have reduced longevity in some patients through aseptic loosening. Our patient underwent a MCL reconstruction. Reconstruction of MCL without revision arthroplasty has good results for injured MCL after total arthroplasty of the knee

Pilon fracture of the tibia with severe complications in a 42-year-old patient – case report.

Pilon type fractures of the distal tibia are among the most difficult injuries of the lower extremity. They occur due to the axial loading injury which drives the talus into the tibial plafond, mainly because of high energy traumas such as car accidents and falls, but may arise from low energy traumas also. Due to specific conditions in the area of the injury: where skin and subcutaneous tissue is delicate, soft tissues are usually severely damaged, it is crucial to choose the correct timing for surgical intervention. There are several surgical options regarding treatment of the pilon fractures, however treatment plan of pilon fractures has not yet been unified. Surgical methods include open reduction with internal fixation and external fixation. Main purpose of the treatment of pilon fractures are the preservation of length and restoration of the joint surfaces. Great risks for the successful treatment are skin and soft tissue infections, that occur quite commonly due to specific anatomy of the fractured area. Wound infection may have potentially catastrophic consequences. Here we present a case of our 42-year-old patient, with a pilon fracture of the tibia who suffered multiple complications due to obtained tauma as well as his concurrent diseases: diabetes, alcohol and nicotine abuse, also as a result of his lack of compliance with medical advice. Despite the complications that occurred, outcome of the overall treatment was satisfactory both to the patient as well as orthopedic team. This example shows that treatment method should be chosen wisely not only on the type of the fracture, but also with patient’s ability to comply with doctors’ recommendation

Impact of the Body Composition on Knee Osteoarthritis Assessed Using Bioimpedance Analysis

Osteoarthritis (OA) ranks among the most prevalent inflammatory diseases affecting the musculoskeletal system and is a leading cause of disability globally, impacting approximately 250 million individuals. This study aimed to assess the relationship between the severity of knee osteoarthritis (KOA) and body composition in postmenopausal women using bioimpedance analysis (BIA). The study included 58 postmenopausal females who were candidates for total knee arthroplasty. The control group consisted of 25 postmenopausal individuals with no degenerative knee joint changes. The anthropometric analysis encompassed the body mass index (BMI), mid-arm and mid-thigh circumferences (MAC and MTC), and triceps skinfold thickness (TSF). Functional performance was evaluated using the 30 s sit-to-stand test. During the BIA test, electrical parameters such as membrane potential, electrical resistance, capacitive reactance, impedance, and phase angle were measured. Additionally, body composition parameters, including Total Body Water (TBW), Extracellular Water (ECW), Intracellular Water (ICW), Body Cellular Mass (BCM), Extracellular Mass (ECM), Fat-Free Mass (FFM), and Fat Mass (FM), were examined. The study did not find any statistically significant differences in the electrical parameters between the control (0–1 grade on the K–L scale) and study groups (3–4 grade on the K–L scale). However, statistically significant differences were observed in BMI, fat mass (FM), arm circumference, triceps skinfold thickness, and sit-to-stand test results between the analyzed groups. In conclusion, the association between overweight and obesity with KOA in postmenopausal women appears to be primarily related to the level of adipose tissue and its metabolic activity