Pimpimol Dangintawat, Jirun Apinun, Thanasil Huanmanop, Sithiporn Agthong, Prim Akkarawanit and Vilai Chentanez
There are various types of peroneal tendon injuries including tear, subluxation, and dislocation of peroneus brevis (PB) and peroneus longus (PL) tendons [ 1 , 2 , 3 ]. These injuries decrease performance in walking, running, and sport [ 1 , 4 , 5 , 6 ].
The pathomechanics of peroneal tendon tear are related to an immediate eccentric contraction in dorsiflexion, while the foot is in contact with the ground. The mechanism of the injury is similar to that for lateral ankle sprain [ 7 , 8 ].
Therefore, only 60% of the patients with peroneal tendon
AIM: The aim of this paper was to present application of the first expert arthrodesis nail in our clinic to a patient with previous performed arthrodesis according to Ulrich Holz.
CASE REPORT: Patients A.M. on the age of 22 (1992) have a motor vehicle injury, (fall from a motor bike) with diagnosis polytrauma, shock, supra and transcondyar open fracture of the right femur III degree, open fracture of the right tibia and fibula. We perform reposition and fixation of supra and transcondyar femoral fracture with “cobra” plate. Also we perform reposition and fixation of right cruris with external fixation. After the operation we found fistula in the place of operation of the right crural regia. During the time the infection goes worse and the patient develop osteomyelittis on the right crural regia. After 5 months with therapy the situation become calm. We remove the external fixation. The patient develops severe “pes equinus” on the right leg and he cannot walk. We try to reduce this equines situation with elongation of the Achilles tendonin the first step, and because we didn’t solve the problem we continue with complete section of the Achilles tendon and after that we perform osteotomy of the right talocrural joint simultaneous to tibia plafond and talus and resection of fibula 2sm.above the syndesmosae tibiofibularis and we fixed the talocrural joint with two screws according the technique of Ulrich Holz.
CONCLUSION: So we received fixed position on of the food on 110 degrees which was steel unacceptable for normal walking. At last we remove the screws, make once again osteotomy with positioning of the food in maximal dorsiflexion and perform the Experf Hindfood arthrodesis nail so with this method we achieve correction of dorsiflexion on 95 degrees, and the patient become satisfied because he can walk without support.
R.S. Cismașiu, R.M. Bîrluțiu, A. Tudor, D. Pop and C.I. Stoica
Intralesional tumoral procedures in giant cell tumor (GCT) are quoted as having a recurrence rate of up to 60%. Thus, a number of studies suggest that broad resection is associated with a lower local recurrence risk compared to intralesional curettage, increasing the free recurrence interval from 84% to 100%. The TCG involvement of the proximal tibia occupies a particular place through the relationship with the articular line, but especially through the frequent, direct, or indirect interest of the extensor mechanism of the knee. Purpose of the paper. Based on the unique tumor registry of “Foişor” Orthopedic Clinic, we proposed to follow all the cases of TCG with proximal tibial localized operation, beneficiaries of an “en bloc” resection and modular tumor prosthesis reconstructions - registering a number of 5 cases between 2009 and 2017. Material and method. The initial evaluation was performed by radiography, CT-scan and MRI investigations and recurrence cases in which histopathological reassessment became mandatory after post-intralesional techniques were also included in the study. The surgical technique followed tumor resection, tumor reconstruction, and the reconstruction procedure of the extensor of the knee, which involved the modulation of the modular tumor prosthesis with a rotary reversible flap of the medial gastrocnemius with the ankle of the patellar tendon to the prosthesis and flap. Quantification of functional outcomes required the use of the revised Muscle-Skeletal Society Score (rMTS) and postoperative complications were centralized; the most commonly reported being the peroneal nerve palsy. Results and discussions. The results obtained were compared to the orthopedic oncology literature data for such a procedure, following their superposition and discrepancy. The challenge of such an orthopedic oncology intervention is the reconstruction of the extensor, with definite functional implications of limiting the knee extension, as well as avoiding the peroneal nerve palsy. However, the results can be reproducible, with an absent relapse rate.
Bălașa Rodica, Z. Bajko, Smaranda Maier, S. Voidăzan and Anca Moțățăianu
Objective: The aim of this study was to evaluate the impact of age, diabetes duration, glycaemic control, existence of cardiac autonomic neuropathy (CAN), retinopathy and of macroangiopathy on the peripheral nerve function in patients with type 2 diabetes.
Methods: One hundred forty-nine type 2 diabetes mellitus patients were assessed with peripheral motor and sensory nerve conduction tests and cardiovascular reflex tests, as well as being evaluated for retinopathy, common carotid artery intimal-media-thickness (IMT) and anklebrachial index (ABI).
Results: The duration of diabetes has the strongest effect in the reduction of the amplitude of motor response in the peroneal nerve and of the sensory amplitude in the sural nerve. The strongest correlations were found between glycaemic control and decreasing motor amplitude in the median nerve and sensory amplitude in the sural nerve, respectively. The motor and sensory nerve action potential amplitudes were significantly affected in the group of patients with CAN. According to multivariate logistic regression analysis, duration of diabetes and presence of CAN were the most important factors that influenced the motor and sensory nerve function.
Conclusion: The presence of CAN together with diabetes duration and poor glycaemic control were associated with impaired peripheral nerve function, while macroangiopathy does not seem to be associated with the impairment of these electrophysiological parameters.
Aim: The purpose of this paper is to present a complicated case of a 2.8 year-old child with knee synovitis of unknown etiology which complicated in a very short time by the appearance of an ankylosis. The removal of the cast after 3 weeks revealed stiffness in flexion of the affected knee. Neither physiotherapy nor attempts to mobilize under anesthesia, led to the expected results. Consequently, the patient was referred to a surgery service for the adherence removal by arthrotomy. During the following 5 months, new complications developed due to a double tibia and peroneal fracture. After the consolidation of the fractures, both the therapist and the recovery protocol were changed.
Method: For one and a half years, the child followed two weekly recovery sessions consisting in physiotherapy and massage. At home the child did an exercise program under parental supervision and worn an orthosis.
Results: At the end of the rehabilitation program we noticed the restoring the normal amplitude of all the lower limb joints, restoring the muscular strength of the lower limb, and normal course resumption.
Conclusion: In addition to the need for a correct diagnosis of the disease, such cases also require an adequate recovery protocol, following the instructions given by the treating physician and to ensure continuity of the rehabilitation program (both in a recovery and home program), until the complete rehabilitation of the deficit.
Hendra Gunawan, Irma Fakhrosa, Nia Ayu Saraswati, Muljaningsih Sasmojo, Reti Hindritiani and Oki Suwarsa
One of the success indicators of the World Health Organization (WHO) leprosy eradication program is the decreasing number of new cases of pediatric leprosy with a grade 2 disability. A case of borderline lepromatous (BL) leprosy with partial claw hand in a 13-year-old boy was reported. On physical examination, we found claw fingers on the fourth and fifth fingers of the left hand accompanied by hypoesthetic erythematous plaques on both cheeks. The patient also presented with the enlargement of bilateral great auricular, ulnar, and peroneal nerves. The bacteriological examination showed the bacterial index 3+ and morphological index 35%. The results of histopathological and serological anti-phenolic glycolipid-I examinations supported the diagnosis of BL type of leprosy. Genotyping of Mycobacterium leprae by variable number tandem repeat of the patient showed 24 copies thymine-thymine-cytosine that were similar to his father, who had been diagnosed with leprosy 12 years before, without adequate therapy. The result indicated the possibility of leprosy transmission from the father to a son. This case report revealed the presence of leprosy in children with a multibacillary infection who have been living with leprosy family members. Genotyping seems to be feasible for epidemiological analysis of leprosy transmission.
15. Kilic E., Ozaydin I.: Repairing of the experimentally induced patellar avulsion of the patellar ligament with stainless steel and PDS-II (Polydioxanon in dogs) Kafkas Üniv Vet Fak Derg 1999, 5, 179–188.
16. Kilic E., Ozaydin I., Aksoy O., Ozturk S.: The treatment of congenital bilateral lateral patellar luxation seen in calves by transposition of partial patellar tendon and m. vastus lateralis . Kafkas Üniv Vet Fak Derg 2008, 14, 185–190.
17. Kilic E., Aksoy O., Ozaydin I., Ozturk S., Sozmen M., Kurt B.: Repair of peroneal paralysis by muscle
Haridimos Tsibidakis, Artemisia Panou, Antonios Angoules, Vassilios I. Sakellariou, Nicola Marcello Portinaro, Julian Krumov and Anastasios D. Kanellopoulos
19. Pinkowski JL, Weiner DS. Complications in proximal tibial osteotomies in children with presentation of technique. J Pediatr Orthop 1995;15:307-12.
20. Stanitski DF, Dahl M, Louie K, et al. Management of late-onset tibia vara in the obese patient by using circular external fixation. J Pediatr Orthop 1997;17:691-4.
21. Kirgis A, Albreicht S. Palsy of the deep peroneal nerve after proximal tibial osteotomy: an anatomical study. J Bone Joint Surg Am 1992;74(8):1180-5.
22. Elgafy H, Ebraheim NA, Shaheen PE, et al. Extensor
Agnieszka Gajos, Sławomir Kujawski, Małgorzata Gajos, Żaneta Chatys and Piotr Bogacki
52. Nishikawa T., Grabiner M.D. (1999) Peroneal motoneuron excitability increases immediately following application of a semirigid ankle brace. Journal of Orthopaedic and Sports Physical Therapy, 29(3): 168-176. DOI: 10.2519/jospt.1922.214.171.124
53. Palmieri R.M., Ingersoll C.D., Hoffman M.A. (2004) The Hoffmann reflex: methodologic considerations and applications for use in sports medicine and athletic training research. Journal of Athletic Training, 39(3), 268.
54. Palmieri R.M., Ingersoll C.D., Edwards J.E., Hoffman M.A., Stone M.B., Babington J
E Vargiami, E Papathanasiou, S Batzios, M Kyriazi, E Dimitriou, A Anastasiou, H Michelakakis, A-K Giese and DI Zafeiriou
normal compound action potentials, suggestive of demyelination.
Brain MRI of the first patient at the age of 3.5 months (T2 weighted sequences TR/TE 4000/99). Note the mildly increased signal in the posterior limbs of the internal capsule bilaterally and in the white matter of the occipital lobe.
Nerve conduction velocities in both patients.
Nerve Conduction Velocities (m/s)
Age When Examined