Research
Chondromyxoid Fibroma of the Lateral Malleolus a En-Block Excision and Steinmann Pin Stabilisation of the Ankle
We report a case of a 25 year old male with a chondromyxoid fibroma located in the lateral malleolus. This was therefore a case of a rare tumour in an unusual location. The tumour was treated via an en-block excision and the ankle was stabilised with a Steinmann pin. The original plan was that the Steinmann pin was to provide temporary stabilisation while awaiting definitive histology. Ankle arthrodesis was supposed to be performed at a later date if the histology confirmed a benign tumour. Delayed wound healing resulted in the Steinmann pin being left in situ for 12 weeks. Two years post Steinmann pin removal; there was no clinical or radiological evidence of tumour recurrence or ankle instability. The patient was satisfied with his function and a secondary procedure was deemed unnecessary. The surgical options for benign distal fibular tumours including chondromyxoid fibroma will be discussed.
The Neglected Clubfoot
The neglected clubfoot is an uncommon condition in the developed world that has not been clearly defined in the literature. The condition is more common in the developing nations as a result of lower detection rates early in life for various economic and cultural reasons. In addition to the physical, social and financial burden which often occurs, there is a psychological component that must be addressed prior to commencing orthopaedic management. When left untreated beyond walking age, the weight bearing on the side of the foot worsens the deformity in addition to the worsened contractures due to increased contractile elements in the soft tissues. Treatment traditionally started with casting utilising the Ponseti technique followed by extensive open surgery which may entail soft tissue procedures plus or minus bony correction. Bony procedures involving osteotomies often result in an obviously shortened foot and may be associated with skin necrosis, psuedoarthrosis, infection and vascular damage. These procedures are also not uncommonly associated with pain, weakness, and stiffness of the foot and ankle postoperatively. The trend is now moving towards more minimally invasive distraction in order to minimise the morbidity mentioned previously, and to achieve a painless plantigrade functional foot. The following article discusses the evolution of the management of the neglected clubfoot.
Management of Distal Biceps Tendon Ruptures
Distal biceps tendon rupture is a fairly uncommon injury but the incidence has risen with the associated increase in recreational activities in the 40 to 60 year old age group. The injury usually occurs from a single traumatic event whereby there is a forceful eccentric contraction of the biceps in the flexed elbow. Management considerations include conservative versus surgical management, and if surgery is chosen, the surgical approach: one-incision versus twoincision, and the choice of fixation technique which includes: suture anchors, bone tunnels or the endobutton. Surgery is indicated in patients who require maximum flexion and supination strength for vocational and recreational activities. The following article discusses the evolution of surgical management and the complications associated with the one and two incision approaches
Surgical Management of Type Iii Acromioclavicular Joint Dislocation – The Biomechanical Basis for Reconstruction
The acromioclavicular joint (ACJ) is a diarthrodial joint which is stabilized by static and dynamic stabilizers. Acromioclavicular (AC) ligaments and the coracoclavicular (CC) ligaments (trapezoid and conoid) and the coracoacromial ligament make up the static stabilizers. The dynamic stabilizers are the deltoid and trapezius muscles. Theprinciples of various surgical techniques involve reduction of the AC joint and were historically classified into two groups: those that focus on primary healing of the CC ligaments and those meant to reconstruct the CC ligaments. Ligament reconstruction must have sufficient immediate stability to prevent acute redisplacement or be protected temporarily until the region heals. The biomechanical basis for reconstructing the CC ligaments in the management of acromioclavicular type 3 injuries is discussed.
Prognostic Factors Affecting Management of Liposarcoma
Soft tissue sarcomas account for 1% of all neoplasms, with the second commonest being liposarcomas. Liposarcomas in the popliteal fossa often grows to a large size, as neither the patient nor the clinician will initially be able to palpate the tumour due to its depth in the tissues and the fact that the tumour is often low grade. Its size often does not facilitate the ability to resect the mass with wide margins. The following article discusses prognostic factors for liposarcomas with regards to histological subtype, anatomical distribution, resection margins and neoadjuvant therapy.
