Asian Journal of Orthopaedic Research

Hydatid Cyst of the Calf: A Rare Location of Hydatid Disease

Raja Amri — 2020-10-21

The location of the hydatid cyst in the soft tissues is exceptional. The localization in the leg produces a swamped painful leg which poses a diagnostic problem, particularly with thrombophlebitis of the lower limb. Ultrasound and Doppler Ultrasound allow the differential diagnosis of deep phlebitis, thus avoiding unnecessary and dangerous anticoagulant treatment. We present a case of hydatid cyst of the leg having had surgical treatment and anti-parasitic chemotherapy with good evolution. Hydatidosis remains a real public health problem in Tunisia. The seriousness of this disease is evidenced by its morbidity and, above all, its mortality.

The eradication of hydatid disease depends on a well-conducted and well-organized prophylaxis. Musculoskeletal hydatidosis represents a rare localization of this parasite. Treatment can be medical using anthelmintic drugs. Complete surgical excision is the best surgical option.

A Rare Case of Isolated Intra-Articular Fracture of Humeral Trochlea: Surgical Management by Posterior Approach

Akshay Mylarappa — 2020-10-21

Introduction: Isolated fracture of the trochlea is rare and is only recorded few times in literature and the surgical management by posterior approach is never described. The rare incidence may be attributed to its position deep inside the elbow joint without any tendinous or ligamentous attachment, thus protected from any injury.

Aim: Our aim is to ascertain the significance of posterior approach to the elbow with Chevron’s osteotomy in adequate reduction of isolated humeral trochlear fractures.

Case: We report a rare case of fracture of trochlea in a 20-year-old male and its surgical management by posterior approach with Chevron’s olecranon osteotomy and also describe the advantages and disadvantages of the approach over medial and anterior approaches. Functional outcome at two-year follow-up was satisfactory without any complications.

Conclusion: Posterior approach of elbow with Chevron’s osteotomy can be used for isolated fractures of humeral trochlea as it provides adequate exposure and for visualization and instrumentation along with protection of important neurovascular structures.

Current Concepts in Total Wrist Arthroplasty: A Review

Hunter Parmer — 2020-10-09

Introduction: Total wrist arthroplasty was envisioned to give patients with severe and debilitating pain the opportunity to regain independence. Prior to the first generation of implants, the standard of care for patients suffering from end-stage arthritis of the wrist was total wrist fusion which provided significant pain improvement at the expense of wrist movement.

Current Techniques: The first three generations of wrist implants showed promise of restored wrist function but were unfortunately plagued with poor long-term outcomes and significantly higher revisionist rates due to joint instability and peri/post-operative fractures. The current fourth generation of implants have shown the most promise in both preserving/restoring wrist motion and providing pain relief on par with the total wrist fusion.

Complications Associated with Total Wrist Arthroplasty: The current generation of implants still face complications of lower long-term survival rates and increased revisionist surgeries as compared to total wrist fusions.

Future Innovations in Surgical Wrist Interventions: Future innovations will focus on less bone resection and greater bone integration on a molecular level. Also, the relatively novel technique of wrist hemiarthroplasty shows promise as an acceptable alternative to total wrist arthroplasty.

Conclusions: Though the current generation of TWAs still have a lower survival rate and higher complication rate vs TWF, the functional gains associated with current models and the novel implants and techniques currently in development make TWA still a promising option.