Background: We report a successful wound treatment of a chronic ulcer with bone exposure using a somehow forgotten technique of creating burr holes into the bone. Most clinics would promote flap surgery to cover wounds with bone exposure, however, in some cases invasive surgery is not mandatory. We bring up an alternative treatment for such cases. Case: We report a case of chronic ulcers on both lower extremities in a 43-year-old Caucasian male. He suffers from a leukocytoclastic vasculitis and sarcoidosis which is medicated by immunosuppressive medication. The patient‘s wounds were initially treated with mechanical debridement and split-thickness skin grafts, however, his wounds tended to worsen the more they were manipulated and finally resulted in tibial bone exposure. After levelling up his immune suppressive drugs, the wounds finally stabilized but didn’t heal after several weeks of follow-up. The wound was ultimately treated by placing burr holes in the underlying cortical bone. Conclusion: Chronic ulcers with bone exposure at the lower leg are challenging to treat. They often require local or free flap surgery. In some cases, because of underlying systemic disease, it is mandatory to stay away from invasive flap surgery. With this case, we like to put under attention an old technique of decorticating the exposed bone to promote secondary wound healing. It has been described mainly for scalp injuries, however, we have proven the viability of this technique for pretibial wounds as well.

• MeSH
• Varicose Ulcer surgery   etiology   pathology   therapy   MeSH
• Adult MeSH
• Immunosuppressive Agents adverse effects   MeSH
• Comorbidity MeSH
• Humans MeSH
• Treatment Failure MeSH
• Leg Injuries surgery   complications   pathology   therapy   MeSH
• Tibia * surgery   pathology   injuries   MeSH
• Limb Salvage methods   MeSH
• Plastic Surgery Procedures * methods   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Case Reports MeSH

PURPOSE: The aim of this study was to describe pathoanatomy and to raise awareness of a fracture of the lateral malleolus combined with a high subcapital fracture of the fibula caused by a dislocation mechanism. METHODS: The study comprised 11 patients, 5 men and 6 women, with the mean age of 57 years (range, 21-87), with a "Double Maisonneuve fracture". Individual lesions of ankle structures were described on the basis of radiographs, CT, and intraoperative findings. RESULTS: The distal fibular fracture was classified as Weber type B in 1 case and Weber type C in 10 cases. The proximal fibular fracture was described as a subcapital oblique spiral fracture with metadiaphyseal involvement in nine cases and a high short oblique fracture with fibular head involvement in two cases. Injury to the deltoid ligament was revealed in six cases; a bicollicular fracture of the medial malleolus was found in five patients. Posterior malleolar fractures were classified as type 1 in eight cases and type 2 in three cases. Avulsion of the Chaput tubercle was detected in four cases. Injury to the interosseous tibiofibular ligament was assessed in nine patients. CONCLUSION: Double Maisonneuve fracture is a rare but probably underreported injury that must be taken into consideration during examination, as it may be easily overlooked. The essential part of diagnosis is a careful clinical examination and radiological assessment of the lower leg with additional CT examination of the ankle.

• MeSH
• Fibula diagnostic imaging   MeSH
• Ankle Fractures * diagnostic imaging   surgery   MeSH
• Ankle Joint pathology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Fractures, Multiple * MeSH
• Ankle Injuries * diagnostic imaging   surgery   MeSH
• Tibia injuries   MeSH
• Fracture Fixation, Internal MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

INTRODUCTION: Although Maisonneuve fracture (MF) is a well-known type of ankle fracture-dislocation, there is still a lack of information about the epidemiology and the extent of all associated injuries. The aim of study is to describe MF pathoanatomy on the basis of radiographs, CT scans and intraoperative findings. MATERIALS AND METHODS: The study comprised 54 adult patients. MF was defined as an ankle fracture-dislocation with a fracture of the fibula in its proximal quarter. Ankle radiographs and lower leg radiographs were obtained in all patients. Computed tomography (CT) examination was performed in 43 patients, of these in 34 patients in combination with 3D CT reconstructions. A total of 51 patients were treated operatively, and in 38 of these an open procedure was performed. RESULTS: The fibular fracture-fibular head was involved in four cases, and the subcapital region of the proximal quarter of the fibula was affected in 50 cases. Fractures of the posterior malleolus were identified in 43 of 54 patients (80%). Injury to the deltoid ligament was recorded in 27 cases (50%), a fracture of the medial malleolus in 20 cases (37%) and medial structures were intact in 7 cases (13%). Position fibula in fibular notch-in 9 cases the position changed only minimally, in 11 cases the space between the tibia and the fibula was larger than 2 mm, in 20 cases widening of the tibiofibular space was associated with external rotation of the fibula, in 2 cases fibula was trapped behind the posterior tibial tubercle and in 1 case it was associated with a complete tibiofibular diastasis. CONCLUSION: MF is a variable injury, always associated with rupture of the anterior and interosseous tibiofibular ligaments. CT examination should be employed widely in MF, and MRI should be considered under special circumstances.

• MeSH
• Fracture Dislocation * diagnostic imaging   pathology   MeSH
• Adult MeSH
• Ankle Fractures * diagnostic imaging   pathology   MeSH
• Tibial Fractures * diagnostic imaging   pathology   MeSH
• Humans MeSH
• Tomography, X-Ray Computed MeSH
• Tarsal Bones * diagnostic imaging   injuries   pathology   MeSH
• Tibia * diagnostic imaging   injuries   pathology   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Publication type
• Journal Article MeSH

Introduction A standard osteosynthetic material for maxillofacial skeleton is titanium and its alloys. The convenience of degradable material is avoiding of second surgery in cases, where removal of the material is necessary. Magnesium biodegradable alloys have similar mechanic properties as cortical bone - reasonable corrosion and sufficient biologic properties. They might be used in facial skeleton fixation. Materials and methods The study included a total of 16 rabbits, and they were randomly divided into two groups. Each group received two screws (WE4 and titanium as a standard material) in artificially drilled defect into right tibia. Animals were euthanized at four-week intervals. Bone samples with implants underwent microfocus CT scans and were histologically examined. Results WE43 alloys showed fragmentation of the material on the 16th week - statistically significant volume loss was found between weeks 12 and 16. Bone healing around the WE43 screws was of similar quality as around titanium screws, and no adverse effect was noticed. Conclusion The study showed good quality of bone healing around WE43 implants. From this point of view, the WE43 alloy meets the requirements of osteosynthetic material for maxillofacial skeleton.

• MeSH
• Magnesium adverse effects   chemistry   MeSH
• Bone Screws * adverse effects   MeSH
• Rabbits MeSH
• Surface Properties MeSH
• Alloys adverse effects   chemistry   MeSH
• Tibia injuries   pathology   surgery   MeSH
• Titanium adverse effects   chemistry   MeSH
• Absorbable Implants * adverse effects   MeSH
• Animals MeSH
• Check Tag
• Rabbits MeSH
• Male MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH

• Keywords
• zevní fixace,
• MeSH
• Arthrodesis methods   MeSH
• Surgical Procedures, Operative methods   MeSH
• Fractures, Bone surgery   complications   physiopathology   therapy   MeSH
• Tibial Fractures * surgery   complications   physiopathology   therapy   MeSH
• Fracture Fixation, Intramedullary methods   adverse effects   MeSH
• Bone and Bones physiopathology   injuries   MeSH
• Bones of Lower Extremity physiopathology   injuries   MeSH
• Humans MeSH
• Orthopedic Procedures methods   adverse effects   MeSH
• Intraoperative Complications surgery   therapy   MeSH
• Leg Injuries surgery   complications   physiopathology   therapy   MeSH
• Tibia physiopathology   injuries   MeSH
• Fracture Fixation, Internal methods   adverse effects   MeSH
• Check Tag
• Humans MeSH

• MeSH
• Blood Vessels anatomy & histology   MeSH
• Surgical Procedures, Operative methods   MeSH
• Adult MeSH
• Fractures, Bone surgery   complications   physiopathology   therapy   MeSH
• Tibial Fractures * surgery   physiopathology   therapy   MeSH
• Fracture Fixation, Intramedullary * methods   adverse effects   MeSH
• Compartment Syndromes surgery   physiopathology   therapy   MeSH
• Bone and Bones physiopathology   injuries   MeSH
• Bones of Lower Extremity physiopathology   injuries   MeSH
• Humans MeSH
• Orthopedic Procedures methods   adverse effects   MeSH
• Osteitis surgery   physiopathology   therapy   MeSH
• Osteonecrosis surgery   physiopathology   therapy   MeSH
• Postoperative Complications surgery   therapy   MeSH
• Leg Injuries surgery   complications   physiopathology   therapy   MeSH
• Pseudarthrosis surgery   physiopathology   therapy   MeSH
• Tibia anatomy & histology   physiopathology   injuries   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Case Reports MeSH

• Keywords
• zevní fixace,
• MeSH
• Surgical Procedures, Operative methods   MeSH
• Fractures, Bone surgery   complications   physiopathology   therapy   MeSH
• Tibial Fractures * surgery   complications   physiopathology   therapy   MeSH
• Infections therapy   MeSH
• Fracture Fixation, Intramedullary methods   MeSH
• Bone and Bones physiopathology   injuries   MeSH
• Bones of Lower Extremity physiopathology   injuries   MeSH
• Humans MeSH
• Orthopedic Procedures methods   adverse effects   MeSH
• Leg Injuries surgery   complications   physiopathology   therapy   MeSH
• Tibia physiopathology   injuries   MeSH
• Fracture Fixation, Internal methods   MeSH
• Check Tag
• Humans MeSH

Cíl práce: Cílem práce bylo představit diagnostický a léčený postup při proximální tibiofibulární luxaci. Materiál a metody: Autoři popisují diagnostiku a léčbu anterolaterální proximální tibiofibulární luxaci u 27letého pacienta po pádu na levé koleno. Diagnostika se zakládala hlavně na klinickém vyšetření, které bylo doplněno rentgenem (rtg) a vyšetřením výpočetní tomografie (CT). Zavřenou repozici autoři provedli v analgezii pacienta, a to při flexi v koleni a dorzální flexi nohy tlakem na hlavu fibuly. Po repozici bylo provedeno kontrolní CT vyšetření a naložena ortéza. Pacient byl a je bez neurologické léze. Výsledky: Pacient je půl roku od úrazu bez potíží. Pohyby v koleni jsou plné, bez známek nestability. Závěr: Popsaný postup při tomto raritním poranění je v souladu s literárními poznatky.

Purpose of study: The aim of this work was to introduce diagnostic and terapeutic process in therapy of pro­ximal tibiofibular dislocation. Material and methods: The authors describe diagnostic process and therapy of proximal anterolateral tibio­fibular dislocation in 27 years old patients after fall to left knee. The diagnosis was founded on clinical examination a­ppenden with plain films and computed tomography. After analgetization of patient dislocation was treated by closed reduction. The knee was flexed and the foot dorsiflexed and externally rotated. Pressure was applied over the fibular head, until a “pop” was heard. Afret reduction authors made control computed tomography and applied orthesis. Patient was without neurologic laesion. Results: Patient is now without any problems. Patient is able to burden fully his limb and the range of motion (ROM) in knee joint is without any restrictions. Conclusion: Described diagnostic and terapeutic procedure are accord with literature.

• MeSH
• Joint Dislocations MeSH
• Adult MeSH
• Fibula diagnostic imaging   injuries   MeSH
• Humans MeSH
• Knee Dislocation * diagnostic imaging   etiology   therapy   MeSH
• Orthotic Devices MeSH
• Tibia diagnostic imaging   injuries   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Case Reports MeSH

Ankle fractures still remain a significant issue in bone and joint trauma surgery that has not yet been adequately resolved. The history of treatment of these fractures is interesting and it is no wonder that it has been the subject of many studies [1–8]. The first detailed historical overview was published by Astley Paston Cooper Ashhurst (1876–1932) in 1922 [1]. This valuable resource was most probably used by Niels Lauge (later known as Lauge-Hansen) (1899–1973) in 1948 [5] and also by Josiah Grant Bonnin (1909–1989) in 1950 [8]. Lauge’s treatise was the most detailed historical study at that time to focus on ankle fractures, a large part of which was later used by Bernhard Georg Weber (1927–2002) in his book “Die Verletzungen des oberen Sprunggelenkes” [9]. Although it may seem that there is nothing to add to this mosaic of historical study, it is not quite true. The facts presented are not always accurate and differences of interpretation may also be found. Depending on each author’s perspective, certain information may have been highlighted or alternatively neglected. Now and then a newly traced fragment of information may be added to the mix [2–4, 7] and thereby present a modified view of the history of ankle fractures. This current historical review focuses on several aspects of the history of posterior malleolar fractures, including the role of radiology, classifications of these fractures, and their operative treatment.

• MeSH
• History, 20th Century MeSH
• Ankle Fractures * history   classification   therapy   MeSH
• Ankle surgery   MeSH
• Humans MeSH
• Orthopedic Procedures history   MeSH
• Radiology history   MeSH
• Tibia surgery   injuries   MeSH
• Check Tag
• History, 20th Century MeSH
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH

healing disturbances occur in 5-10% of the cases. The anatomical region of the lower limb predisposes the tibia for bone healing disturbances. Reports about the incidence of non-unions of the tibial shaft are inhomogeneous. Different treatment strategies have been published which depend on the type of non-union as well as the history of the patient. These range from conservative approaches to complex procedures including segmental resection and bone transport. This review aimed to summarize the state of the art treatment of tibial non-unions and report about recent basic research results that may improve bone healing. Key words: tibial non-unions, treatment strategies, bone healing.

• MeSH
• Tibial Fractures surgery   MeSH
• Fracture Healing MeSH
• Conservative Treatment MeSH
• Humans MeSH
• Fractures, Ununited epidemiology   therapy   MeSH
• Orthopedic Procedures MeSH
• Tibia injuries   surgery   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH