A 24-year-old female with high-grade dysplastic spondylolisthesis, underwent posterior decompression, L4 to S2-ilium instrumentation, and in situ fusion with two fibular strut grafts. Subfascial closed suction drains were placed to prevent hematoma formation. On post-operative Day 2, the drain tube snapped during removal, leaving a retained portion in the wound. Removal of the retained drain tube was performed using a minimally invasive tubular microscopic technique. The drain tube was found to be entangled with the cross-link. This case highlights the possible entrapment of deep fascial drain over the cross-link and feasibility of removal using a minimally invasive technique.
Superior patellar dislocation is a rare condition and is often misdiagnosed as patellar tendon rupture because of similar clinical features. We report the case of a 60-year-old woman with known left knee osteoarthritis who presented acutely with the left knee locked in extension, associated with pain and effusion. Examination revealed an infrapatellar dimple, and plain radiographs demonstrated patella alta with tilting of the patella. Magnetic resonance imaging (MRI) confirmed superior patellar dislocation caused by an inferior patellar osteophyte locked against the superior trochlea. The patellar tendon was intact. Closed manipulation and reduction under sedation were successfully performed. A review of the literature identified hyperextension and direct trauma as the most common mechanisms of injury, with osteoarthritis recognised as an important risk factor. Closed reduction, performed under various forms of anaesthesia, was successful in the vast majority of cases. Rare recurrences were managed either by open surgery or arthroscopic intervention.
Phalanx fractures are among the most frequently encountered hand injuries, with fractures at the base of the proximal phalanx presenting unique management challenges due to their diverse presentations. We present a case of a 47-year-old male with a complex fracture at the base of the proximal phalanx following a motorcycle accident. Radiology revealed severe comminution with apex volar angulation. Treatment involved open reduction and internal fixation with a miniplate using the distraction plating method; the hardware was removed at six weeks. Physical therapy was then initiated, and after one year, the patient achieved an excellent range of motion post-operatively (metacarpophalangeal joint of 45 – 90°, proximal interphalangeal joint and distal interphalangeal joint were 0 –90°) comparable to pre-injury function. Radiographs showed union of the fracture and proper alignment. The successful application of distraction plating in complex comminuted distal radius fractures inspires further research and application in other challenging fractures. Distraction plating can effectively maintain proper fracture alignment while minimising strain on surrounding soft tissues. This supports bone healing and allows good radiological and functional outcomes. The favourable outcome in this case supports the use of distraction plating in situations where traditional fixation methods, such as Kirschner wire fixation, may be insufficient. Distraction plating may be an alternative to Kirschner wire fixation to maintain the proper alignment and avoid the risk of pin-track infections, and allow an early return to daily activities. The successful application of distraction plating in complex comminuted distal radius fractures has inspired further research and its application in other challenging fractures. Distraction plating can effectively maintain proper fracture alignment while minimising strain on surrounding soft tissues, thereby supporting bone healing and enabling favourable radiological and functional outcomes. Distraction plating may serve as a viable alternative to Kirschner wire fixation by maintaining proper alignment, reducing the risk of pin-track infections, and allowing an earlier return to daily activities.
Anterior cruciate ligament (ACL) revision surgeries remain challenging, with higher failure rates than primary reconstructions. This case report aims to demonstrate the clinical outcomes of revision ACL reconstruction using the Modified UKM Internal Bracing (MUIB) technique and evaluate its protective role in maintaining graft integrity after high-impact trauma. This case report describes a 37-year-old male with recurrent ACL graft failure who underwent revision reconstruction using the MUIB technique. Post-operatively, the patient achieved excellent knee stability with no functional limitations at the post-operative nine month. Following a high-energy motorcycle accident, a second-look arthroscopy after one year from the last reconstruction revealed only a small tear of the ACL graft and just one of the strands of MUIB ruptured. There was also no evidence of tunnel widening, a common complication in revision cases. These findings demonstrate that MUIB effectively protected the graft from complete failure despite significant trauma. Additionally, suture tape reinforcement using the MUIB technique improves outcomes in revision ACL reconstructions by preventing graft elongation, tunnel widening, and stress shielding while also providing protective reinforcement.
Stable surgical fixation of the distal femur relies significantly on accurate restoration of the lower limb mechanical axis. Methods previously described such as the cable method, axis board method, and alignment rod method require assessment to be performed with the lower limb in extension. We describe a novel technique – which utilises simple and easily accessible components such as an Ilizarov half-ring, connecting rod, and two nuts – that permits intra-operative assessment of the lower limb mechanical axis with the knee in both flexion or extension. Allowing the knee to remain in flexion also facilitates fracture reduction, as the flexed position reduces the pull of the gastrocnemius muscle on the distal fragment. Intra-operatively, the Ilizarov half-ring is attached to the connecting rod in at the perpendicular and secured with two nuts. Fluoroscopy is used to confirm that the ring is placed parallel to the knee joint, and the tip of the rod centred on the femoral head; when both of these landmarks are aligned, it indicates the lower limb mechanical axis has been restored. This technique has proven accurate and reproducible in our institution but will require further evaluation with more detailed studies in a larger patient sample.
