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9 pages, 2162 KiB

Open AccessArticle

Single-Lateral-Incision Technique for Talar Neck Fractures—A Viable Option

by Paul M. Ryan, Jacob Arthur, Keanu McMurray and Alicia Unangst

Osteology 2023, 3(4), 122-130; https://doi.org/10.3390/osteology3040013 - 20 Oct 2023

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Abstract

Background: Displaced talar neck fractures are subject to avascular necrosis and degenerative joint disease. A single-lateral-incision approach may avoid damage to the remaining blood supply to the talar body provided by the deltoid artery. The purpose of this paper is to describe the surgical technique for a single approach to talar neck fractures, to evaluate the outcomes in a cohort of patients, and to review the literature on the topic. Method: A retrospective review. Patients were identified at a single medical center and met the following inclusion criteria: closed fracture, type-II talar neck fracture with displacement of the subtalar joint, single lateral operative approach, and radiographic follow-up of at least 6 months. Results: Five patients were identified meeting the inclusion criteria. The mean follow-up was 18 months (12–25). The mean VAS (Visual Analog Score) score at the final follow-up was 1.2 (0–3). Four of five patients returned to running at the final follow-up. The one patient who did not return to running was able to bike and hike. There were no cases of avascular necrosis and no cases of degenerative joint disease. Conclusions: Although a two-incision approach could be considered for all displaced talar neck fractures, there are certain fractures that can be anatomically reduced and stabilized through a single lateral incision which may limit the risk of avascular necrosis. Full article

(This article belongs to the Special Issue Current Trends in Sports Medicine Based on Orthopedics and Osteology)

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7 pages, 917 KiB

Open AccessArticle

Tibial Plateau Fractures among Alpine Skiers: A Retrospective Case Series

by Tyler R. Williamson, Joel N. Smith, Britta L. Swanson, John D. Robinson, Keith R. Swanson and Kyle E. Swanson

Osteology 2023, 3(3), 71-77; https://doi.org/10.3390/osteology3030008 - 29 Jun 2023

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Abstract

The purpose of this retrospective case series was to review the demographics of alpine skiers who sustain tibial plateau fractures, evaluate the inter-observer reliability of the Schatzker classification for fractures sustained while alpine skiing, and to evaluate patient-reported outcomes. We hypothesized that most tibial plateau fractures would be low-energy fracture patterns (Schatzker I–III) and occur in women and less-experienced skiers. Charts and radiographs of patients treated surgically for tibial plateau fractures caused by alpine skiing were evaluated. Patients treated less than two years prior to review were excluded. Patients who qualified were contacted to complete a questionnaire regarding their skiing experience, their pain levels experienced following their accident, the weather conditions during the accident, and their return to sport. Forty-seven patients met the inclusion criteria. The mean age was 49, and 60% of the participants were male. There were 28 low-energy fracture patterns (Schatzker I–III) and 19 high-energy patterns (Schatzker IV–VI) with a 95.7% inter-observer reliability. Contrary to the hypothesis, tibial plateau fractures sustained while alpine skiing occurred in older, experienced riders. Approximately 40% were high-energy fractures. Although over 75% of patients reported having no pain or occasional pain at their final follow-ups, less than half of the patients returned to alpine skiing. Full article

(This article belongs to the Special Issue Current Trends in Sports Medicine Based on Orthopedics and Osteology)

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6 pages, 2645 KiB

Open AccessCase Report

Diagnosis and Management Controversies Illustrated by an Uncommon Case of Postpartum Pubic Symphysis Diastasis

by Ryan J. Bickley, Ronald G. Blasini, John D. Johnson and Paul M. Ryan

Osteology 2023, 3(3), 116-121; https://doi.org/10.3390/osteology3030012 - 20 Sep 2023

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Abstract

Pubic symphysis diastasis is a complication of pregnancy that can lead to prolonged recovery, persistent pain, and functional disability if managed inappropriately. There is a lack of universally accepted clinical guidelines with regards to the timeframe and defect criteria for surgical management, which contributes to delayed care resulting in increased surgical complexity and subsequent impairments in functionality and quality of life. The current standard of care utilizes non-operative measures exclusively for separations measuring less than 2.5 cm correlating to symphyseal ligament sparing. Surgical interventions are typically reserved for severe cases or those resistant to initial non-operative treatment. Non-surgical methods have been attempted for 4–6 weeks, even in severe cases, with patients still requiring eventual surgery. We herein report an uncommon case of pubic symphysis diastasis measuring 5.5 cm and the successful implementation of non-surgical management to demonstrate the need for updated standardized treatment guidelines. The defect in this case was treated with early application of a pelvic binder resulting in anatomic alignment and full resolution of pain within 3 months, and full return to activity within 6 months. In conclusion, the establishment of management guidelines for pubic symphysis is recommended, including the use of non-surgical management early in the patient recovery process and in cases with diastasis greater than 2.5 cm. This treatment strategy may decrease morbidity, recovery time, and complications in affected patients. Full article

(This article belongs to the Special Issue Current Trends in Sports Medicine Based on Orthopedics and Osteology)

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