Left Patella Research Articles

Intraoperative pulmonary embolism during general anesthesia diagnosed with transesophageal echocardiography: A case report

Introduction: Acute pulmonary embolism (APE) is a potentially life-threatening condition with significant morbidity and mortality, particularly in the perioperative period. Early detection and intervention are crucial, but common signs and symptoms may not be easily identifiable under general anesthesia. This report presents a case of intraoperative APE in a 43-year-old female undergoing general anesthesia for left patella tendon repair following a ground-level fall. Case Report: During the procedure, the patient experienced an acute pulmonary embolism. Rescue transesophageal echocardiography (TEE) revealed a thrombus in the right main pulmonary artery and signs of right heart strain, including tricuspid regurgitation and right ventricular dilation. The patient was immediately taken to the interventional radiology suite for catheter thrombectomy. Following the procedure, her condition stabilized, and she was discharged with anticoagulation therapy. Conclusion: This case highlights the clinical challenges of diagnosing intraoperative APE in anesthetized patients, where typical symptoms may be obscured. Intraoperative TEE proved crucial in the timely detection of the embolism and enabled life-saving intervention. The importance of utilizing advanced diagnostic tools in managing intraoperative emergencies is underscored. Future research aimed at developing pathophysiologic models and diagnostic flowcharts for intraoperative APE may help improve outcomes in similarly challenging cases.

Total knee arthroplasty combined with simultaneous open reduction and internal fixation in the treatment of knee osteoarthritis with patellar fracture: a case report and review of the literature

BackgroundPatients with severe knee osteoarthritis combined with patellar fracture are rare, and it is unclear whether single-stage surgery affects the enhanced recovery after surgery.Case presentationThis case report describes two patients of Han nationality. A 69-year-old male patient was previously diagnosed with severe knee osteoarthritis of the left knee joint and was treated conservatively with long-term oral nonsteroidal antiinflammatory drugs and intraarticular injection of sodium hyaluronate. He was hospitalized for acute left knee injury owing to a fall from a height. He was diagnosed with knee osteoarthritis of the left knee joint and patellar fracture. Another 74-year-old female patient was previously diagnosed with severe knee osteoarthritis, long-term oral nonsteroidal antiinflammatory drugs and topical Chinese medicine to relieve the pain. A month ago, she fell down the stairs and fractured the patella in her left knee, she was diagnosed with severe left knee osteoarthritis combined with an old left patella fracture. Both patients were successfully treated by single-stage primary total knee arthroplasty and fixation of the patellar fracture. They both carried out early functional exercise normally and successfully achieved enhanced recovery.ConclusionSuccessful single stage total knee replacement with patella management can not only reduce the number of operations, but also enable patients to achieve rapid postoperative recovery. However, single stage may increase the risk of local surgical complications. Therefore, for most patients, especially those with low risk of anesthesia related complications, standard of treatment remains first fixing the patellar fracture and when the fracture is healed proceed with the total knee arthroplasty.

Casting light in the shadows: Exploring the influence of biological sex and age-at-death on heat-induced shrinkage in experimentally burned patellae

Burned human remains have been studied by both forensic anthropologists and bioarchaeologists to understand how fire impacts and alters bone in different scenarios. Heat-induced changes can occur including differences in colour and shrinkage, where the extent of the latter varies in different studies. The current study aimed to bring information regarding this topic and to observe how the individual’s biological sex and age at death impact shrinkage. The variability of shrinkage was analysed, relating to temperature and duration of burning. The sample comprised of the patellae of 32 individuals (18 [56.3 %] females and 14 [43.8 %] males) with age at death between 60 and 93 (age grouped in decades) from the sub-collection of experimentally burned skeletons, part of the 21st Century Identified Skeletal Collection (ISC/XXI). The right patellae were subjected to experimental burning at different temperatures and durations using an electric muffle furnace. Both the right and left patellae had three measurements taken, maximum height, maximum thickness and maximum width, with a digital calliper. The shrinkage percentage was higher in males and among the younger individuals (60–79 years old of both sexes). The values of standard deviation were high which indicates high variability. Shrinkage occurred at every temperature with bigger values observed in the patellae that had been subjected to temperatures over 800ºC. However, three patellae showed an increase in size at temperature under 800ºC. These findings align with previous studies where a non-linear correlation between shrinkage and exposure duration was found. It is essential to underscore that the percentage of shrinkage exhibits substantial variability even under identical temperature and duration conditions, highlighting the critical significance of meticulous experimental design and thorough analysis.

The Effectiveness of Rheumatic Gymnastics on Patella Joint Flexibility in Elderly with Rheumatoid Arthritis at the Elderly Integrated Service Post (Posyandu Lansia) in Mipiran Village, Purbalingga

Background: Based on data from the 2018 Riskesdas, 7.30% of the Indonesian population is estimated to suffer from rheumatoid arthritis. Rheumatoid arthritis (RA) is a chronic disease that causes joint pain, swelling, stiffness, and limited joint movement. As the most common autoimmune rheumatic disease, rheumatoid arthritis is a chronic inflammatory condition that permanently damages the joints, where the body's immune system, which generally protects the body from infections and diseases, attacks joint tissues for unknown reasons. Method: The research design used in this study was the Pre-Experimental one-group pre-test post-test method. The sample consisted of 31 individuals selected using a total sampling technique. The research instruments used were rheumatic gymnastics SOP and the Long-arm universal goniometer (UG) for measuring patella joint flexibility. Data were analyzed using the Wilcoxon statistical test. Results: There was an increase in the average value of right and left patella joint flexibility before and after the application of rheumatic gymnastics. The obtained P value was 0.005 for the right patella and 0.001 for the left patella. Both statistical analyses discovered that P-value was less than 0.05. Conclusion: Rheumatic gymnastics significantly affects patella joint flexibility in elderly patients with rheumatoid arthritis at the elderly integrated service post (Posyandu Lansia) in Mipiran Village, Purbalingga.

The first presentation of a case of nail-patella syndrome newly diagnosed at the onset of rheumatoid arthritis: a case report

/SummaryBackgroundNail-patella syndrome (NPS) is a rare autosomal dominant disorder that is characterized by dysplasia of the nails, hypoplasia and/or dislocation of the patella and the presence of iliac horns. Using the CARE guidelines, we present the first reported case of NPS that was newly diagnosed at the onset of rheumatoid arthritis (RA).Case presentationA 74-year-old man was admitted to our hospital due to an 8-month history of arthralgia in bilateral wrists, elbows and fingers. He had a past history of glaucoma and left patella dislocation that had been operatively recentered at the age of 15 years. Laboratory data showed elevated levels of serum C-reactive protein and rheumatoid factor and an elevated titer of anti-SS-A antibodies, while estimated glomerular filtration rate (eGFR), titers of other antibodies and the results of a urinary test were normal. An X-ray showed deformity of bilateral radial heads and the right elbow, and magnetic resonance imaging (MRI) of his hands showed synovitis and erosion in the multiple swollen joints of the wrists and fingers. In addition to these typical features of RA, he had bilateral thumb nail dysplasia with mild hypoplasia of bilateral patellae and iliac horns as shown by the X-ray. He was diagnosed as having autosomal dominant disorder NPS co-existing with RA and he was treated with methotrexate in combination with an oral Janus kinase (JAK) inhibitor, leading to induction of remission.ConclusionsWe have presented a rare case of NPS that was newly diagnosed at the onset of RA. Clinical and radiographic findings of NPS are highlighted in this case report for diagnosing NPS on the basis of typical manifestations.

Primary total knee arthroplasty after extensor mechanism reconstruction with structural allograft (case report)

Introduction. Total knee arthroplasty (TKA) in patients with the extensor mechanism insufficiency is traditionally considered as a complex case. Purpose. To demonstrate the specific features of primary TKA in a patient with a history of the extensor mechanism reconstruction using a structural allograft. Case description. A 32-years-old male was admitted to the hospital due to severe pain and decreased range of motion of the left knee 6 month ago. In 2014, due to a road traffic accident, he experienced an open comminuted fracture of the left patella, complicated by infection. During debridement, the partial patellectomy was performed followed by elimination of surgical site infection. One year after the injury, due to significant extension lag and knee instability during walking, an extensor mechanism reconstruction was performed using a structural allograft including the quadriceps tendon-patella-patellar ligament-tibial tubercle. The screws that were fixing the allograft in the tibial crest were removed one year after the reconstruction. The patient resumed an active lifestyle and practiced martial arts. In 2023, he began experiencing increasing pain, limited range of motion (0°–20°–110°), varus deformity (8°), and extensor lag of 20°. Oxford Knee Score (OKS) was 29 points. Due to the low efficacy of conservative treatment TKA was performed in February 2024. Results. After performing standard medial parapatellar approach, the fusion both of the tendon and bone parts of the structural allograft to the surrounding tissues was confirmed. Surprisingly, disintegration of the distal third of the anterior surface of the patella from the retinaculum was identified. To preserve the integrity of the extensor mechanism, the refixation of the patella to the retinaculum was performed with two anchors and non-absorbable sutures. At the 6-month follow-up, the patient reported no pain, full range of motion and walked without additional support or distance limitations. The OKS was 42 points but extensor lag of 5° persisted. Conclusion. After transplantation of structural allograft of the extensor mechanism, the fusion with the native tissues occurs only in the zones of proximal and distal fixation. Despite the reliable long-term mechanical properties, the whole graft did not go through complete revascularization by host tissue and full remodeling. Therefore, during subsequent surgical interventions, including TKA, it is necessary to be technically prepared for augmentation of the extensor mechanism or its secondary reconstruction

Success of the pain relief drug injections in management of the bertolloti syndrome: case report and review of the literature

Introduction: Low back pain accompanied by the lumbosacral transitional vertebra (LSTV) is called the Bertolotti syndrome. This report discussed a case treated with combined corticosteroid and local anesthetic injections based on the literature. Case report: A 35-year-old female patient was admitted to the hospital suffering from low back pain. On neurological exam, her left sacroiliac joint was painful on palpation. Her muscle strength was full, but the left patella reflex was hypoactive. X-ray images revealed “Castellvi Type IIa” LSTV on the left side; therefore, it was considered that the patient might have Bertolotti Syndrome. Because şhedid not accept surgical intervention, “betamethasone dipropionate+betamethasone sodium” and “bupivacaine hydrochloride” were injected into her bilateral sacroiliac joints, bilateral L3-4, and L4-5 facets, and left LSVT joint under fluoroscopy. Her low back pain vanished immediately after the procedure, and she was discharged from the hospital with a full recovery. With an interval of about six months, she was hospitalized 5 more times with complaints of recurrent low back pain, and at each hospitalization, "local anesthetic" (LA) alone or "local anesthetic+corticosteroid" (LA+S) combination was injected into the primary trigger zones. During long-term follow-up, she continued his daily life without any problems. Discussion: This case report showed that sequential LA and LA+S administrations could be curative for patients with Bertolotti syndrome who do not accept surgical treatment, or who cannot undergo surgical intervention. Thus, it was concluded that it would be beneficial to conduct studies with larger samples to obtain more precise information about this method.

Differences in collagen types in the semitendinosus, quadriceps, and patellar tendons: A report using samples from an 11-year-old patient

BackgroundThis study aimed to determine the differences in the proportions of types I and type III collagen in the semitendinosus tendon (ST), quadriceps tendon (QT), and patellar tendon (PT), which are frequently used as autografts for anterior cruciate ligament (ACL) reconstruction. MethodsOrthopedic surgeons diagnosed habitual dislocation of the left patella and surgically treated an 11-year-old boy. Medial patellofemoral ligament reconstruction, medial patellar tibial ligament reconstruction, and arthroscopic lateral release were performed simultaneously. Tissue samples obtained during treatment that were no longer necessary were used as samples for this study. The samples were fixed, paraffin-embedded, and immunostained for type I and type III collagen. Stained samples were observed under a confocal microscope and evaluated visually and quantitatively to determine the percentages of type I and type III collagen. ResultsVisually, the ST had a higher percentage of type III collagen than the PT and QT. The QT and PT were similar in appearance; both consisted mostly of collagen type I. Quantitative evaluation using images showed that the PT comprised 100% type I collagen. The QT comprised 1% type III collagen. The ST comprised 34% type III collagen. ConclusionIn this patient, the QT and PT had higher percentages of type I collagen, which is considered physically strong. Type III collagen, which is considered physically weak, was most common in the ST. These factors may be associated with the high re-injury rates after ACL reconstruction using the ST for physically immature patients.

Anatomic differences in patellar dimensions: A comparative study of left and right sides

The patella is an important bone in the knee joint, and its morphology can vary between different populations. The present study aimed to perform a morphometric analysis of dry human patellae from the Kashmiri population to determine their anatomical features and to compare them with Indian and global studies.The study included 40 dry human patellae (20 right and 20 left) from the Kashmiri population. Various parameters such as patella height, patella width, patella thickness, ridge length, medial and lateral articular facet length and width were measured using a digital Vernier caliper. The mean values of these parameters, along with their standard deviations, minimum and maximum values were calculated. The t-value and p-value were also calculated to determine the significance of any differences observed between the two sides.The results showed no significant differences between the right and left patellae for most of the parameters analyzed, including patella height, patella width, patella thickness, ridge length, medial and lateral articular facet length. However, there was a significant difference in the medial articular facet width (p=0.136) and lateral articular facet width (p=0.318) between the two sides. The mean values for all parameters were within the range of values reported in previous studies of patellar morphology in different populations.The present study provides important information about the morphometric features of patellae in the Kashmiri population. The findings suggest that there are no significant differences in the morphological features of the patellae between the right and left sides, except for the medial and lateral articular facet widths.

Management of Chronic Patellar Tendon Rupture Left Knee Joint with Primary Repair Using Fiber Wire and Endo Button As A Cost-Effective and Simple Anatomical Reconstruction Without Grafts: A Case Report

Patellar tendon ruptures mostly occur in persons under 40 years of age, typically during sports activities. Neglected ruptures of the patellar tendon, defined as ruptures presenting after six weeks, are often difficult to repair, and different techniques have been described for reconstruction of this uncommon problem including the use of auto-grafts, allografts, and synthetic materials. We hereby describe a cost-effective and simple anatomical reconstruction without the requirement for grafts for chronic patellar tendon injuries. This is a retrospective study of a 29-year-old man who came to the orthopaedic clinic with the chief complaint of pain in the left knee. Pain has been felt since 2 years ago after the patient falls when were playing football. After the incident, the patient was taken to alternative therapy, but still felt the pain and difficulty moving the left knee. From the physical examination, the patient presented elevation of left patella height, localized tenderness, palpable gap below the inferior pole of the patella, and limited range of movement on the left knee. There was also a straight leg raise provocative test positive. The x-ray results were obtained patella alta with Insall-Salvatti Index was 1.6. An MRI examination was also performed, showing patella contusion and marrow edema, suspicious of soft tissue rupture, with intact ACL/PCL. The patient was diagnosed with chronic patellar tendon rupture of the left knee. At the time of surgery, it was found that the patellar tendon ruptured with remnants still on the distal part, and the cartilage was still in good condition. The next step is to perform a primary repair of the patellar tendon using fiber wire and endo button at the tibial part. Postoperative rehabilitation was carried out by starting limited ROM exercise of the left knee on day 4. Six weeks after surgery, there was an improvement in left knee ROM and improvement in walking ability. In this case, primary repair of patellar tendon using fiber wire and endo button provides good results and can be used as a costeffective and simple anatomical reconstruction without the requirement for grafts.

Neglected Patellar Fracture Treated Using Ipsilateral Hamstring Autograft Augmentation: A Case Report

Introduction: Inferior pole patellar fractures occur in relatively young patients after eccentric contraction of the quadriceps or direct trauma. Early diagnosis and adequate treatment lead to excellent outcomes and prevent tendon retraction and scarring. The aim of surgical treatment is to restore of extensor mechanism rather than anatomical articular reduction. We propose a cerclage wire technique using ipsilateral hamstring augmentation for the patellar tracking restoration. Case Description: A forty nine-year-old female, presented to our sport clinic with chief complaint of pain in the left knee and difficulty in walking and standing in long period of time following a direct trauma falling from the stairs to the knee one year back. Clinical examination revealed gap in the left knee cap and the patient could not able to straighten the knee actively. Plain radiographs of knee were taken in anteroposterior and lateral views show fracture of the inferior pole of the left patella. Magnetic resonance imaging (MRI) of the knee confirmed inferior pole patellar fracture with the proximal migration of patella with no other intraarticular injuries with partial tear of left patellar tendon. Patellar tendon reconstruction was planned using ipsilateral semitendinosus (ST) and Gracillis (G) autograft and ORIF cerclage wire augmentation. Follow-up was performed after one month post-operation. Patient was able to straighten the left knee and fully weight bearing mobilized without any pain. Range of motion was 0/100 compared to the contralateral knee. Muscle atrophy was not found. Xray was performed and shows callus formation with stable fixation. Conclusion: Neglected patellar fracture is a rare occurrence, the treatment of which is a difficult challenge for orthopaedic surgeons. Therefore, the goal of surgical treatment of inferior pole fractures is restoration of extensor mechanism rather than anatomical articular reduction. In inferior pole fracture of the patella, comminution in fractured distal fragment is common and secure fixation to allow early motion is difficult to achieve. The advantage of the described technique is the possibility of immediate weightbearing and early mobilization. A parallel could be drawn with the biological augment for patellar tendon repair, in which semitendinosus augmentation allows immediate postoperative mobilization with excellent functional results. This allows patients with early functional exercise and has a positive significance for the smooth recovery of the articular surface of the patella and recovery of knee extensor device function. Functional impairment of the extensor mechanism and postoperative complications triggers the quest for finding the ideal technique.

The Morphometric Analysis of Adult Dry Patellae: A Cross-sectional Study

Introduction: The patella is the largest sesamoid bone in the body, which develops within the tendon of the quadriceps femoris muscle. It is a flat, distally tapered, and proximally curved bone. The morphometric study of the patella is important for orthopaedic surgeries. Aim: To conduct a morphometric analysis of the adult dry patella. Materials and Methods: A cross-sectional observational study was conducted on 50 dry human patellae from both the right and left sides of unknown gender. These specimens were obtained from the “Bone Library” of the Department of Anatomy, TN Medical College, and Nair Hospital, Mumbai, Maharashtra, India, during the period from December 2022 to February 2023. Patellar length, width, thickness, as well as the width of the articular facet, were measured using an electronic digital vernier caliper. Mean, standard deviations, and p-value were calculated using the Statistical Package for Social Sciences (SPSS) version 26.0. Patellar parameters between the right and left sides were compared, and an unpaired student's t-test was applied. Results: The mean height, width, and thickness of the right patellae were 42.08±3.44 mm, 45.20±4.35 mm, and 18.85±2.16 mm, respectively, while those of the left patellae were 42.68±3.52 mm, 45.00±2.57 mm, and 19.56±1.62 mm, respectively. The mean width of the medial and lateral articular facets of the right patellae were 18.65±2.65 mm and 23.20±2.20 mm, respectively, while those of the left patellae were 19.10±2.25 mm and 22.61±1.69 mm, respectively. Conclusion: The present study evaluates different dimensions such as length, width, thickness, and the articular facet of the patella. These findings will be helpful in designing knee implants and during reconstructive surgeries related to the knee.

A MORPHOMETRIC STUDY OF PATELLA IN LUCKNOW REGION

Background: Patella is the largest sesamoid bone which develops in the tendon of Quadriceps femoris muscle and protects the front of knee joint. It has gained anatomical, clinical & forensic significance due to its vital role in patellofemoral mechanics and its property of resistance to post mortem changes. Aims and Objectives: Our study aims to measure the various dimensions of left and right human patella which can be useful for the manufacture of patellar prosthesis, better suited to Indian population, in contrast to already available prosthesis which are mostly based on the western anthropometric measurements. Methods: The study involves 100 dry human patellae, 50 each from left and right sides. Total patellar height, maximum height of articular surface, maximum width, maximum thickness, shape, width of medial and lateral articular facets of patella were measured using digital Vernier calipers. Mean and standard deviation were calculated for each parameter for left and right sides and the data was analyzed using SPSS. Results: The mean of patellar width on left side came out to be 41.65± 2.78, while for right side, the mean of patellar width was observed to be 42.83± 3.02. A statistically significant difference was observed in patellar width of left and right sides (p= 0.044). Conclusion: Anthropometric study of patella in India can thus be helpful in designing femoropatellar prosthesis for our population leading to better post-operative outcome.

AGENESIS OF MEDIAL PATELLOFEMORAL LIGAMENT (MPFL) WITH HABITUAL PATELLAR DISLOCATION IN ADOLESCENT WOMAN WITH CEREBRAL PALSY – A CASE REPORT

Background: The current treatment for habitual dislocation and nonoperative treatment failure is surgical therapy. Therefore, this study describes chronic patella dislocation's comprehensive evaluation and management in an adolescent woman with cerebral palsy (CP).Case Report: A 15 years old female patient has suffered knee pain for almost three years. Furthermore, the physical examination revealed positive adam's forward bending test and left knee cap dislocation with positive patellar J-sign at 90°. Radiologic examination of the vertebrae and left knee shows scoliosis left thoracolumbar curved with 43 cobb angle and patellar shift. The patient was then diagnosed with habitual patellar dislocation, spastic diplegia type of CP, and neuromuscular scoliosis, consulted to the pediatric department, and then planned for medial patellofemoral ligament (MPFL) reconstruction. During the surgical examination, we discovered the MPFL Agenesis. Finally, lateral release and plication of the medial retinaculum were selected for surgery and planned to receive a Boston brace for scoliosis. After six weeks of follow up, the patient shows a reduction in pain.Discussion: Lateral release and MPFL reconstruction for patellar stabilization generate better results. However, in this case, the absence of the medial patellar facet and the medial femoral condyle enhances Lateral release and plication of the medial retinaculum more preferable to fixate the left patella and improve functional limitation.Conclusion: Comprehensive and immediate treatment for a patient with habitual patella dislocation and other predisposition diseases increases the chances of success.

A morphologic and morphometric study of articular facets of Patella

Background: The patella plays a major role in flexion and extension of the knee. The patella morphology can be a predisposing factor in patella instability. The congruency between the patella and femur affects the kinematics of the patellofemoral joint, contact mechanics of the patellar cartilage, and strain in the underlying bone, whereby higher stresses and strains potentially contribute to cartilage wear and anterior knee pain. Aim and Objective: The present study was conducted to assess the morphology of facets of patella. Materials and Methods: The present study was conducted to assess the morphology of facets of patella. Ninety-six patella of unknown sex from bone store of Department of Anatomy were included in the study. The patellar morphology and morphometry were investigated. Statistical analysis was performed using the SPSS (v 12.01) software package (SPSS Inc., Chicago, Illinois). Statistical significance was set at P < 0.05. Results: In the present study; 96 patella of unknown sex from bone store of Department of Anatomy were included in the study. The mean size of the right lateral facet was 23.34 mm and left lateral facet patella was 23.06. P value was non-significant. The shape of lateral facet was concave in 93.9% in the left patella and 100% in the right patella. The shape of lateral facet was flat in 6.1% in the left patella and 0% in the right patella. The mean size of the right medial facet was 17.68 mm and left medial facet patella was 17.39 mm. P value was nonsignificant. The shape of medial facet was concave in 2% in the left patella and 10.6% in the right patella. The shape of medial facet was convex in 69.4% in the left patella and 61.7% in the right patella. The shape of medial facet was flat in 28.6% in the left patella and 27.6% in the right patella. P value was non-significant. Conclusion: The present study concluded that the mean size of the right lateral facet was more left lateral facet patella. The shape of lateral facet was concave in 93.9% in the left patella and 100% in the right patella. The shape of lateral facet was flat in 6.1% in the left patella and 0% in the right patella. The mean size of right medial facet was more than left medial facet patella. The shape of medial facet was concave in 2% in the left patella and 10.6% in the right patella. The shape of medial facet was convex in 69.4% in the left patella and 61.7% in the right patella. The shape of medial facet was flat in 28.6% in the left patella and 27.6% in the right patella.

Infrared thermographic assessment of spinal anaesthesia-related cutaneous temperature changes during caesarean section

IntroductionAssessment of adequacy of spinal anaesthesia, prior to obstetric surgery is extremely important but can be problematic because currently available clinical assessment methods are indirect and subjective. As the sympathectomy associated with spinal anaesthesia is known to cause vasodilation and heat redistribution, we sought to assess whether spinal anaesthesia led to significant and consistent cutaneous temperature changes as measured by infrared thermography. MethodsFollowing ethics committee approval, this observational study was conducted in a tertiary level obstetric centre. Participants included women undergoing elective caesarean section under spinal anaesthesia. Following consent, a Flir T540 infrared camera captured thermographic images over the feet, patella, buttock, iliac crests, xiphisternum and axilla. Temperature was measured prior to spinal needle insertion (T0) and following clinical assessment when the block was deemed adequate. ResultsThirty patients were included. Baseline temperature varied considerable by site. Spinal anaesthesia altered skin temperature in all areas of interest: right and left hallux (mean of differences (MD) +4.0°C and 5.2°C respectively, P <0.0001), right and left plantar (MD +6.1°C and 6.8°C respectively, P <0.0001), patella (MD −0.33°C, P=0.0445), buttock (MD −0.5°C, P=0.009), iliac crest (MD −0.7°C, P=0.0004), xiphisternum (MD −0.95°C, P <0.0001) and axilla (MD −0.71°C, P=0.0002). ConclusionsFollowing spinal anaesthesia thermographic imaging identified different patterns of skin temperature changes, with pronounced temperature increases measured in the feet and cooling of a lesser amplitude in the thoracic and lumbar dermatomes. Infrared thermography has the potential to provide objective measurement of sympathectomy.

A Case Report of Comminuted Patella Fracture with Open Reduction

Introduction: Patellar injuries are usually caused while a person slips or falls on a flexed knee and when the forces from the extensors surpass the inherent strength of patella. As the bony failure advances, it concurs or follows injury to medial and lateral extensions of quadriceps mechanism. This happens by pulling mechanism of the muscles. The patient is unable to extend the affected knee actively. This is indicative of disruption of the extensor mechanism and a torn retinaculum. This requires repair or reconstruction through operative means.&#x0D; Case Presentation: To find out complications of comminuted fracture of patella and open reduction after 15 years of surgery. Case Report: A 32-year-old man had a history of fall on ground due to slipping of the wheelchair over wet floor while taking a patient on wheelchair which led to comminuted fracture of left patella with shift knee and had undergone Open reduction and Tension band Osteosynthesis. After this surgical intervention, the patient presented with knee stiffness and pain (rated 6 on numerical pain rating scale) and was referred to physiotherapy.&#x0D; Conclusion: This case study concluded that there is evident stiffness and muscle wasting observed after 15 years of post-fracture surgery of patella, which was managed with the physiotherapeutic rehabilitations.

MPFL Reconstruction, 3 Years After the Goldthwait Patellar Tendon Hemi-transfer and Vastus Medialis Oblique Advancement, Performed to Treat Recurrent Patellar Instability: A Case Report

The treatment of patellar instability in skeletally immature patients is challenging for an orthopedic surgeon. We report a case of a 14 years old girl who after an acute traumatic dislocation of the left patella and the failed initial conservative treatment underwent medial patellofemoral ligament (MPFL) reconstruction, using the fascia lata as an autograft. At the age of 10, the Roux-Goldthwait patellar tendon hemi-transfer combined with lateral retinacular release and the advancement of the vastus medialis oblique was performed for the treatment of the recurrent patella dislocation of both her knees. The patient evaluated for re-dislocation risk factors using the patellar instability severity score proposed by Balcarek et al. The clinical evaluation of the patient included the modified Cincinnati rating system and the Kujala score. The imaging assessment included knee MRI for the identification of anatomical risk factors. The four anatomical risk factors, trochlear dysplasia, increased tibial tubercle to trochlea groove offset, patella alta, and patellar tilting > 20°, were identified on MRI. At the final follow-up, the mean modified Cincinnati score increased from 49 to 90 points 6 years postoperatively. The mean Kujala scores increased from 49 to 91 points postoperatively. The MPFL reconstruction is an effective treatment to restore patellar stability in skeletally immature patients who underwent less successful surgeries to treat a recurrent patella dislocation.

Heterotopic ossification in a patient with paroxysmal sympathetic hyperactivity following multiple trauma complicated with vitamin D deficiency: a case report

BackgroundParoxysmal sympathetic hyperactivity (PSH) may occur in patients with traumatic brain injury. Heterotopic ossification (HO) has frequently been observed in patients with PSH and has been found to impair patients’ recoveries. However, the pathophysiology of HO in patients with PSH remains unelucidated. Vitamin D deficiency is a common abnormality among critically ill patients and may be associated not only with musculoskeletal complications, but also with high morbidity and mortality. The association between vitamin D deficiency and HO in patients with PSH has not yet been evaluated.Case presentationA 21-year-old man was in a motorcycle accident. The initial diagnosis was diffused axonal injury, thoracic aortic injury, bilateral lung contusion with hemopneumothorax, liver injury, vertebral injury of T5, along with fractures of the right humerus, left patella, bilateral scapula, and a stable pelvic fracture, with an Injury Severity Score of 50. Two weeks after admission, he was diagnosed with PSH. One month after the injury, decreased joint mobility and progressive pain were evident. Computed tomography (CT) showed HO in his humerus, ulna, radius, scapula, ilium, pubis, ischium, knee joint, patella, and tibia, as well as renal calculus. To evaluate metabolic bone abnormalities, we measured levels of 25-OH vitamin D, parathyroid hormone, calcitonin, procollagen type I N-terminal propeptide (a marker of bone formation), and tartrate-resistant acid phosphatase 5b (a marker of bone resorption). This revealed a vitamin D deficiency. Bisphosphonate agents and vitamin D were administered for 1 month. Thereafter, his symptoms, radiographic findings, and laboratory abnormalities improved, and he was transferred to another facility.ConclusionsHO in patients with PSH, following severe head injury, may be associated with vitamin D deficiency. Medication for vitamin-D-related metabolism abnormalities may represent a novel intervention for HO with PSH.

What's Important: Age-Related Bias in Orthopaedic Care.

What's Important: Age-Related Bias in Orthopaedic Care.