Tushar Nayak

Introduction: Split tears of the peroneus brevis tendon (PBT), often associated with superior peroneal retinaculum (SPR) insufficiency, are a frequently overlooked cause of posterolateral ankle pain and instability, particularly in athletes. Accurate diagnosis requires a high index of suspicion and dynamic imaging to detect tendon subluxation and associated pathology. Case Report: We present the case of a 28-year-old athlete with persistent posterolateral ankle pain and instability following an ankle twist. Clinical examination and imaging confirmed a partial longitudinal tear of the PBT with concomitant SPR insufficiency. Surgical management involved tendon debridement, tubularization with side-to-side repair, and SPR reconstruction. Post-operative rehabilitation included progressive weight-bearing, range-of-motion exercises, and structured strengthening protocols. Conclusion: The patient achieved excellent recovery, with an American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score of 85 at 3 months and a full return to sports without pain or instability. This case highlights the importance of early recognition and comprehensive management of both tendon and ligament pathology to achieve optimal functional outcomes. Keywords: Peroneus brevis tendon, ankle instability, superior peroneal retinaculum, tendon repair, rehabilitation.

Currently, the management of acute osteochondral fractures (OCFs) of the patella is well established. However, the management of chronic OCFs remains debatable, as it is not clear whether such lesions can be accurately reduced or whether they will reliably heal. With well proven results of open reduction and internal fixation (ORIF) with headless compression screws (HCS) for acute OCFs, the application of this technique in late presenting cases is inconclusive. Thus, we present the clinicoradiological outcome of patients with chronic osteochondral injuries managed with ORIF. Fifteen patients who underwent surgical fixation by ORIF with HCS for chronic OCFs of the patella, between February 2013 and June 2018, were retrospectively analyzed after a mean follow-up of 3.8 years (range: 2–7 years). The mode of injury, size of the osteochondral fragment, and knee range of motion along with Kujala's scoring were examined clinically and radiological assessment was done by X-rays and magnetic resonance imaging (MRI) scans. Fifteen patients (11 males and 4 females), with a mean age of 17 years with chronic OCF of patella were enrolled. Noncontact twisting injuries were the most common mode of injury seen in 86.66% of patients and postcontact injuries in two patients (13.33%). The mean time from trauma to presentation was 7 weeks (range: 6–14 weeks). The mean preoperative Kujala's score improved from 44 to 84.8 at 6 months and 92.6 at 2 years, postoperatively. Intraoperatively, the lesion was found in medial patellar facet in 12 patients and 3 had lesions in the central facet. The mean size of the lesion was 20 mm × 18 mm. Radiological union was observed in all patients, at a mean duration of 16 weeks (range: 12–20 weeks). One patient underwent implant removal 1 year after initial surgery for mechanical symptoms. ORIF of OCFs of the patella using headless cannulated screws is simple, reliable, reproducible, and provides satisfactory outcomes. This technique can be considered for fixation of fragments with adequate subchondral bone.

Background Comminuted fractures of the posterior acetabular wall, pose a significant challenge in the reduction and fixation of the fracture fragments and usually result in dubious functional outcomes. Primary reconstruction of the severely comminuted posterior wall using the autologous tricortical iliac crest graft has shown promising results, especially in fractures not amenable for anatomical reduction and fixation. Thus, the present study analyses the functional and radiological outcomes of severely comminuted posterior wall acetabular fractures, primarily reconstructed with an autologous tricortical iliac crest graft. Methodology This is a retrospective study, where all cases of comminuted posterior wall acetabulum fractures treated primarily with reconstruction using ipsilateral autologous tricortical iliac crest graft between January 2011 and November 2018 were included. The data of patients were retrieved from the hospital records and all the patients were assessed clinically and radiologically at the final follow-up. Results Fourteen patients (ten males and four females) were operated on with a mean operative time of 160 min (range 125 to 190 min) and a mean blood loss of 410 ml (range 320 ml to 830 ml). At 2 years of follow-up, 11 patients (78.57%) had good to excellent functional outcomes based on the modified Merle d'Aubigne and Postel scoring system. The radiological assessment using Matta's criteria indicated excellent outcomes in two patients (14.48%), good in six patients (42.85%), fair in six patients (42.85%). Conclusion Primary reconstruction of the comminuted posterior wall acetabulum fractures is a potential alternative and salvageable option with favourable outcomes. However, it ought to be considered in severely comminuted fractures where anatomical reduction and internal fixation is not feasible.