Level IV: Retrospective, case series.

No abstract

Poikiloderma with neutropenia (PN), is a rare autosomal recessive condition with many associated complications and manifestations. Here we present a patient with confirmed PN who is of one‐quarter Chucktaw or Cherokee heritage with no known descent from the Navajo tribe. The patient's condition was complicated by chronic bilateral lower limb cellulitis and associated osteomyelitis which was unresponsive to extensive antibiotic regimens. Subsequent treatment with hyperbaric oxygen therapy (HBOT) was successful. To date, no author has reported on the treatment of recurrent cellulitis using HBOT in this patient population. Based on our experience, HBOT should be considered in patients with PN.

Category: Ankle; Trauma Introduction/Purpose: Syndesmosis screw fracture is a common occurrence post syndesmosis screw fixation. The purpose of this study is to analyze all studies that include syndesmosis injury fixed with syndesmosis screws based on patient, screw, and surgical/rehabilitation characteristics. An emphasis will be placed on patients who suffered syndesmosis screw fracture following fixation. To date, no review has examined patient, screw, and surgical/rehabilitation characteristics with an emphasis on screw fractures in this patient population. Methods: Of the 482 articles assessed for eligibility, a total 52 articles were selected for full-text review. Following further inclusion criteria requirement 21 articles were included in the study. Each study was analyzed based on patient, screw, and surgical/rehabilitation characteristics. Patient demographics and comorbidities of gender, age, BMI, smoking, alcohol abuse, diabetes, soft tissue conditions were included. Screw characteristics that were included were screw material, number of screws, screw width, number of cortices, and number of patients with screw fracture (screw fracture rate). Surgical/rehabilitation characteristics included ankle position, screw placement above tibial plafond, screw angle, routine removal, rehabilitation process, and time to full weight bearing. Results: A total of 1,196 patients, 761 men and 440 females, were included in the analysis. The average number of patients in each study was 59.80±39.41(12-161). Comprehensive screw, surgical, and rehabilitation + outcome data can be seen in Table 1, 2, and 3, respectively. Nine studies reported on ankle position during surgery; dorsiflexion was the most common. Fourteen reported on placement of the screw above the tibial plafond, with 2 cm being the most common. Five reported on screw angle. 141 patients had a fractured screw(s). The average fracture rate was 11.41%. Five of the 21 studies reported BMI. Three studies stratified data comparing broken screw versus intact screw patients. Five reported on diabetes, one on alcohol abuse, and one study reported on comorbidities. Conclusion: In conclusion, analysis of syndesmosis screw fracture patients versus those with no fracture was difficult due to lack of differentiation in almost all the studies. Notably, syndesmosis screw fracture studies under report patient characteristics, specifically BMI. Comorbidities, especially BMI, are potential cofounding variables within this patient population and could contribute to screw failure. Future studies should include both BMI and comorbidities when analyzing patients whose syndesmosis fixation resulted in screw breakage.

Category: Ankle; Trauma Introduction/Purpose: Syndesmosis screw fixation remains a common standard of care in patients with syndesmosis injuries. Screw fracture is a relatively common occurrence in these patients. The purpose of this is study is to examine the screw characteristics of 28 syndesmosis screws that resulted in screw breakage. Methods: This retrospective study examined all tibia procedures from 2008 to 2019 at a level 1 trauma center. Patients that were treated with a syndesmosis screw that resulted in a screw breakage were included for further analysis. In total, 14 patients satisfied this criterion. A comprehensive analysis of the screw characteristics was then performed. Screw angle was determined using the fibular plate as the vertical axis. Distance of screw fracture also used the fibular plate as a reference point. The tibial plafond was used to determine screw placement. Screws were stratified into subcategories based on standard deviation for screw angle and screw placement. Results: 28 screws were analyzed in 14 patients (6 males, 8 females). On average, 2 syndesmosis screws were placed with a range of 1 to 4. Average screw length was 50.54±5.67 (45-65) mm. Average screw width was 3.64±.36 (3.50-4.50). Average angle of screw placement was 88.70±(65.90-99.50). Eighteen (64.29%) of the screws were placed at an angle greater than 90 degrees. Six were between 80-90 (21.42%) degrees. Average height above the tibial plafond was 25.90±(9.75-49.90). Fifteen (53.57%) of the screws were placed between 20-30mm above the tibial plafond. Six (21.43%) were between 10-20 mm. Twelve screw fractures occurred within the fibula, 7 within the tibia, and 2 screws had a fracture within the fibula and tibia. The average fracture distance from the fibular plate was 14.81±2.36(0-36.23) mm. Conclusion: The aim of this study was to examine syndesmosis screw characteristics following fracture. Eighteen of the 28 screws were placed above a 90-degree angle and 15 were placed between 20-30mm above tibia plafond. This may suggest higher risk for screw fracture above 90 degrees and between 20-30mm above the tibial plafond, however, further analysis with more subjects should be done before any determination is made. [Table: see text]