IntroductionDespite advances in treatment, chronic osteomyelitis and infected nonunion after trauma remain a challenge to the orthopaedic field. The Papineau technique, firstly described in 1973, is an alternative to treat such conditions in hospitals where microsurgery is not available, making closure of defect using flap is not feasible. We described our experience in treating patients with chronic osteomyelitis and infected non-union of tibial fractures using the Papineau technique.MethodsWe reviewed the records of patients with severe open tibial fractures with bone defects who were treated using the Papineau technique at Cipto Mangunkusumo Hospital, Jakarta, Indonesia during the period of January 2017 to August 2019. Those with diabetes mellitus, severe liver disease, or malignancies were excluded. All surgical procedures were performed by one senior orthopedic surgeon.ResultsA total of four subjects were enrolled in this study. All subjects were male, with a mean age of 29 ± 6.16 years of age. The mean time to granulation tissue was 21.5 ± 1.29 days, and the mean time to union was 6 ± 0 months. There were no complications.ConclusionsThe Papineau technique may provide successful eradication of infection, reconstruction of bone defect, and soft-tissue closure. In addition, this technique is feasible and safe, and it could be performed in small healthcare centres.

Introduction This case report presents a rare case of vertebral artery and spinal cord injury due to air rifle pellet. Case presentation A previously healthy 19-year-old male was shot on his left neck incidentally during recreational air rifle game. He was taken to the other hospital before being referred to our hospital. Clinical findings and investigations The patient presented with total loss of motoric function on his left side of the body together with sensoric function on the contralateral side from the level of C5 and below. Signs of stroke were also spotted on the patient's face. The cervical plain radiograph and CT scan were carried out preoperatively to depict pellet fragments. Meanwhile, the CT angiography which was commenced postoperatively revealed the left vertebral artery injury. Interventions Surgery comprising of pellet fragments removal, decompression and posterior stabilization of the cervical spine was carried out to retrieve the pellet fragments, which were embedded at the posterior epidural space. Relevance and impact Our findings were consistent with the vertebral artery injury and Brown-Sequard syndrome. Hence, these clinical entities should be considered in the setting of penetrating cervical trauma.

Introduction: Patellar tendon rupture is a rare entity, accounting for 3% of all knee extension system injuries. In some cases, the tear is accompanied with avulsed tibial tubercle. Such concurrent fracture is extremely rare, and only a few previously cases have been described in the literature. We reported a 13-year-old male with combined avulsion fracture of the tibial tubercule and patellar tendon rupture. Case Report: A 13-year-old male junior basketball athlete presenting with left knee pain since 2 days before admission. The patient had previously fell to the ground with his left knee hitting the ground while playing basketball. Physical examination demonstrated swollen left knee. Radiographic examination suggested tibial tubercle avulsion, and magnetic resonance imaging demonstrated partial rupture of distal patellar tendon. The patient then underwent open reduction and internal fixation using single cannulated screw for the avulsed tibial tubercle, and patellar tendon reconstruction using suture anchor with ultra high molecular weight polyethylene fibers. Postoperatively, the patient was placed in a locked straight leg brace. One week after surgery, the patient began range of motion exercises and progression of weight bearing with physical therapy. At 4 months of follow-up, the patient can already weightbear, and he had regained active knee range of motion. Discussion: Combined avulsion fracture of the tibial tubercle and patellar tendon rupture in young athlete is an extremely rare case. As such, there is no guideline regarding the best treatment. In this report, we chose open surgery for anatomical reduction of the tuberosity fragment because we consider the growth plate and direct visualization of the patellar tendon. Rigorous physical therapy is of utmost importance in this patient for return to sport, as he is a young athlete. Conclusions: Open reduction and internal fixation using single cannulated screw, and patellar tendon reconstruction suture anchor might be a treatment of choice for those with combined avulsion fracture of the tibial tubercle and patellar tendon rupture in young patients.

Introduction: Meniscal root tear is frequently misdiagnosed and often lead to knee osteoarthritis. Historically, such entity was often treated nonoperatively or with partial meniscectomy. We reported a case of a 78-year-female with osteoarthritis of the knee and meniscal root tear treated with transtibial double tunnel pullout technique. Case Report: A 78-year-old female presenting with left knee pain. One month ago, the patient fell in her bathroom. Physical examination demonstrated locking knee, positive McMurray test. Radiograph suggested osteoarthritis of the left knee Kellgren-Lawrence (KL) grade 2. Magnetic resonance imaging demonstrated traumatic medial posterior meniscal root tear. The patient then underwent meniscal root repair using transtibial double-tunnel pullout technique. Postoperatively, the patient’s knee was placed in a brace and she was kept non-weight-bearing for 6 weeks. At six months of follow-up, the patient no longer complained of pain and locking knee. The Knee Injury and Osteoarthritis Outcome Score (KOOS) also improved from 50 to 90 after six months of follow up. She could weightbear and perform daily activities. Discussion: Meniscal root tear is commonly underdiagnosed, and it often go unnoticed on magnetic resonance imaging and arthroscopy in large part due to the lack of anatomic understanding. Surgery is worthwhile in this case, as it may prevent osteoarthritis from getting worsen. Repairing the meniscal root with a transtibial pullout repair may restore contact pressures to those of the intact states and allow for the dispersion of hoop stresses across the meniscus. In this report, the patient had satisfactory outcome at 6 months of follow-up, where she no longer felt pain and locking knee. Conclusions: Transtibial double-tunnel pullout technique may be treatment of choice for those with meniscal root tear and may provide the greatest improvement in function and lowest risk of conversion to Total Knee Arthroplasty. Further clinical studies are required to investigate the comparative benefit of the transtibial repair technique.