Traumatic dislocation of the tibialis posterior tendon is one of the significantly rare conditions that we might deal with in the emergency department. Approximately only 50 cases have been reported in the literature, and, usually, this condition is misdiagnosed as an ankle sprain in acute settings. It might be neglected in case of improper clinical examination and imaging techniques. We present a case of a 39-year-old patient diagnosed with traumatic dislocation of the tibialis posterior tendon as a result of twisting injury after falling from a 1-meter jump height while playing basketball; the patient was clinically diagnosed primarily as a case of simple ankle sprain in the emergency department and treated conservatively with cold compression. The patient was seen in the clinic after five days with the same complaint, which was medial ankle pain without any improvement. Proper examination and imaging techniques lead us to the accurate diagnoses. The patient was managed surgically and had an excellent outcome postoperatively with a full range of motion of the ankle joint and full weight-bearing without any complaint. Tibialis posterior dislocation should be one of the possible differential diagnoses while dealing with any ankle injury even with unremarkable X-rays. History and physical examination, if conducted correctly, are the keys to making an accurate diagnosis. Therefore, we recommend a proper history-taking and precise physical examination with a high index of suspicion for any possible diagnoses. Early surgical intervention for such cases is the preferable method of treatment to avoid further complications and promote early functional recovery.

Background Patients with avascular necrosis related to sickle cell disease (SCD) can be severely disabled by the severe degenerative changes of their hip. Total hip arthroplasty (THA) remains the only surgical option for some of these patients. Total hip arthroplasty can be a challenging procedure, and SCD patients demonstrate high percentages of medical, intraoperative, and postoperative complications and implant failure. Furthermore, the need for THA following avascular necrosis in the Eastern Province of Saudi Arabia is high, and the subsequent risk of periprosthetic fracture is prevalent. Therefore, it is crucial to conduct such a study. Aim of the study This cross-sectional retrospective study aimed to assess the prevalence and associated risk factors for periprosthetic fractures during total hip arthroplasty in sickle cell disease patients at King Fahad Hospital Hofuf, Saudi Arabia. Methods We collected the data of all SCD patients who had undergone THA during the study period, January 2015 to September 2020. Forty-nine SCD patients who had undergone THA during the study period were included. Patients who had undergone hip hemiarthroplasty, postoperative fractures, or had an indication of THA other than avascular necrosis were excluded. Surgeon factors, assistant factors, and surgical technique were also excluded. We then analyzed the data according to gender, age, BMI, American Society of Anesthesiologists classification, implant fixation type, avascular necrosis stage, proximal femoral morphology, Vancouver classification type, sickle cell type, preoperative hemoglobin (Hb) level, and the risk of periprosthetic fractures. Descriptive statistics were presented using frequency and percentages for categorical variables, and continuous variables were summarized using means ± standard deviations. Independent t-tests and chi-square tests were used to test for associations between categorical variables. At 0.05, the significance level was set. Results Of the patients, 32.7% were male and 67.3% were female. 32.7% of the patients had advanced degenerative changes due to avascular necrosis. Among the patients, 20.4% had an intraoperative periprosthetic femoral fracture, 90% had a Vancouver classification class A, and 10% had a Vancouver classification class B1. According to Dorr classification, 75.5% were classified as Dorr A and 24.5% as Dorr B. Of the patients, 48 had an uncemented implant, and only 1 had cemented. The mean perioperative Hb was 9.02 + 2.02, with a minimum of 6 and a maximum of 14. No significant associations were found between the incidence of intraoperative femoral fracture and the demographic variables and the operative profile characteristics. However, a significantly higher rate of fracture was observed in patients operated on the right side compared to patients operated on the left side. Conclusion The prevalence of periprosthetic intraoperative fracture among SCD patients at King Fahad H...