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Background: Anterior cruciate ligament (ACL) injury in children is an increasingly common occurrence. Historically, nonsurgical treatment has been the main treatment option; however, the indication for surgical reconstruction is increasing, as the histological characteristics of the immature skeleton are better known. Indications: The extra-articular surgical technique for ACL reconstruction is a good option for Tanner I patients, aged up to 8 years, with knee instability and recurrent pain. Its advantage in skeletally immature patients is due to the fact that it avoids the bone growth plates. Technique Description: After skin incision and subcutaneous dissection, we isolated the iliotibial band and released the proximal portion of the band. We proceeded with the tubularization of the graft, suturing its edges, and with the aid of radioscopy we marked the top of the lateral femoral condyle. Thus, we transported the graft, in an over-the-top position, to the intercondylar portion of the femur. Femoral fixation is performed by placing the graft close to the lateral femoral condyle. For fixation on the tibia, a second incision is made, preserving the physis, and the graft is fixed to the tibia using an absorbable Swivelock anchor. Results: Six months after the surgery, when his physical rehabilitation was completed, the patient was asymptomatic and able to perform his daily activities, and also returned to sports. Clinical evaluation showed a knee with almost the same functional parameters as the uninjured one. Furthermore, radiographic studies showed no bone abnormalities and magnetic resonance image showed a newly reconstructed ligament with good positioning. Discussion/Conclusion: According to the literature, surgical treatment seems to be better than conservative treatment in skeletally immature patients. However, there is a continuous discussion about the most appropriate surgical technique. The decision is relative to many specific characteristics for these patients: age, bone age, graft choice, sports modality, and surgeon expertise. In this case, we decide to do an ACL extra-articular reconstruction technique with the iliotibial band over the top in the femoral condyle and fixed in the anterior cortical bone of the tibia. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication. Graphical Abstract This is a visual representation of the abstract. [ABSTRACT FROM AUTHOR]

Introduction/Purpose: Ankle fractures correspond to a substantial portion of traumatic injuries assisted in a primary health care unit. These fractures are usually promptly recognized by physical exams and conventional radiographs. Nevertheless, the number and pattern of the lesions and the identification of possible associated injuries still fail when using only these methods. CT scans have developed into an excellent instrument to analyze joint fractures in recent years. This study aims to compare ankle fracture assessment using CR in isolation with CT and CR in combination. This comparison will be performed considering diagnosis, lesions features, and treatment. We hypothesize that CT, in conjunction with CR, can significantly modify the diagnosis, therapeutics, and operative planning of ankle fractures when confronted with isolated CR. Methods: A total of 53 patients (mean age: 42 years, 15 - 75) diagnosed with an ankle fracture between 2011 and 2016, were assessed with CT and CR. Evaluations of the fractures using CR in isolation and CR combined with CT were compared using seven different readers. Fractures were assessed in terms of type, displacement, size, associated injuries, treatment, patient position, the implant of choice, and surgical planning considering the presence or absence of malleolar fractures and potential associated injuries. The concordance was measured for the own examiner's evaluations and between the examiners' assessments (intra-observer and inter-observer) by the Kappa coefficient. The results were determined by relative frequency distribution analysis (in percentage terms) and compared using a two-proportions test. Results: The Kappa index was higher than 0.75 for all interobserver and intra-observer reliabilities. Medial malleolus fractures characteristics (posteromedial fragment and anterior colliculus), the presence of posterior malleolus fracture and its characteristics (displacement, size, posteromedial or posterolateral segment) (ps<0.042), syndesmosis injury (p<0.001), and the absence of deltoid ligament lesion (p<0.001), were more evident with the combination of CT and radiographs. There was an increase in an operative indication (p=0.007), prone positioning (p=0.002), posterior malleolus surgical treatment (p<0.001), posterolateral approach for the lateral malleolus (p=0.003), and syndesmosis fixation (p=0.020) with the association of CT and CR, among all groups of expertise, with high inter-observer reliability (>0.75). Conclusion: Conventional radiographs may fail to demonstrate subtle and more complex lesions of the ankle joint, such as posterior and medial malleolus fractures, undermining its capability to determine the appropriate treatment plan. This study showed evidence that a CT scan, a widespread available exam, and the standard for the study of other articular fractures, increased the diagnostic capability in ankle fractures when used with radiographs. In addition, the combination of methods may improve the quality of the information received by the orthopedic surgeon, providing more details for a proper surgical or nonsurgical treatment, positively affecting patient care. [ABSTRACT FROM AUTHOR]

Introduction/Purpose: Ankle fractures are one of the most operated injuries in orthopedic practice. The decision upon the best management is based on the displacement of the bone fragments and the presence of associated lesions (osseous and/or soft tissues). The therapeutic decision is classically established upon plain radiographs, which might be temerarious due to the usual difficulty in analyzing those exams. In recent years, some authors have advocated that computed tomography could be used as an assistant instrument on the decision-making. Our study aims to demonstrate the superiority of the association between both methods on diagnosis, therapeutic decision, and surgical plan for these injuries. Methods: Patients diagnosed with an ankle fracture, between 2011 and 2016, and assessed with CT and X-ray were included in our investigation. Seven examiners with different degrees of experience analyzed the exams, determined the injuries, chose how they would treat, and the defined surgical strategy when applicable. This was done, at first, only with radiographs and after with the combination of CT and radiographs. The data were statistically compared. Results: Fifty-three patients were included. The medial malleolus fractures characteristics (posteromedial fragment and anterior colliculus), the presence of posterior malleolus fracture and its characteristics (displacement, bone fragment greater than 25%, posteromedial or posterolateral segment), syndesmosis injury, and the absence of deltoid ligament lesion were more noticeable from the combination of CT and radiography. Concerning surgical treatment, the prone position, the posterolateral surgical approach (rather than anterolateral) on lateral malleolus osteosynthesis, the decision to surgically treat the posterior malleolus fracture (through posterolateral approach with posterolateral plate), the option to include the syndesmosis approach in the treatment, and not to include deltoid ligament repair were more noticeable from the combination of CT and radiography, among all groups of expertise, with high inter-observer reliability. Conclusion: The usual radiographs may fail to demonstrate subtle lesions, as posterior malleolus fractures and syndesmotic injuries. The tomographic evaluation increases the precision of diagnosis and improves the quality of information that the surgeon receives, providing data that can positively affect patient care. [ABSTRACT FROM AUTHOR]