Bác sĩ Tiến sĩ Nguyễn Văn Lượng

Purpose The mechanical characteristics of leg lengthening over a nail (LON) using an external fixator are not well known; specifically, the number of rings and K-wires required for this method has not been determined. This study aimed to compare the mechanical characteristics of leg LON using the simplest configuration for a domestic frame and those of leg lengthening using the Ilizarov frame alone. Methods The mechanical characteristics of cow tibial samples for lengthening over an intramedullary nail in combination with a domestic external fixator (LON samples) and for lengthening with the Ilizarov frame (Ilizarov samples) were evaluated by assessing axial compression, bending load, and torsional load. The research indices were compression stiffness, bending stiffness, torsion stiffness, yield axial load, ultimate axial load, yield bending load, and ultimate bending load. Results No statistically significant differences were observed in the compression stiffness, ultimate axial load, bending stiffness, and ultimate, yield bending forces between the Ilizarov samples and LON samples. The compressive stiffness, yield axial load, and ultimate axial load of the LON samples were 98 ± 1.31 N/mm, 915 ± 23.89 N, and 1032 ± 29.86 N, respectively. The anterior–posterior bending stiffness and lateral bending stiffness of the LON samples were 122.48 ± 2.92 N/mm and 116.34 ± 3.95 N/mm, respectively. The yield anterior–posterior bending and ultimate anterior–posterior bending forces of the LON samples were 616.4 ± 3.64 N and 753.2 ± 3.49 N, respectively. The yield lateral bending and ultimate lateral bending forces of the LON samples were 624.6 ± 4.04 N and 759.0 ± 3.39 N, respectively. The axial torsional stiffness of the LON samples was 1.73 ± 0.05 N m/°, which was significantly lower than that of the Ilizarov samples (2.63 ± 0.03 N m/°). Conclusion No statistically significant differences were observed in the mechanical fixation characteristics of axial compression and bending between the Ilizarov samples and LON samples. However, the axial torsional stiffness of the Ilizarov samples was statistically greater than that of the LON samples. We recommend using the simplest configuration for domestic frames in combination with LON for limb lengthening. Partial weight-bearing is permitted in the distraction stage. Level of evidence Case–control study.

Introduction and importance: In rare cases of ankle fracture dislocation, PTT can be incarcerated in the ankle syndesmosis. We report a case of a patient who had a fracture-dislocation of the ankle with the interposition of PTT in the ankle syndesmosis and discuss a systematic review of injury mechanics, pathology, diagnosis, management, and outcomes of this injury. Case presentation: I reported a 43-year-old patient presented with an irreducible lateral displacement of the talus after ORIF of the malleolar ankle fractures and fixation of ankle syndesmosis. Subsequent open reduction and surgical management revealed an interposition of PTT in the syndesmosis 1- month post-operative. A systematic review was completed afterward with the following terms: "ankle fracture" OR "ankle dislocation" AND "tibialis posterior tendon interposition" OR "tibialis posterior tendon entrapment" OR "tibialis posterior tendon incarceration" on Medline, ScienceDirect, and Ovid for articles between 1970 and 2022. Clinical discussion: 5 months postoperative, the patient reported no pain and became capable of walking without a steppage gait. The systematic review showed that the entrapment of PTT could be concurrent with FHL, FDL, and tibial neurovascular. It usually occurs in patients with pronation/eversion injury, Weber C ankle fracture with a valgus deformity and a syndesmosis diastasis. Conclusion: The PTT entrapment usually occurs in patients with pronation/eversion injury, Weber C ankle fracture, a valgus deformity, a syndesmosis diastasis. The entrapment of PTT could be concurrent with FHL, FDL, and tibial neurovascular. The tibiofibular syndesmosis and retromalleolar groove should be explored intraoperatively with suspicion of irreducible ankle fracture-dislocations.

Introduction and importance: The management of extreme limb-length discrepancy remains a challenge for surgeons. Limb lengthening using an external fixator is a popular method for managing limb-length discrepancy; however, it had many complications. Other techniques using external fixators have been described, such as lengthening over a nail (LON) technique and lengthening and then plating (LATP), which decrease external fixator duration, equinus contracture, pin-site infection, bone alignment, and bone fracture. Only a few cases of management of extreme limb-length discrepancy due to hip dysplasia using LATP and LON techniques are reported in the literature. Case presentation: We report a 24-year-old case of an 18 cm lower limb length discrepancy, who had tibial lengthening and Chiari pelvic osteotomy for treatment of congenital hip dislocation 12 years ago. The treatment for the patient was underwent the lengthening over nail technique in the tibia and lengthening and then plating in the femur. 9 months post-operative, the tibia and femur are union. The patient reported no pain and could walk and climb stairs without a crutch. Clinical discussion: Following pelvic osteotomy, leg lengthening is a good treatment for limb-length discrepancy due to hip dysplasia. The LON technique or LATN in the tibia and in the femur is an alternative choice for the treatment of extreme limb-length discrepancy. Lengthening and then plating could be widely employed in patients who are not suitable for the LON technique. Although the patient had gained the 18 cm lengthening, the range of motion of the left knee joint and left ankle joint was unrestricted, and without neurovascular complication. Conclusion: Following pelvic osteotomy, LON technique in the tibia and or LATP in the femur is considered an alternative choice for the treatment of extreme limb-length discrepancy due to hip dysplasia. LATP should be widely employed in patients who are not suitable for limb lengthening over a nail. Level of evidence: A case report.

Introduction and importance The incidence of postoperative infection after ACL reconstruction is reported to be 0.3 to 1.7%. Early debridement and complete removal of the artificial implant have been reported to be very important for complete recovery from postoperative infection after ACL reconstruction. Extra-articular infection of tibial tunnel post ACL reconstruction is a rare case and only a few cases are reported in the literature. The treatment for this lesion is not defined. Case presentation We report a 36-year-old case of recurrent infection at the tibial bone tunnel after ACL reconstruction. The treatment for the patient was debridement and then reconstruction using a medial gastrocnemius muscle flap. 9 months post-operative, there were no signs of infection at the surgical site and the knee joint. The patient reported no pain and was capable of walking without a crutch. Clinical discussion Treatment of infection post ACL reconstruction can be accomplished by arthroscopic and surgical wound irrigation and debridement and antibiotic therapy. It was reported that debridement and then bone cement mixed with vancomycin and gentamycin loaded into the tibial bone tunnel was a good method for treatment of this lesion. If the treatment is not successful, a partial medial gastrocnemius muscle flap should be another choice for treatment of the recurrent infection at the tibial bone tunnel after ACL reconstruction. Conclusion A partial pedicle medial gastrocnemius muscle flap is to be considered an alternative choice for treatment of the recurrent infection at the tibial bone tunnel after anterior cruciate ligament reconstruction.

Introduction and importance Fabella syndrome is a rare cause of posterolateral knee pain. The definitive diagnosis and management of this syndrome remain unclear. Case presentation We report a case of a 19-year-old patient who is a Vietnamese professional football player. He presented with persistent pain in the posterolateral aspect of the knee joint for 12 months that was unrelated to trauma. He was treated conservatively for 6 months without any improvement in the previous hospital. He was diagnosed with fabella syndrome and underwent open surgery to remove the bone. Evaluation after surgery 12 weeks revealed the symptoms disappeared and he was able to return to practice. Clinical discussion In order to diagnose fabella syndrome, the clinicians need to be vigilant and base on the clinical signs as well as imaging to exclude other causes of posterolateral knee pain. Conservative therapy is always the first choice of treatment although the recurrence rate is high, especially in professional athletes. If the initial conservative therapies failed, the fabella surgical removal surgery should be made in athletes. Conclusion Fabella syndrome is a rare cause of posterolateral knee pain in professional athletes. The definitive diagnosis and management of this syndrome remain unclear. Our case shows that surgical removal of the bone fragments can be considered if failure after the initial conservative therapies.

Background The purpose of this study was to evaluate clinical outcomes and complications of our modified Maffuli's mini-open technique for repairing acute Achilles tendon rupture using fiber wire and calcaneal fixation. Material and methods Between January 2017 and August 2020, 21 patients with acute rupture of the Achilles tendon who underwent the modified mini-open Maffulli's procedure have been enrolled in the study. Result All surgical incisions healed well without scar adhesions or infections. One year postoperatively, the ATRS score and AOFAS score were 91.2 ± 1.8; 97.2 ± 1.6 respectively; the range of ankle joint movement was normal. Patients could return to their work and their light sporting activities at the time of 16.9 ± 1.1 weeks and 19.7 ± 0.9 weeks postoperatively, respectively. 21 out of 21 patients were able to perform single heel raise. There were no sural nerve injuries, re-ruptures, tendon elongation, or deep vein thromboses. Conclusion We have shown that the modified Maffulli's technique using fiber wire with a calcaneal fixation for repairing acute Achilles tendon ruptures to be a safe and reliable method without requiring specialized or expensive materials. It allows a durable repairing, a limitation of healing problems, and a quick return to physical therapy and full activity. This technique can be widely employed in a low-income country.

Introduction and Importance: The purpose of this study was to assess the functional outcomes and complications of tibial lengthening using unilateral external fixation and then plating. Material and methods This was a prospective case series study that enrolled people of short stature or leg length discrepancy of more than 3 cm from January 2019 to January 2021. A total of 11 patients (one male and 10 females) were recruited for the study, including seven short statures and four patients with leg length discrepancies. The external fixaters in this study were Muller's frame or Nhan's frame. Results The average age of patients at the time of surgery was 25.89 years (range: 13–41 years). The study included 18 tibias that were lengthened and then plated. Average tibial lengthening was 6.89 ± 1.25 cm (21.87 ± 6.59%). The functional result was excellent in seven patients and good in four patients. Pin-track infection occurred in three tibias. There was one case of superficial infection. 12 legs (66.7%) developed ankle equinus after removing the external fixator. Four legs with severe equinus deformity were treated with percutaneous tendo-Achilles lengthening. Valgus deviation occurred in eight tibias. Peroneal nerve neuropraxia occurred in two legs during distraction. Distal migration of the fibula head occurred in four legs. Conclusion Our study suggested that tibial lengthening using Nhan's external fixater or Muller frame then plating was safe and effective provided complications were looked for and kept in check. Equinus contracture, pin-site infection, and valgus alignment were the most common complications. Level of evidence Level IV, prospective case series study.

Introduction and importance Tibial dysplastic pseudoarthrosis associated with large leg-length discrepancy and extensive scarring was a great challenge for orthopedic surgeons. The treatment for these lesions was not defined. Case presentation We report a 24-year-old case of dysplastic pseudoarthrosis at the middle third of the right tibia with a 10 cm leg-length discrepancy and a 25⁰ medial deviation and 20⁰ internal torsion due to osteomyelitis 14 years previously. She was treated by fibula lengthening then centralization for the treatment of tibial pseudoarthrosis. Eight months after the operation, the patient reported no pain and became capable of walking without an orthosis. X-rays showed full bone union at the proximal tibiofibular synostosis and the lengthening site of the right fibula. The distal tibiofibular synostosis was healing. The range of movement of the knee and ankle was restored. Clinical discussion This technique was different from the Huntington procedure. A good union between the transposed fibula and the remaining part of the fibula brought a better strength of the reconstructed tibia. The tibial pseudoarthrosis, leg-length discrepancy, and malalignment had been solved by our techniques. The procedure was easy, rapid, and inexpensive without requiring microsurgery skills and special devices. Conclusion Leg lengthening then centralization of ipsilateral fibular graft is an excellent option for reconstruction of a tibial pseudarthrosis with a large leg-length discrepancy. It is a safe, rapid, and inexpensive procedure. The procedure was not difficult, and microvascular skills.

Introduction Open Achilles tendon laceration was managed surgically by wound irrigation, debridement and Achilles tendon repair. The poor vascularization at the midsection of Achilles tendon and surrounding skin, extensile open approaches were factors, that contributed to higher complication rate of wound healing and infection. We had not seen a report of minimal invasive repair techniques for treatment of open Achilles tendon injury. Material and methods Between January 2018 and May 2020, 14 patients with open Achilles tendon laceration had been enrolled in the study and underwent the modified Maffulli's procedure at the Central Military Hospital 108. The characteristics of the patients, ATRS score AOFAS score and complications were recorded. Results No wound infection was encountered in our series. The range of ankle movement was restored in all patients. After one year post-operatively, the ATRS score was 92.2 ± 1.5 (range: 90–96), and AOFAS score was 97.4 ± 1.8 (range: 92–100). All patients could return to their work and their light sporting activities at the time of 16.7 ± 2.5 weeks (range, 14–20) and 19.8 ± 4.6 weeks (range: 17–25) postoperatively, respectively. 14 out of 14 patients were able to perform single heel raise. Conclusion We showed the modified Maffulli's technique using fiber wire with calcaneal fixation for repairing open Achilles tendon laceration to be a safe and reliable method without increasing financial cost and specially designed tools. Level of evidence Level IV, a prospective case series study.

Introduction and importance The treatment of a fractures in tibial distal metaphyseal remained controversial. The purpose of this study was to assess the results and complications of minimally invasive medial plate osteosynthesis for distal metaphyseal tibial fractures. Material and method From April 2014 to December 2019, 70 patients were enrolled in the study who were underwent MIPPO for metaphyseal tibial fractures using a medial distal tibial locking plate in our hospital. Wound healing, alignment, full weight bearing time, function, and complications were recorded. Results All wounds primarily healed, just one fibular plating wound was deeply infected. All tibial fractures were solid union without secondary displacement. The average time back to walk without a crutch was 12,5 weeks. The mean AOFAS score was 89 at a mean of 15 months follow-up. There were seven cases of late infection, 14 patients of skin impingement by implants and nine cases of broken screws, who were older than 65 years old. No case was varus, valgus or rotation >5°. Conclusion Minimally invasive medial plate osteosynthesis for the distal metaphyseal tibial fracture is safe and effective. This technique decreases the incidence of complications and can help patients to resume their function early. The implant impingement, late wound infections and screw breakage were the quite common complications in old patients but these complications could be simply resolved and did not affect the overall rehabilitation and functions of the patient.

Introduction and importance Irreparable sciatic nerve palsy is a cause of foot drop and resulting in absent or weak most of the muscles in leg. There may be dysfunctions of all tendons in the leg excepting Achilles tendon and plantaris tendon. The treatment of this atypical neurologic injury has not been defined. Case presentation I reported a case of foot drop following irreparable sciatic nerve palsy in which there was a dysfunction of all tendons in leg excepting Achilles tendon and plantaris tendon. The medial gastrocnemius tendon and plantaris tendon were transferred into the anterior tibialis tendon, the extensor digitorum longus tendon and extensor hallucis longus tendon. The lateral gastrocnemius tendon was transferred into the peroneus brevis. Four months post-operative, he reported no pain and became capable of walking without the assistance of an orthosis or a crutch and without steppage gait. Clinical discussion Anterior transfer of the tibialis posterior tendon was the preferred procedure. If no posterior tibial tendon function was presented, then in order of preference, the extensor hallucis longus, extensor digitorum longus, peroneal, flexor hallucis longus tendon, medial gastrocnemius, lateral gastrocnemius and plantaris tendon would be used. Conclusion The atypical dysfunction of all tendons in the leg excepting Achilles tendon and plantaris tendon following irreparable sciatic nerve palsy was presented. Tendon transfer using medial gastrocnemius tendon, lateral gastrocnemius tendon and plantaris tendon seemed to be a good choice for treatment of this injury. It allowed reconstruction of a stable, painless, plantigrade foot.

Introduction and importance The parathyroid cancer is sometime only diagnosed after a pathological fracture has occurred, and pathology fracture is often misdiagnosed as a malignancy tumor. The treatment for pathology fracture and multiple bone lesions is not defined. Case presentation We report a 41-year-old case of parathyroid carcinoma in which pathological femoral fracture and brown tumors are the first clinical signs of the disease and that masqueraded as a malignancy tumor. The treatment for the patient was parathyroidectomy and then surgical treatment of the right femur with a locking plate osteosynthesis. Four months post-operative, the patient reported no pain and became capable of walking without a crutch. X-rays showed full bone union at fracture site of right femur, and brown tumors regression seen to be taking place in the upper limb, lower limbs and pelvis. Clinical discussion A brown tumor was diagnosed by a high concentration of blood parathyroid hormone and serum calcium. Despite the lack of clinical guidelines, most authors agreed that parathyroidectomy was the first choice of treatment then orthopaedic treatment. The principles of osteosynthesis of fracture were based on stable osteosynthesis. It was reported that osteolytic lesions caused by brown tumor were recovered when hyperparathyroidism had been treated. Conclusion Brown tumor needs to be considered in the differential diagnosis when there are osteolytic lesions and high serum calcium. It is advisable to have a parathyroidectomy and then orthopaedic treatment. Brown tumor with Mirels' score less than 7 scores should be applied a conservative treatment.

Background The purpose of this study was to assess the functional, psychological outcomes and complications of bilateral tibial lengthening over intramedullary nail. The intramedullary nail in this study was the Surgical Implant Generation Network (SIGN) nail.Material and methodsWe enrolled patients desiring stature lengthening at the 108 Military Central Hospital (Hanoi, Vietnam) from October 2011 to January 2019. A total of 104 people have been enrolled in the study and underwent the bilateral tibial lengthening procedure.ResultsAverage tibial lengthening was 7.1 ± 0.8 cm in men and 6.5 ± 0.6 cm in women. Percentage of tibial lengthening as compared with tibia length at the time of pre-operation was 23.9 ± 3.5% for male patients and 21.5 ± 3.7% for female patients. The outcome was excellent in 85 patients (81.7%) and good in 19 (18.3%). All patients experienced improved self-esteem and enhanced quality of life.Conclusion Our study suggests that bilateral tibial lengthening over nail was safe and effective provided complications are looked for and kept in check. Equinus contracture, pin tract infection, and valgus deviation were the most common complications. Valgus deviation occurs during distraction period. In patient who had neutral or valgus alignment, we recommend to use a blocking screw at the proximal segment post-operatively and use a blocking screw at the valgus distal segment at the end of distraction period to maintain the mechanical axis of both tibias. Bilateral tibial lengthening over nail should be widely employed in low-income countries.