We present a case of a 49-year-old patient who initially presented in May 2020 with an open pilon fracture. Managed with initial debridement, fixation and flap - who subsequently underwent circular frame application for failure of fixation, requiring a transport to fusion frame who developed beta-haemolytic streptococcus A within the site of the proximal corticotomy. A systematic review of the literature was conducted searching EMBASE, MEDLINE and Cochrane library for all articles discussing infected bone regenerate- a paucity of information was found. Abstracts were independently reviewed by 2 authors (LH and LT). In total, there were 16 papers, and then subsequently analysed we identified two case reports regarding infected regenerate.Introduction
Materials & Methods
This study looks for correlation between pre-operative MRI and intra-operative surgical findings regarding the site of medial patellofemoral ligament (MPFL) rupture in first time patella dislocaters with the aim of confirming the reliability of this modality of imaging. A retrospective analysis of all patients who were referred for MRI following patella dislocation was performed. The surgical and MRI findings of those who subsequently underwent MPFL repair were compared to look for any correlation.Aim
Methods
The medial patellofemoral ligament is commonly torn in first patella dislocation and according to the literature occurs most frequently at the femoral insertion. As research has demonstrated the MPFL to be a primary soft tissue stabilizer of the patella there has been increased interest in acute repair of the ligament with the aim of reducing the risk of recurrent dislocation. MRI is generally used pre op to identify the site of rupture allowing planning of the surgical repair, however there is currently no published data regarding the correlation between surgical and MRI findings to confirm the reliability of this modality of imaging. A retrospective analysis of all patients who were referred for MRI following patella dislocation was performed. The surgical and MRI findings of those who subsequently underwent MPFL repair were compared to look for any correlation. 41 patients were first time patella dislocators and 38 had MPFL rupture diagnosed on MRI. Of these 19 progressed to surgical intervention and 17 had adequate data available from the notes and to permit comparison. All of the MPFLs ruptured at the patella insertion. In 76.5% (13/17) of patients the site of MPFL rupture was correctly identified on MRI scan. Of those that were discordant 3/4 had the site of rupture identified as the femoral insertion on MRI and on 1/4 the MRI suggested rupture at both the femoral and patella insertions. MPFL rupture is common in first time dislocations occurring in 93%% of this cohort. There was a clear predominance patella insertion rupture in our study which contrasts with the majority of the published literature. By correlating surgical and radiological findings we can conclude that while MRI can accurately diagnose MPFL rupture at the patella insertion but it is less accurate in identifying rupture at the femoral insertion.
