Fracture-dislocation of lumbosacral junction is rare. It usually affects the patients with multiple trauma. In all reported cases, anterior or posterior displacement of L5 on S1 have been reported, but ANTEROLATERAL displacement has not been reported yet. Herein, we report delayed diagnosis of fracture-dislocation of L5-S1 with ANTEROLATERAL displacement of L5 on S1, which was treated successfully with surgery (open reduction, posterior fusion, and instrumentation).      

BACKGROUND: The treatment of combined ANTEROLATERAL posterolateral rotary instability has been done by correcting knee alignment, anterior cruciate ligament (ACL) reconstruction plus repair or reconstruction of the posterolateral complex. Because of the technical difficulties encountered in these operations and the need for more than two stages, and considering the controversy among the role of posterolateral complex (PLC) in valgus knees, this study was designed to observe the results of treating this instability by ACL-reconstruction alone, after correction of varus, without reconstruction of the posterolateral complex or further extra-articular manipulation.METHODS: This was a clinical trial performed on 29 patients (29 knees) with combined ANTEROLATERAL posterolateral rotary instability. Subjective and objective instability signs were recorded. Arthroscopy was then performed and a valgus osteotomy was done to correct alignment. Then in a second stage, an ACL-reconstruction was carried out. Results, after a mean of 23 months follow-up, were compared to the conditions before surgery. Fisher exact test, X2 and Wilcoxon tests were used to analyze the data. P<0.05 was considered to be meaningful.RESULTS: Pain was relieved in more than half and locking was improved in all of the patients. Giving way of the knee was diminished from 79.3% to 6.9%. Special instability tests showed a significant improvement after surgery (P<0.001). Most of the patients returned to the preinjury level of work or sports.CONCLUSIONS: Based on the results of this study, ACL-reconstruction alone, after correction of varus, can be sufficient to address this combined knee instability without farther procedures on extra-articular structures and posterolateral complex, thus avoiding unnecessary complications and longer rehabilitation.

Background and Aim: Combined ANTEROLATERAL and posterolateral rotary instability are treated by correcting knee alignment, Anterior Cruciate Ligament (ACL) reconstruction and repair or reconstruction of the Posterolateral Complex (PLC). Because of technical difficulties encountered in these operations and the need for more than tow stages, and considering the controversy among the importance of Posterolateral Complex (PLC) in valgue knee, this study was performed to treat this instability by ACL reconstruction alone, after correction of varus, without reconstruction of the posterolateral complex and further extra-articular manipulation. Methods: This clinical trial was performed on 29 patients (29 knees) with combined ANTEROLATERAL and posterolateral rotary instability. Subjective and objective instability signs were recorded. Arthroscopy was then performed. To correct alignment, a valgus osteotomy was done and then an ACL reconstruction carried out. Results after a mean of 23 months follow-up, were compared to the ones of before surgery. Fisher Exact test, 2 and Wilcoxon tests were used to analyze data. Results: Pain was relieved in more than half and locking disappeared in all of the patients. giving way diminished from 79.3% to 6.9%. Special instability tests showed a significant improvement after surgery (P<0.001). Most of the patients returned to the preinjury level of work or sports. Conclusion: Based on the results of this study, after correcting varus, ACL-reconstruction alone, without further invasive procedures on extra-articular structures and posterolateral complex, is sufficient to cure this instability, avoiding unneeded complications and longer rehabilitation.

Introduction: Brucellosis is a common zoonosis in Iran, transmitted to humans by direct contact with infected animal materials like fleece, animal excrement, leather, butchery or by the consumption of contaminated animal products (e.g. fresh cheese, unpasteurized milk or dairy products, and raw meat and raw liver that is consumed semi-roasted by kebab sellers in Iran.Case Presentation: A 21-year-old woman presented with respiratory failure due to pulmonary edema from severe acute mitral valve regurgitation in the setting of acute Brucella endocarditis. She was found to have a ruptured ANTEROLATERAL papillary muscle from necrosis caused by corroding large vegetations on the anterior mitral valve leaflet.Conclusions: This occurrence is an exceptionally rare phenomenon, in Brucella mitral endocarditis. Urgent transesophageal echocardiography (TEE) revealed large mobile vegetation on the anterior papillary muscle with severe mitral valve regurgitation. The patient underwent mitral valve replacement. During valve replacement surgery, anterior mitral valve vegetation and rupture of the AL-PM were confirmed. We also considered that prolonged post-operative antibiotic treatment was indicated in our patient to protect the newly implanted prosthetic valves.

Background: Aortic Valve Replacement (AVR) is usually done through median sternotomy. The present study aimed to compare the right ANTEROLATERAL thoracotomy and median sternotomy approaches for AVR.Methods: The present prospective study was conducted on 60 patients who had aortic valve disease and were subjected to AVR. Thirty patients underwent aortic valve replacement via right ANTEROLATERAL thoracotomy (study group) and thirty patients via median sternotomy (control group). Statistical analysis was done using Mann Whitney U test and Fischer’s Exact test. Statistical Package SPSS 17 was used for data analysis.Results: The mean length of the incision was 18.7±1.8 cm in the patients who had undergone AVR through median sternotomy, while 7.8±0.9 cm in the study group patients. Besides, the mean bypass time was 121.8±18.6 minutes for the patients who had undergone AVR through median sternotomy, while 122.1±20.8 minutes for the study group. In addition, the mean aortic cross clamp time was 67.7±13.4 minutes for the patients who had undergone AVR through median sternotomy, while 68.0±8.9 minutes for the study group. The mean operating time was 181.6±31.5 minutes for the patients who had undergone AVR through median sternotomy, while 190.8±29.8 minutes for the study group. Patient satisfaction with respect to cosmesis was higher in the study group. Only 50% of the patients who had undergone AVR through median sternotomy in comparison to 73.3% of those in the study group were satisfied with the cosmesis.Conclusions: The right ANTEROLATERAL thoracotomy approach for aortic valve replacement proved to be easy to perform whilst maintaining the maximum security for the patients.Besides its better cosmetic result especially in female patients, this approach proved to have several advantages.