Several studies have evaluated the risk of
Aims. The optimal management of posterior malleolar ankle fractures, a prevalent type of ankle trauma, is essential for improved prognosis. However, there remains a debate over the most effective surgical approach, particularly between screw and plate fixation methods. This study aims to investigate the differences in outcomes associated with these fixation techniques. Methods. We conducted a comprehensive review of clinical trials comparing anteroposterior (A-P) screws, posteroanterior (P-A) screws, and plate fixation. Two investigators validated the data sourced from multiple databases (MEDLINE, EMBASE, and Web of Science). Following PRISMA guidelines, we carried out a network meta-analysis (NMA) using visual analogue scale and American Orthopaedic Foot and Ankle Score (AOFAS) as primary outcomes. Secondary outcomes included range of motion limitations, radiological outcomes, and complication rates. Results. The NMA encompassed 13 studies, consisting of four randomized trials and eight retrospective ones. According to the surface under the cumulative ranking curve-based ranking, the A-P screw was ranked highest for improvements in AOFAS and exhibited lowest in infection and
Abstract. Introduction. Knee dislocations (KDs) are complex injuries which are often associated with damage to surrounding soft tissues or neurovascular structures. A classification system for these injuries should be simple and reproducible and allow communication among surgeons for surgical planning and outcome prediction. The aim of this study was to formulate a list of factors, prioritised by high-volume knee surgeons, that should be included in a KD classification system. Methods. A global panel of orthopaedic knee surgery specialists participated in a Delphi process. A list of factors to be included in a KD classification system was formulated by 91 orthopaedic surgeons, which was subsequently prioritised by 27 experts from 6 countries. The items were analysed to find factors that had at least 70% consensus for inclusion in a classification system. Results. The four factors that reached consensus agreement and thus deemed critical for inclusion in a classification system were vascular injuries (89%), common
Abstract. Background. Fracture dislocation of the knee involves disruption of knee ligaments with associated tibial plateau fracture. If these injuries are not evaluated swiftly, can result in a limb-threatening injury. The aim of this study is to look at the clinical outcomes of a single surgeon case series at a major trauma centre. Methods. Prospectively collected data was analysed for a 5-year period. Primary outcome measures used were International Knee Documented Committee (IKDC) score and Knee Injury & Osteoarthritis Outcome Score (KOOS). The secondary outcome measures include Tegner activity scale, knee range of movements and complications. Results. 32 patients were presented with the mean age was 34 years (range 17–74). 14% of patients sustained vascular injury and 19% had common
Abstract. Background. Fracture dislocation of the knee involves disruption of two or more knee ligaments with associated tibial plateau fracture. If these injuries are not evaluated swiftly, can result in a limb-threatening injury. The aim of this study is to look at the clinical outcomes of a single surgeon case series at a major trauma centre. Methods. Prospectively collected data was analysed for a 5-year period. Primary outcome measures used were International Knee Documented Committee(IKDC) score and Knee Injury & Osteoarthritis Outcome Score(KOOS). The secondary outcome measures include Tegner activity scale, knee range of movements & complications. Results. 23 patients were presented with the mean age was 37 years(17–74). 14% of patients sustained vascular injury & 19% had common
The aim was to report operative complications, radiographic and patient-reported outcomes following lateral tibial plateau fracture fixation augmented with calcium phosphate cement (CPC). From 2007–2018, 187 patients (median age 57yrs [range 22–88], 63% female [n=118/187]) with a Schatzker II/III fracture were retrospectively identified. There were 103 (55%) ORIF and 84 (45%) percutaneous fixation procedures. Complications and radiographic outcomes were determined from outpatient records and radiographs. Long-term follow-up was via telephone interview. At a median of 6 months (range 0.1–138) postoperatively, complications included superficial
Patients with longstanding hip fusion are predisposed to symptomatic degenerative changes of the lumbar spine, ipsilateral knee and contralateral hip. 1. In such patients, conversion of hip arthrodesis to hip replacement can provide relief of such symptoms. 2 – 4. However, this is a technically demanding procedure associated with higher complication and failure rates than routine total hip replacement. The aim of this study was to determine the functional results and complications in patients undergoing hip fusion conversion to total hip replacement, performed or supervised by a single surgeon. Twenty-eight hip fusions were converted between 1996 and 2016. Mean follow up was 7 years (3 to 18 years). The reasons for arthrodesis were trauma 11, septic arthritis 10, and dysplasia 7. The mean age at conversion was 52.4 years (26 to 77). A trochanteric osteotomy was performed in all hips. Uncemented components were used. A constrained liner was used in 7 hips. Heterotopic ossification prophylaxis was not used in this series. HHS improved a mean of 27 points (37.4 pre-op to 64.3 post-op). A cane was used in 30% of patients before conversion and 80% after. Heterotopic ossification occurred in 12 (42.9%) hips. There was 2
Background. Although gradual bone transport may provide a large-diameter bone, complications are common with the long duration of external fixation. To reduce such complications, a new technique of bone transport with a locking plate has been done for tibial bone defect. Methods. In 13 patients (mean age, 38.9 years) of chronic osteomyelitis or traumatic bone defect, segmental transport was done using external fixator with a locking plate. In surgical technique, a locking plate was fixed submuscularly, holding the proximal and distal segments. Then, the external fixator for transport was fixed without contact of the locking plate. After docking, 2 or 3 screws were fixed at the transported segment through the plate holes. At the same time, the external fixator was removed. Results. The mean transported amount was 5.8cm, and the mean external fixation index was 13.3 days/cm. The primary union at the docking site was achieved in all cases. No patients showed angular deformity over 5 degrees. There were 2 patients of leg length discrepancy with less than 1.5cm. Deep infection or recurrence of osteomyelitis was not developed. Except for two patients with pre-existed
High Tibial Osteotomy (HTO) is an established treatment for unicompartmental osteoarthritis of the knee with malalignment. The classic procedure for correcting varus deformity is the lateral closed wedge osteotomy of the tibia with osteotomy of the fibula. The disadvantages of this technique are well known. Open wedge osteotomy from the medial sideeliminates the risk of compartment syndrome and
Objective: To determine the success of 20 cases treated with TomoFix high tibial medial opening wedge osteotomy. Study design: Retrospective review of 20 cases with 6 months of follow up including; indications for treatment, surgical technique, results, complications and patient satisfaction. Background: High Tibial Osteotomy is an established technique for the treatment of unicompartmental osteoarthritis of the varus malaligned knee. Corrections are usually achieved by closed wedge osteotomy from a lateral exposure. This technique has associated risks of;
We reviewed the outcome of Agility total ankle replacements carried out in our institution between 2002 and 2006. Follow-up consisted of clinical and radiological review pre-operatively, at 6 weeks, 6 and 12 months, and annually until 10 years post-op. Clinical review included the American Orthopaedic Foot and Ankle Score, satisfaction and pain scores. 30 arthroplasties were performed in 30 consecutive patients. Pre-operative diagnosis was rheumatoid arthritis (16), primary osteoarthritis (12) and post-traumatic osteoarthritis (2). After a mean follow up of 6.2 years (1.4–10.1), 4 patients had died, and 20 out of the remaining 24 were available for follow-up. Complications included lateral malleoli fracture (3), superficial
Total knee arthroplasty revisions (TKAR) are increasing in incidence. These complex and demanding procedures are typically associated with a higher complication rate than primaries. We report on the actual complications encountered in a prospective study of TKAR patients to determine the current nature and incidence of these problems. 230 consecutive patients undergoing TKAR were enrolled to our database and had information on demographics, comorbidities, outcomes (WOMAC and SF-36) and complications recorded. Baseline information and data from 2 month, 6 month and 1 year follow up was collated. Mean patient age was 68.0 and clinical outcomes scores showed significant improvements for function, stiffness and pain at all points of follow-up. The total number of complications was 131 in 97 (42.2%) patients (48 by 2 months, 46 at 6 months and 32 at 1 year). Systemic complications comprised 41 of these, many being relatively minor. There were no deaths, 4 deep vein thromboses and 3 myocardial infarctions. The majority of complications (90) were local, including 2 patellar dislocations, 3 periprosthetic fractures, 3
Aims: The results of surgical repair and reconstruction of knee dislocations were reviewed at average follow-up of 32 months. Methods: Twenty-one patients with 22 knee dislocations presented between 1994 and 2001. There was one vascular and one common
Purpose: To describe the technique and outcomes of patients requiring Lateral Gastrocnemius flaps for soft tissue coverage of the lateral side of the knee after sarcoma. Methods: Four patients with sarcomas on the lateral knee capsule were identified. 1 patient had an Osteosarcoma of the proximal tibia resected, requiring reconstruction. 2 patients had Malignant fibrous hystiocytoma proximal to the lateral knee joint and 1 patient had a leiomyosar-coma who presented after 6 failed local resections. The length of follow up is from 13 months to 5 years, average 3.25 years. There were no graft failures. The average surface area of the resection was 118 cm2. There were two sarcoma recurrences requiring excision and radiation. There was one death due to metastases. The technique involves the releasing the gastroc flap down to the aponeurosis and then the careful dissection of the peroneal nerve with delivery of the muscle up behind the peroneal nerve to the lateral aspect of the knee. The flap is rotated fibrous layer down and the muscle readily accepts a meshed skin graft taken locally, giving this technique the advantage of reconstructing a capsule and creating a superior bed for accepting skin grafts. Results: Average time to healing was 3.8 weeks. There have been no nerve injuries, no graft loss and all had a function range of motion. The functional results have been very reliable. Using the musculoskeletal tumour society score (MSTS) and the Toronto Extremity Salvage Scoring (TESS) system we had an average MSTS score of 21.5 with a percent of 71.5 and a TESS score of 44.5 for the living patients. These correlate to very good outcomes. Conclusions: The lateral gastrocs flap has a reputation of being technically complex. Meller et al.(1997) report
Introduction: Traumatic knee dislocations are rare but devastating injuries. We have evaluated the clinical results of ligament repair and reconstruction. Knee dislocation was defined as an acute event that produced multidirectional instability with at least 2 of the 4 major ligaments disrupted. Materials: Twenty-one patients with 22 knee dislocations presented between 1994 and 2001. There was one vascular and one common
Traumatic knee dislocations are rare but devastating injuries. We have evaluated the clinical results of ligament repair and reconstruction. Knee dislocation was defined as an acute event that produced multidirectional instability with at least 2 of the 4 major ligaments disrupted. Twenty-one patients with 22 knee dislocations presented between 1994 and 2001. There was one vascular and one common
Anatomy &
Biomechanics. Lateral Collateral Ligament (LCL). Primary stabilizer to varus opening. Femoral attachment – proximal/posterior to lateral epicondyle. Fibular attachment – midway along lateral fibular head. Popliteus Complex. Important stabilizer to posterolateral rotation. Stabilizer to varus opening. Popliteus attachment on femur. 18mm anterior/distal to LCL. anterior fifth of popliteal sulcus. Popliteofibular ligament (PFL). originates at musculo-tendinous junction of popliteus. attaches at medial aspect of fibular styloid. Mid-Third Lateral Capsular Ligament. Secondary stabilizer to varus opening. Thickening of lateral midline capsule. Meniscotibial portion often injured. Segond injury. Biceps Femoris Complex. Short head of biceps. Long head of biceps. Lateral Meniscus. Injury Mechanism. Rarely isolated injury. Usually as a combined ligamentous injury. ACL/PLC. PCL/PLC. Knee Dislocation. Hyperextension. Varus blow. Noncontact twisting. Importance of injury. Grade III injuries do not heal. Lead to instability and osteoarthritis. Compromise cruciate ligament reconstructions. Diagnosis of LCL/PLC injury. History. Usually due to varus/hyperextension injuries. 15 % have a
Purpose. No knee-specific outcome measures have demonstrated reliability, validity or responsiveness in patients with multiligament knee injuries. Furthermore, the content validity of existing questionnaires has been challenged and remains unknown for patients with concomitant neurovascular injury. As a first step in developing a disease-specific outcome measure, the objective of this study was to identify items from existing knee questionnaires pertinent to patients with multiligament knee injuries using established a priori criteria. Method. Eighty-five consecutive patients from a level one trauma centre were mailed a questionnaire comprising 124 items from 11 knee-specific instruments. They rated the frequency and importance for each item on a five-point Likert scale. Criteria for item selection included a mean importance rating (MIR) ≥ 3.5 and frequency < 30% for the response never experienced. The World Health Organization International Classification of Functioning, Disability and Health (ICF) framework was used to support the content. Results. The average age of the 60/85 respondents (70.6%) was 34.7 years and most were male (n=45). Average time from injury was 845 days. Using the Schenck classification, 19 patients were KD I, two were KD II, 39 were KD IIIL or IIIM, and nine were KD IV. Nineteen had
Introduction. Debate remains which surgical technique should be used for ankle arthrodesis. Several open approaches have been described, as well as the arthroscopic method, using a variety of fixation devices. Both arthroscopic and open procedures have good results with union rates of 93–95%, 3% malunion rate and patient satisfaction of 70–90%, although some report complication rates as high as 40%. Aims. To identify union, complication and patient satisfaction rates with open ankle fusions (using the plane between EHL and tibialis anterior). Method. A retrospective review of all isolated primary fusions performed between 2005 and 2009. Patient records were reviewed and patients were recalled for clinical evaluation and AOFAS scoring. Follow up range was 7 months–8.3 years (mean 4 years). Results. 82 ankles were identified in 73 patients. Medical notes were reviewed for all patients. Fifty five patients were clinically reviewed (75% response rate), a further 3 contacted by telephone (79% response rate). Fifeteen were not contactable. Male 47: 35 female, age range at surgery 18–75 years (mean 56.1), left 37: 45 right, 8 were smokers. Causes leading to fusion were: Trauma 52 (63%), OA 17, Rh.A 7, CMT 3, CTEV 2, Talar AVN 1. All fusions were performed with 2 (78) or 3 (4) medial tibiotalar screws. Length of stay range: 1–12 days (mean 3.1). All patients were placed in plaster post operatively for a minimum 12 weeks. Time to union ranged from 8 to 39 weeks (mean 13.3) with a union rate of 100%. Major complications were 14.6%: 7 (8.5%) malalignment, 3 (3.7%) wound problems, 2 (2.4%) complex regional pain syndrome. There were no non unions, DVT, PE, stress fractures or deep infections. There were 2 (2.4%) delayed unions (> 6 months, both smokers), 6 (7%) asymptomatic superficial
Osteotomies around the knee are still utilized a lot in Europe and in Asia while in US unicompartmental and total arthroplasty for the same indications have more and more taken over, partially due to fear of complications. We think that with careful planning and technique the indications can be maintained. Furthermore with modern methods of cartilage repair it is of utmost importance to unload overloaded compartments. Also many young patients having suffered ligamentous tears of the knee and having been reconstructed are in need of OT’s later on. Many of the poor results are due to absent or poor planning and to poor OT technique and fixation. Not every knee needs to be operated to an overcorrected position. While opening wedge OT has become trendy because of fewer neurological complications we think there are definite indications for closing wedge technique. In this lecture we would like to summarize the principles and the steps which are very personal and that are based on 20 years of practice. Indications for osteotomies around the knee. Varus Knee. Opening wedge osteotomy: Advantages: Rapid surgery, small incision, fast healing, precise correction. Indicated when:. Degree of OA moderate and angular correction of not >
8°. Useful in associated MCL Instability. Useful when open surgery on medial femoral condyle needed (Mosaicplasty). In case of associated ACL instability when tibial slope is not >
10°. Patella alta. Has a tendency to increase the tibial slope. We use tricortical grafts from the iliac crest where the base of the wedges in mm corresponds to the degrees of correction. A cervical spine AO plate with for screws is used for fixation. Creates less deformity of the proximal tibia which is an advantage for a later total knee. Increases the intraarticular pressure even when the MCL is cut or detached distally, without us knowing the effect on the degree of OA, no long term studies being known to us. Closing wedge osteotomy: Advantages: Allows higher degrees of correction. Degree of OA advanced, need for higher corrections. Useful when open surgery on lateral femoral condyle needed. In ACL instability when tibial slope must be corrected, because of need to break the medial cortical hinge a heavier implant is needed may be enforced by a sagital Ex.Fix. Patella baja. Corrections over 5 degrees need an OT of the proximal or distal fibula. We perform the resecting OT in the fibular neck, the proximal cut is incomplete removing only the anterior and lateral cortex, the distal cut is complete. This allows to shift the distal fragment proximally and in front of the proximal cortical shelf allowing nerve protection. For fixation of the tibial OT we use the 90° angled cannulated AO osteotomy plate, that is inserted over a 2,0 K wire using a specific “transporteur” in relation to the amount of correction. The OT is done using the precise AO osteotomy jig, cutting along 2,5 mm K wires inserted through the jig. The two cuts meet 5–10 mm short of the opposite cortex. The closing wedge OT creates more deformity, carries a certain risk of
