With the increasingly accepted method of suprapatellar tibial nailing for tibial shaft fractures, we aimed to compare intraoperative and postoperative outcomes of infrapatellar (IP) vs suprapatellar (SP) tibial nails. A retrospective cohort analysis of 58 patients. 34 SP tibial nails over 3 years versus 24 IP tibial nails over a similar time frame. We compared; radiation exposure, patient positioning time (PPT), non-union rate and follow-up time. Knee pain in the SP group was evaluated, utilising the Hospital for Special Surgery (HSS) Knee injury and Osteoarthritis outcome score (KOOS).Abstract
Background
Methods
Current literature of definition, classification and outcomes of fractures of talar body remains controversial. Our primary purpose is to present an unusual combination of fractures of talar body with pantalar involvement / dislocation / extension as a basis for modification of Müller AO / OTA Classification. We include four consecutive patients, who sustained talar body fractures with pantalar subluxation/dislocation /extension. These unusual injury patterns lead us to reconsider Müller AO / OTA Classification in the light of another widely used talar fracture classification, Hawkins Classification of fractures of neck of talus and subsequent modification by Canale and Kelly.Background
Methods
To critically evaluate exciting new technology to reconstruct menisci for the treatment of post menisectomy pain and relate results to indication and surgical technique in a non-inventor's general knee practice. We present our early experience of two non-comparative series with different meniscal implants. Series 1: Thirteen patients received a Menaflex implant (Regen Bio, USA). Mean age 30, male/female 11/2, mean length of implant 44mm, mean chondral grade 1.9 (Outerbridge). At 24 months clinical scores showed improvement in 12. Second look arthroscopy in 5 however showed disappointing amounts of regenerative tissue. One patient has been revised. Series 2: Twelve patients received an Actifit implant (Orteq, UK). Mean age 38, male/female 8/4, mean length implant 43 mm, mean chondral grade 1.3. At 12 months all have improved clinical scores. We have performed two second looks, one of these showed excellent integration. However one showed only 50% regeneration. Critical review of the initial implantation shows that there may not have been adequate preparation of the host meniscus tissue.Purpose
Methods
Recent advances in understanding of ACL insertional anatomy has led to new concepts of anatomical positioning of tunnels for ACL reconstruction. Femoral tunnel position has been defined in terms of the lateral intercondylar ridge and the bifurcate ridge but these can be difficult to identify at surgery. Measurements of the lateral wall either using C-arm x-ray control or specific arthroscopic rulers have also been advocated. 30 patients undergoing ACL reconstruction before and after introduction of a new anatomical technique of ACL reconstruction were evaluated using 3D CT scan imaging with cut away views of the lateral aspect of the femoral notch and the radiological quadrant grid. In the new technique, with the knee at 90 degrees flexion, the femoral tunnel was centred 50% from deep to shallow as seen from the medial portal (Group A). Group B consisted of patients where the femoral tunnel was drilled through the antero-medial portal and offset from the posterior wall using a 5mm jig.Hypothesis
Method
In a novel external fixation system for tibial fractures accurate reduction is achieved with a complex temporary device (Staffordshire Orthopaedic Reduction Machine: STORM) following which the reduced fracture is fixed using a simple titanium bar fixator (IOS). With the fracture reduced, the external fixator screws may be placed in the optimum position. The fixator is designed to allow controlled bending to optimise movement at the fracture site for callus growth. With no need for adjustable elements, the fixator is small and short enough for epicentric placement in the commonest fracture of the middle and distal thirds. Optimum mechanical properties are approached: elastic return is to the reduced position; epicentric placement minimises shear and distraction on weightbearing. Integral healing assessment measures bending stiffness. The device is single-use. In 40 tibial fractures (closed or grade I compound) the mean healing time was 15 weeks with a healing endpoint of bending stiffness of 15Nm/deg in two orthogonal axes and full weightbearing on fixator removal with no subsequent creep or refracture. Good reduction, defined as less than 5 deg of maximum angulation and less than 3mm of maximum translation, was achieved and maintained. The incidence of pin site complications was extremely low and there were no deep infections. This new device thus far has had few of the drawbacks commonly associated with external fixation. The infection rate is low, healing time is comparable to other methods and there have been no malunions. We feel our strict adherence to fracture reduction and pin site hygiene are the most important factors in producing these excellent results.
