Total knee arthroplasty (TKA) is an established and successful operation. However patient satisfaction rates vary from 81 to 89% 1,2,3. Pain following TKA is a significant factor in patient dissatisfaction 1. Many causes for pain following total knee arthroplasty have been identified 4 but rates of unexplained pain vary from 4 to 13.1% 5,6. Recently computerised tomography (CT) has been used to assess the rotational profile of both the tibial and femoral components in painful TKA

We reviewed 57 patients with an unexplained painful following TKA and compared these to a matched control group of 60 patients with TKA. Datum gathered from case notes and radiographs using a prospective database to identify patients. The CT information recorded was limb alignment, tibial component rotation, and femoral component rotation and combined rotation.

The two matched cohorts of patients had similar demographics. A significant difference in tibial, femoral and combined component rotation was identified between the groups. The following mean rotations were identified for the painful and control groups respectively. Tibial rotation was 3.46 degrees internal rotation (IR) compared to 2.50 degrees external rotation (ER)(p=0.001). Femoral rotation was 2.30 IR compared to 0.36 ER(p=0.02). Combined rotation was 7.08 IR compared to 2.85 ER(p=0.001).

This is the largest study presently in the literature. We have identified significant internal rotation in a patient cohort with unexplained painful TKA when compared to a matched control group. Internal rotation of the tibial component, femoral component and combined rotation was identified as a factor in unexplained pain following TKA.

Purpose: To evaluate the functional outcome of operatively treated Lisfranc injuries.

Method: Over a 7-year interval from 1998 to 2005, 184 skeletally mature patients were identified retrospectively with operatively treated Lisfranc injuries. 85 patients had prospectively measured SMFA functional outcomes and satisfaction surveys. The gender was 37 males and 48 females. Mean age was 39 years (range 17–93).

Results: The mechanism was fall (31), MVA (24), crush (15), equestrian (5), or twisting (10). Patients were operatively treated with open reduction internal fixation (ORIF, 53) or primary arthrodesis (PA, 32). The SMFA reliability for this patient sample was 0.892. The function and bother outcomes were 19.4 and 15.8, respectively. The function (21.5 vs. 16.0, p=.11) and bother (17.5 vs. 13.0, p=.25) outcomes were not significantly different for ORIF vs. PA, respectively. In the ORIF group, HW removal (40 of 53) performed better than HW retention (13 of 53) with outcome bother but not function measures of (14.7 vs. 26.1, p< 0.05).

Conclusion: If performed well, either ORIF or PA technique function well. Patients are more satisfied with the results and appearance of PA over ORIF. HW removal compared to HW retention positively affect bother not function measures. Secondary surgeries negatively affect both bother and function measures. Patients with pain, associated foot or polytrauma injuries function worse.

Purpose: Pediatric femoral fracture treatment is varied. Each treatment has advantages and disadvantages. The goal of treatment is to avoid complications, reduce costs, and return function. Percutaneous bridge plating has many advantages and little disadvantages. The purpose of this study was to examine the results of percutaneous bridge plating for pediatric femoral diaphyseal fractures.

Method: Over a 4-year time span (2002–2005), all pediatric femoral fractures were diagnosed. A retrospective chart review was completed and only percutaneous bridge plating treatment was analyzed.

Results: 78 fractures were noted in 73 patients. Average age was 9 (range 3–16). Gender was 56 males and 22 females. Most common mechanisms were falls 15 (19%), MVA 12 (15%), and pedestrians 9 (12%). Four fractures (5%) were open. Forty-three fractures (61%) were associated with polytrauma. Time to operation averaged 1 day (0–11 days, 89% 0–1 day). Most plates were 3.5 combi locked plates with a lesser but equal number of 3.5 DCP and 4.5 DCP. Length of stay averaged 5 days (range 0–45 days, 18% 0–1 day, 58% 2–4 days). The majority of patients (58%) began weight bearing at 2–6 weeks. Callus formation began at 2–6 wks (84%). Fracture healing occurred by 6 weeks in 91%. Limp was resolved by 3 months in 54%. Pain was resolved by 3 months in 90%. Patients were back to active daily living without restrictions by 3 months in 96% of the fractures. Complications were noted with 4 superficial wounds, 4 problematic scars, 3 leg overgrowth < 12 mm, and 3 distal prominent plates. No nonunions or refractures were noted. Hardware (HW) was removed on average by 6 months (range 3 mo to never). Outpatient percutaneous HW removal was performed in 100% of the cases.

Conclusion: Percutaneous bridge plating for pediatric femoral fractures is predictable and effective with minimal complications. Asymptomatic femoral overgrowth was minimal.