Orthopaedic injuries in the knee are often associated with vascular injury. When these vascular injuries are missed devastating there are devastating outcomes like limb ablation. Pulse examination in these patients is not sensitive to exclude vascular injuries. That often lead to clinicians opting for Computed Tomography Angiogram (CTA) to exclude vascular. this usually leads to a burden in Radiology Department. This study aimed to evaluate the prevalence of vascular injury in patient with orthopaedic injury in the knee. The computed tomography (CT) done in patients with distal femur fracture, knee dislocation and proximal tibia fractures were retrieved from the picture archiving and comunication system (PACS). The CTs were done between June 2017 and June 2022. The computed tomography angiogram (CTA) reports were reviewed to determine cases that vascular injury. A sample size of 511 cases was collected. 386 cases were done CTA and 125 cases were not done CTA. There were 218 tibial plateau fractures, 79 knee dislocations, 72 distal metaphyseal femur fractures, 61 floating knees, 55 distal femure intraarticular and 26 proximal metaphyseal tibia fractures. The mechanisms of injury in these were gunshot, fall from standing height, fall from height, MVA, MBA, PVA and sports. Prevalance was 9.17% (47) of the total injuries in the knee. Prevalance in patients who were sent for CTA was 12.08%. Routine CTA in patients with injuries in the knee is not recomended. The use of ankle brachial index may decrease the number of CTA done

Anatomically contoured periarticular plates for treatment of proximal tibia fractures is fast becoming the standard for care. The aim of our study was to assess the accuracy of the anatomic contour of proximal lateral tibial plates of AO Stryker and Zimmer in Indian patients. We assessed the accuracy of the anatomic contour of proximal lateral tibial plates of AO Stryker and Zimmer in 50 Indian dry tibiae. All the plates were placed on the 50 tibia by two independent surgeons according to what they felt was the best fit. The tibiae and the plate fits were mapped, quantified, and analysed using digital image capturing and adobe photoshop software. By corresponding the clinical appearance of good fit with our digital findings, we created numerical criteria for plate fit in three planes: coronal (volume of free space between the plate and bone), sagittal (alignment with the tibial plateau and shaft), and axial (match in curvature between the proximal horizontal part of the plate and the tibial plateau). An anatomic fit should mirror the shape of the tibia in all three planes and only ten plates of different companies qualified this. Recognising and understanding the substantial variations in fit that exist between anatomically contoured plates, it might be worthwhile developing proximal tibia plates specific for the Indian population or validating this study by having a larger multicentric study group. This paper would suggest caution when these plates are used as a tool for indirect reduction of the fractures

Introduction. 47 yrs male patient had a prior history. 2005 Fx. proximal tibia (open Fx.). 2007 Metal removal. 2008 Arthroscopic debridement (2 times). He visited out hospital with severe pain and tenderness X-ray (Fig 1) and MRI (Fig 2) findings as follows. Conclusively, He had a chorinic osteomylitis of proximal tibia with soft tissue absess. 1st Surgery. I did arthroscopic debridement Arthroscopic finding shows synovitis, meniscus tear and chondromalacia. I did meticulous debridement (irrigation & curettage). 2nd Surgery. He did primary total knee arthro-plasty instead of two-stage exchange arthroplasty in may, 2010 at the another hospital. 3rd Surgery. After 7 months since he had did total knee arthroplasty, he visited to my hospital again with sudden onset of painful swelling & heating sensation. 4th Surgery. I did second stage reimplantation for infected total Knee arthroplasty after 7 weeks. Now he got a pain relief & ROM restroration. Results. Follow up 12 months X-ray showing all implants to be well-positioned and stable. Clinically, there was no implant considered to be loose. In this study, the knee society and functional scores at final follow up were 82 and 68. Conclusion. The infection after sequales of open proximal tibia fracture is treated by two-stage exchange total knee arthroplasty instead of primary total knee arthroplasty. Two-stage reimplantation of an infected total knee arthroplasty using a static antibiotic-cement spacer achieved an infection control and improvement in the clinical result 3). We use an antibiotic-loaded cement spacer(ALACS) preserved knee function between stages, resulting in effective treatment of infection, facilitation of reimplantation, and improved patient satisfaction 1). The principle surgical technique used for two-stage revision of infected total knee including: (1) exposure, (2) implant removal and debridement, and (3) construction of both static and mobile antibiotic spacers 2

Non- or semi-constraint TKA implants do have their limitations in the absence of collateral ligaments, severe deformity, large osseous defects and gross flexion - extension instability or mismatch, even in primary TKA. Additionally instability is increasingly recognised as a major failure factor in primary and revision TKA. Historically most of the first pure hinged TKA implants have shown disappointing results, due to early loosening based on excessive force transmission from the hinge mechanism to the bone-cement interface, used the use of all metal articulation, suboptimal instrumentation or design. Consequently a hinged design was abandoned by most US surgeons. However, some European centres continued with the use of some early European designed pure- and rotating hinged implants. Although most indication in primary TKA can be solved with modular non- or semi-constrained implants, an adequate balancing might require a relevant soft tissue release or reconstruction with allografts. This consequently increases the complexity and operative time with less predictable results in the elderly patient with principal less healing potential, desirable early post-operative full weightbearing and full range of motion. Thus potential indications in the elderly for a rotating- or pure hinged implant in primary TKA include: . –. Complete MCL instability. –. Severe varus or valgus deformity (>25°) with necessary relevant soft tissue release. –. Relevant bone loss with insertions of collaterals. –. Gross flexion-extension in balance. –. Post-traumatic with distal femur or proximal tibia fracture. –. Stiff knee. –. Severe osteoporosis in the old patient. –. Post infectious for a one staged implantation with specific antibiotics in cement. While some authors showed excellent survival rates in of 96% after 15 years in primary TKA, some recent studies revealed high complication rates of up to 25%, including a high infection rate of 2.9%. This remains inconsistent with our clinical results in primary TKA, which revealed an overall survival rate in patients over 60 years of 94% after 13 years, while patients < 60 years revealed a survival rate of only 77%. Correlation between survival rate and deformity revealed in varus alignment a survival rate of 97%, whereas in valgus only a rate of 79%. Consequently we strictly reserve a rotational hinge for patients > 60 years with a combined varus alignment, whereas in severe valgus deformities a pure hinged should be used for our implant design. Limitations of most hinged implants are relatively rare. In our hands the main limitation is hyperextension and weak extensor mechanism, because this leads to early loosenings