Introduction

Throughout the years treatment of patellar fractures have been held in much controversy and various treatment procedures have been described. In the literature, there are only a few studies that compare the results of the different treatment modalities.

Introduction: Penetrating injuries of the foot are very common. Although apparently straightforward, inappropriate approach and treatment can lead to complications and unsatisfactory results. We present our diagnostic and therapeutic approach using an outcomes approach, clinical results and complication rate.

Patients & Methods: Between 2001 and 2003, 63 patients (57 M and 6 F; mean age- 38, range 8 to 63; follow-up: mean 2.5Y range of follow-up 2–4 years) were treated for penetrating foot injury. Each patient had a routine x-ray and foot sonography. The most common injuries were those that penetrated shoes (45/63 pts) – nails (39/45) and wood pieces (6/45), – or bare feet (18/63 Pts) – nails (10/18), glass (5/18), wood pieces (2/18) and even seashells (1/18). The medical files of all these patients were searched for the relevant parameters.

Results: The presence of a foreign body inside the foot tissues was detected in 58/63 Pts (92%) and they were operated upon by meticulous debridement and removal of FB. In the remaining 5 Pts we could not trace any FB and they were treated initially by IV antibiotics. In these 53 Pts (91%) penetrating foreign bodies were detected by sonography, most of them on arrival. Only 5% of the cases could be diagnosed initially by x-ray. The false negative rate of sonography was 19% (11/58 pts). In 6 of these 11 pts, the presence of FB was detected only by a second sonography. In the remaining 5 pts, foreign bodies were not detected even in the second sonography, but found only during surgery. Complete healing was observed in 62/63 (98%) of patients, although 6 /63 (9%) underwent secondary debridement. One patient (diabetic) developed chronic osteomyelitis of the second metatarsal bone and needed repeated surgical interventions.

Conclusions: In order to avoid complications and poor clinical outcome, penetrating injuries of the foot must be approached in an orderly and appropriate manner. The main purpose is to confirm the presence of a foreign body. Plain x-rays and sonography should be used in order to identify or rule out the presence of FB. Sonography is a good diagnostic technique, but it is operator dependent; thus a high index of suspicion must be maintained when the imaging study is negative and there is no clinical improvement despite appropriate systemic and local treatment. In our experience, repeated sonography and sometimes surgical exploration in such circumstances are likely to reveal the presence of a FB. It should be emphasized that injury through a shoe rather than a bare foot may result in local infection secondary to the penetrating object and also complications related to the additional presence of fiber, rubber or leather foreign body. Excellent results are observed following meticulous debride-ment combined with systemic antibiotics.

Introduction: The optimal treatment of osteoarthritis of the medial compartment of the knee joint is still controversial. Optional procedures include arthroscopic knee debriedement, high tibial osteotomy, and total knee arthroplasty. In the last decade the use of unicompart-mental knee arthroplasty (UKA) for localized knee arthritis has become more and more common. This study reviews our experience with unicondylar meniscal bearing knee arthroplasty in patients with localized osteoarthritis of the medial compartment of the knee joint.

Material & Methods: Between 2001–2004, 26 Pts. (17F, 9M; 52–74 year old, mean 63Y) underwent surgery using the Medial Oxford Unicompartmental Knee. Four of them had since been operated on their other knee, usually 1–2 years after the first UKA. The mean age at surgery was 63 years (52–74). There were 17 women and 9 males. All patients had a stable knee and their preoperative ROM was between −10 degrees to full extension and between 100 to 120 degrees of flexion. Patients were followed for 1.5 – 4 years (mean 2.5Y), and evaluated by the Knee Society Score and radiographs.

Results: 24/26 (92%) patients, including the four patients who had staged bilateral procedures of both knees, had satisfactory results, of them 16/26 (61%) had excellent results and 8/26 (31%) had good results. They were almost free of pain, and most of them had marked improvement in knee function. Similar results were observed in each of both knees of the patients who had staged bilateral unicondylar knee arthroplasty. The remaining 2 patients (8%) had fair results. A second look arthroscopy of these patients revealed a progressive development of degenerative changes of the lateral compartment in one patient, and development of degenerative changes of the patella and patellar groove in the second patient.

Conclusions: Based on this study it seems that unicondylar knee arthroplasty is a favourable procedure in patients with localised arthritis of the medial compartment. This procedure allows replacement of only the affected joint compartment with less bone loss, and therefore enables preservation of healthy tissue and bone. Recovery following surgery is fast, rehabilitation is quick and ambulation is early. The ideal patient for UKA is a relatively young patient with localized degenerative changes, who has a stable knee, a flexion contracture less than 15 degrees and a mechanical axis of less than 10 degrees from neutral for a varus knee, or less than 5 degrees for a valgus knee.