Stress fractures at tracker after computer navigated total knee replacement are rare. Periprosthetic fracture after Minimally Invasive Plate Osteosynthesis (MIPO) of stress fracture through femoral tracker is unique in orthopaedic literature. We are reporting this unique presentation of periprosthetic fractures after MIPO for stress fracture involving femoral pin site track in computer assisted total knee arthroplasty, treated by reconstruction nail (PFNA). A 75-year old female, who had computer navigated right total knee replacement, was admitted 6 weeks later with increasing pain over distal thigh for 3 weeks without trauma. Prior to onset of pain, she achieved a range of movements of 0–105 degrees. Perioperative radiographs did not suggest obvious osteoporosis, pre-existent benign or malignant lesion, or fracture. Radiographs demonstrated transverse fracture of distal third of femur through pin site track. We fixed the fracture with 11-hole combihole locking plate by MIPO technique. Eight weeks later, she was readmitted with periprosthetic fracture through screw hole at the tip of MIPO Plate and treated by Reconstruction Nail (PFNA), removal of locking screws and refixation of intermediate segment with unicortical locking screws. Then she was protected with plaster cylinder for 4 weeks and hinged brace for 2 months.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
Methods &
Results: We treated concomitant dorsal dislocation of first metatarsophalangeal joint and divergent Lisfranc fracture-dislocation in an intoxicated patient as a heavy weight fell on foot. Closed reduction of first metatarsophalangeal joint was unstable until after open reduction and fixation of first tarsometarsophalangeal joint. First to third tarsometatarsal joints were stabilised with cannulated screws and lateral two rays with Kirschner wires. Prophylactic fasciotomies were performed to preempt potentially high risk of failure of recognition of compartment syndrome in intoxicated patient. Clinical pathodynamic analysis suggests that natural tendency to withdraw the foot contributed to primary medial loading with forced hyperextension of hallux metatarsophalangeal joint and enhanced complementary hyperflexion of midfoot. The former resulted in dorsal dislocation of first metatarsophalangeal joint. Then load shift toward secondary axis of lateral divergent loading became the operative force to produce divergent Lisfranc dislocation, which effectively resulted in a floating forefoot. Conclusions: Floating forefoot is a unique injury after high-energy trauma, although floating metatarsal and association between Jahss Type I complex dislocation of first metatarsophalangeal joint and Lisfranc injury were described. Floating forefoot also represents Grade V in the modified classification of metarsophalangeal injuries (Kodali Siva R K Prasad et al Modification of Clanton’s classification) as progression of injury pattern transcends the local barrier and raises the spectrum of dynamic cascade of multidirectional transmission of the operative forces with the resultant unique injury.
We reviewed the results of 13 adults of secondary reconstruction of malunited and ununited intraarticular distal humeral fractures. Their average age was 39.7 years, and preoperatively all had pain, loss of motion and functional disability; the average arc of motion was only 43 degrees and the average flexion contracture was 45 degrees. Nine patients had ulnar neuropathy. Elbow reconstruction, at an average of 13.4 months after the original injury, included osteotomy for malunion or debridement for nonunion, realignment with stable fixation and autogenous bone grafts, anterior and posterior capsulectomy and ulnar neurolysis. The elbows were mobilised 24 hours postoperatively. There were no early complications and all nonunions and intra-articular osteotomies healed. After a mean follow-up of 25 months, the average arc of motion was 97 degrees with no progressive radiographic degeneration. Ulnar nerve function improved in all cases and clinical assessment using the Morrey score showed two excellent, eight good and three fair results. Reconstruction of intra-articular malunion and nonunion of the distal humerus in young active adults is technically challenging, but can improve function by restoring the intrinsic anatomy of the elbow.
