Safely obtaining adequate exposure is an integral step in successfully performing a Total Knee Arthroplasty. In this study, we look at approaching the valgus knee through a lateral arthrotomy and tibial tubercle osteotomy. 20 knees in 19 consecutive patients with valgus deformities are included in this study (2006 to 2010). LCS mobile bearing prostheses were implanted by a single senior surgeon (GF). Navigation was used for all the knees. The knee is approached throught a skin incision 5–10mm more lateral than the standard midline incision. The lateral arthrotomy is made to Gerdy's tubercle 7–10cm distal to Tibial Tendon insertion. 7cm long and 2cm wide osteotomy is performed. Richards staples are used to fix the osteotomy once the prosthesis is fixed. All patients were followed up by the operating surgeon. All osteotomies united. 2 postoperative complications were encountered during follow up. One patient had a postoperative haematoma that was washed out. A second patient had a fall 6/52 post-op and sustained a minimally displaced fracture at the navigation pin site (Tibia). This was treated in a cylinder cast and went onto full union. Our technique of lateral arthrotomy and TTO in the valgus knee is safe and predictable. It delivers wider exposure, facilitates soft tissue management, preserves viability of the extensor mechanism and allows some movement of the tibial tubercle for improved patella tracking. We recommend planning this procedure preoperatively for best results.
Diphosphonates remain among the most common drug treatments for osteoporosis. Recent evidence has implicated diphosphonate therapy, specifically, alendronate, with low-energy fractures of the subtrochanteric region of the femur. The general conclusion is that prolonged suppression of bone remodelling with alendronate may be associated with a new form of insufficiency fracture of the femur. Three case reports of patients with alendronate related insufficiency are discussed here with their treatment modalities and lessons learnt. One of the three patients had bilateral subtrochanteric stress fracture. A comprehensive review of the literature is presented with the best evidence for investigating, treating and preventing these fractures Our experience in Launceston has increased awareness amongst the local medical community regarding the long term use of Diphosphnates and the fractures they may cause. Changes to our practice have included: Increased suspicion of patients with hip pain on diphosphonate therapy, imaging the contralateral femur to rule out stress fractures, reassuring GP's and Patients that benefits of Diphosphonate therapy far outweigh the potential risks. There are many unresolved questions about the prolonged use of diphosphonates, but there is sufficient evidence to show subtrochanteric stress fractures do occur. We, as Orthopaedic Surgeons, must be able to recognize this new entity and educate our medical colleagues appropriately.
To assess patient following operative fixation of clavicle fractures. In the literature, the incidence of paraesthesia following operative fixation of clavicle fractures is reported to be between 7–29%. This problem can be bothersome to patients and the degree of disability is poorly documented. All clavicle fractures (67) treated operatively at the Alfred Hospital between 01/06/2003 and 01/06/2006 were included in the study. Patients were asked to complete paper based questionnaires assessing satisfaction, presence of numbness and degree of disability following clavicle operation. Additionally, they were followed up clinically to assess the area of numbness and scarring. The response rate was 65% (43/67). Most of the patients were satisfied with the operation and only 15% reported significant problems with the wound. Majority of patients returned to pre-morbid activities and employment. The degree of paraesthesia varied among respondents and it was associated with the type of incision used. There was little difference in patient satisfaction with regard to various surgical devices utilised. It is important to address wound complications such as scarring and paraesthesia when discussing operative treatments for patients with clavicle fractures. The results suggest that wound related problems can be frequent and a significant percentage of operatively managed patient experience long term numbness. It is possibly an under appreciated problem. Additionally our results suggest that vertical incisions achieve a more favourable outcome compared to horizontal incisions.
