No abstract

The comparability of studies of extra-articular proximal femur fractures is compromised by the lack of a widely accepted, simple classification system with clinical and prognostic relevance. The aim of the study is to define the complication profile as well as differences relating to age, gender and survival rate of simple trochanteric fractures, intertrochanteric comminuted and subtrochanteric fractures. Records of 335 consecutive patients were analysed. Patients had a median follow-up of 10 (1-56) months, and were treated operatively with three intramedullary nailing systems. Simple trochanteric fractures (n=67) show wound healing problems (1.5%). Median age is m/f 77(45-98) years/ 85(39-101), and two-year survival rate is m/f 50.3%/ 84.9%. Intertrochanteric comminuted fractures (n=204) show the highest complications (25%), 9.7% femoralhead perforations, 3.5% hardware related problems and 11.8% wound healing problems. Median age is m/f 75(41-94) years/ 85(54-100), survival rate is m/f 92.7%/ 66.5%. Complication rate is 17.0% in subtrochanteric fractures (n=64), no femoralhead perforation but 9.1% other hardware problems and 7.8% wound healing problems. Median age is m/f 72(24-91) years/ 83(38-99), survival rate is m/f 92.3%/ 67.9%. Females show higher complication rates compared to males (19% versus 10%). The three types of fractures show different patterns of complications, survival rates, age, and sex distribution.

Regarding cost effectiveness and benefit no indication for the use of 2 ml QUIXIL(®) fibrin sealant in standard knee arthroplasty could be proofed statistically.

Ankle joint affections and injuries are common problems in sports traumatology and in the daily routine of arthroscopic surgeons. However, there is little knowledge regarding intraarticular loads. Pressures on the ankle were determined in a dynamic model on 8 cadaver specimens, applying forces to tendons of the foot over the stance phase under vertical loading. A characteristic course of loading in the tibiotalar joint with a rapid increase upon heel contact was observed. It increased gradually to reach a maximum after 70% of the stance phase, during the push-off phase. The major torque in the ankle joint is located anterolaterally. A dynamic loading curve of the ankle joint can be demonstrated. These observations explain phenomena such as the appearance of osteophytes on the anterior tibia in the case of ankle osteoarthritis and the relatively low incidence of posterior tibial edge fragments in the case of trimalleolar ankle fracture. Furthermore, the medial side of the talus is less loaded compared to the lateral side, which appears relevant to the treatment of osteochondrosis dissecans.

BackgroundIn the current discussion of surgical treatment of arthroses in the ankle joint, arthrodesis is in competition with artificial joint replacement. Up until now, no valid biomechanical findings have existed on the changes in intraarticular loads following arthrodesis. One argument against tibiotalar arthrodesis is the frequently associated, long-term degeneration of the talonavicular joint, which can be attributed to changes in biomechanical stresses.MethodsWe used a dynamic model to determine the changes in intraarticular forces and peak-pressure in the talonavicular joint and in the calcaneocuboid joint on 8 cadaver feet under stress in a simulated stance phase following tibiotalar arthrodesis.ResultsThe change seen after arthrodesis was a tendency of relocation of average force and maximum pressure from the lateral onto the medial column of the foot. The average force increased from native 92 N to 100 N upon arthrodesis in the talonavicular joint and decreased in the calcaneocuboid joint from 54 N to 48 N. The peak pressure increased from native 3.9 MPa to 4.4 MPa in the talonavicular joint and in the calcaneocuboid joint from 3.3 MPa to 3.4 MPa. The increase of force and peak pressure on the talonavicular joint and decrease of force on the calcaneocuboid joint is statistically significant.ConclusionThe increase in imparted force and peak pressure on the medial column of the foot following tibiotalar arthrodesis, as was demonstrated in a dynamic model, biomechanically explains the clinically observed phenomenon of cartilage degeneration on the medial dorsum of the foot in the long term. As a clinical conclusion from the measurements, it would be desirable to reduce the force imparted on the medial column with displacement onto the lateral forefoot, say by suitable shoe adjustment, in order to achieve a more favourable long-term clinical result.