In comminuted patellar fractures, we performed modified tension band wiring using a FiberWire (Arthrex) instead of the conventional methods. From March 2016 to March 2018, 63 patients with patellar fractures who needed surgical treatment were treated with modified tension band wiring using two Kirschner wires (K-wires) and FiberWire. We inserted two 1.6-mm K-wires perpendicular to the fracture line after accurate reduction. With the knee flexed over 90°, we sutured around the patella using a FiberWire. Visual analog scale score and Levack's score were improved postoperatively. The mean bone union time was 5.6 months. None of the patients had breakage of wires, and nonunion with deformity occurred in one patient. We think that our method can be easier to handle and reduce irritation or breakage of the wires than conventional methods. In addition, early rehabilitation can be allowed. Therefore, we suggest that this method could be a useful method for the treatment of patellar fractures.

BackgroundGlenoid loosening and postoperative instability are common causes of failed reverse total shoulder arthroplasty (RTSA). When soft-tissue problems or large glenoid bone defect interferes with reimplantation in revision RTSA, conversion to hemiarthroplasty can be considered. We present a case series of patients who underwent conversion to hemiarthroplasty due to glenoid loosening and early instability after RTSAs, along with clinical results.MethodsA total of 72 primary RTSAs using the Aequalis prosthesis were performed at our institution from May 2009 to December 2016. Of these, five patients, including one with humeral neck fracture and absent rotator cuff and four with cuff tear arthropathy, underwent conversion to hemiarthroplasty. Another patient who had RTSA at a local clinic underwent hemiarthroplasty at our institution for unresolved postoperative anterior dislocation. The mean age of the six patients was 71.7 years (range, 62 to 76 years), and the mean follow-up period was 24.4 months (range, 18 to 30 months). Clinical assessments were conducted by using the visual analog scale (VAS), American Shoulder and Elbow Surgery (ASES) score, and University of California at Los Angeles (UCLA) shoulder score at the last follow-up.ResultsThe conversion to hemiarthroplasty in the six patients dramatically improved the mean VAS score (preoperative, 8.1; postoperative, 2.5), ASES score (preoperative, 22.1; postoperative, 56.5), and UCLA score (preoperative, 12; postoperative, 18.1). However, the range of motion was almost unchanged after surgery.ConclusionsConversion to hemiarthroplasty can be a good alternative to revision RTSA in patients with serious complications (such as unresolved instability and glenoid loosening) difficult to treat with revision RTSA.

Objective: To compare clinical and radiologic results and complications of patients who underwent arthrodesis using a transfibular approach with either a cannulated screw or an anterior fusion plate. Methods: Patients who underwent ankle arthrodesis were divided into two groups according to the used materials: 6.5 mm cannulated screw (A) and anterior fusion plate (B). The clinical scores were compared between groups. The radiologic results were then assessed by union time. The results were statistically analyzed using SPSS 20. Results: There was no significant difference between both groups in the American Orthopedic Foot & Ankle Society (AOFAS) score (p = 0.75), and in the visual analog scale (p = 0.42). In group B, two cases included wound infection at the surgical site. In tt A, the mean union time was 10.5 ± 2.3 weeks. In group B, it was 7.8 ± 1.3. There was a statistically significant difference (p = 0.007) between union time in both groups. Conclusion: Anterior fusion plate is an effective method for shorter union time, but the surgeon should be careful with the surgical wound at the skin incision site in the lesion of the distal tibia. Level of Evidence III, Retrospective comparative study.

BackgroundWe investigated whether the patellar tilt angle influences the maximum knee flexion after total knee arthroplasty (TKA) performed by using a posterior cruciate ligament-substituting (PS) fixed-bearing prosthesis in patients with relatively loose or tight flexion gap.MethodsIn this prospective cohort study, we followed up 169 patients for at least 2 years after TKA using PS fixed-bearing prosthesis. The patients were divided into two groups according to the flexion gap value—calculated by subtracting the thickness of the final bearing from the flexion gap measured intraoperatively under 200-cN·m force after patellar reduction and insertion of the final femoral and tibial components—into a relatively tight group (group T; 3–6.5 mm) and a relatively loose group (group L; 7–11 mm). Patellar tilt angles and maximum non–weight-bearing active knee flexion angles were assessed postoperatively. Group T was further divided into subgroup Tn if the patellar tilt angle was < 5° and subgroup Tw if the angle was ≥ 5°. Pearson correlation test was used for the correlation analysis of the flexion gap, patellar tilt angle, and postoperative flexion range.ResultsThe mean postoperative flexion was 137.3° in group T and 137.5° in group L. The mean patellar tilt angle was 6.5° in group T and 6.9° in group L. In group T, a strong negative correlation (r = −0.78, p < 0.05) was observed between the patellar tilt and postoperative flexion range. However, further analysis revealed that only the subgroup Tw showed a strong negative correlation (r = −0.76, p < 0.05). Significant correlations were not found in the subgroup Tn and group L.ConclusionsIn TKA where a relatively tight flexion gap (≤ 6.5 mm) is created because of concerns about postoperative flexion instability due to a loose flexion gap, the patellar tilt angle should be < 5° for maximal postoperative knee flexion.

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