Introduction: Patellar and quadriceps tendon ruptures after total knee arthroplasty (TKA) have historically poor outcomes. To date, there is no consensus for optimal treatment. The purpose of this study is to directly compare clinical outcomes and survivorship between allograft versus synthetic mesh for reconstruction of native extensor mechanism (EM) rupture after TKA. Methods: A multicenter, retrospective review identifying consecutive TKA patients operated between December 2009 to November 2019 was conducted. Patients aged $ 45 years old with native EM disruption treated with either allograft or synthetic mesh with minimum 2 year follow-up were included. Demographic information, injury mechanism, range of motion, surgical time, revision surgeries, and postoperative Knee Injury and Osteoarthritis Outcome Scores (KOOS Jr.) were collected. Student t-tests and Fisher exact tests were used to compare the demographic data between groups. The Kaplan-Meier survival curve method was used to determine the survivorship as treatment failure was defined as postoperative EM lag .30°or revision surgery. Survival curves were compared using the log-rank test. Univariate Cox proportional hazard regression identified risk factors associated with treatment failure. Results: Twenty patients underwent EM reconstruction using allograft versus 35 with synthetic mesh. Both groups had similar demographics and an average follow-up time of 3.5 years (P = 0.98). Patients treated with allograft had significantly greater postoperative flexion than patients treated with mesh (99.4 6 9.5 allograft versus 92.6 6 13.6 synthetic mesh, P = 0.04). Otherwise, there was no difference in postoperative outcomes between the two groups in average KOOS Jr. (P = 0.29), extensor lag (P = 0.15), graft failure (P = 0.71), revision surgery rates (P = 0.81), surgical time (P = 0.42), or ambulatory status (P = 0.34) at the most recent follow-up. Survival
Intertrochanteric fractures are common, accounting for nearly 30% of all fracture related admissions. Some have suggested that these fractures should be treated in community hospitals so as not to tax the resources of Level One trauma centers. Since many factors predictive of fixation failure are related to technical aspects of the surgery, the purpose of this study was to compare radiographic parameters after fixation comparing trauma fellowship trained surgeons to non-fellowship trained community surgeons to see if these fractures can be treated successfully in either setting.Using our hospital system's trauma database, we identified 100 consecutive patients treated with cephalomedullary nails by traumatologists, and 100 consecutive patients treated by community surgeons. Quality of reduction, neck shaft angle (NSA), tip-to apex distance (TAD) were compared.The mean TAD for the trauma group was 10mm compared to 21mm for the community group (p<0.001). The mean postoperative NSA for the trauma group was 133 degrees compared to 127 degrees for the community group (p<0.001). The mean difference in the NSA of the fractured side compared to the normal hip was 2.5 degrees of valgus in the trauma group compared to 5 degrees of varus for the community group (p<0.001). There were 93 good reductions in the trauma group compared to 19 in the community group (p<0.001). There were no poor reductions in the trauma group and 49 poor reductions in the community group (p<0.001).Fellowship trained traumatologists achieved significantly more accurate reductions and implant placement during cephalomedullary nailing of intertrochanteric hip fractures.
Introduction: Intertrochanteric femoral fractures are common orthopaedic injuries accounting for nearly 30% of all fracture-related hospitalizations. Because many factors predictive of failure are related to technical aspects of the surgery, the purpose of this study was to compare radiographic parameters after fixation, comparing fellowshiptrained orthopaedic trauma surgeons with surgeons who did not complete an orthopaedic trauma fellowship. Methods: We initiated a search for CPT code 27245 across our hospital network to identify 100 consecutive patients treated by five fellowship-trained orthopaedic traumatologists and 100 consecutive patients treated by community surgeons. Patients were then stratified based on their surgeon's subspecialty training (trauma vs community). Primary outcome variables were neck-shaft angle (NSA), a comparison of the repaired NSA with the uninjured side, tip-apex distance, and reduction quality. Results: One hundred patients were included in each group. The mean age in the community group was 77 years compared with 79 years in the trauma group. The mean tip-apex distance for the trauma group was 10 mm compared with 21 mm for the community group (P , 0.001). The mean postoperative NSA for the trauma group was 133°compared with 127°for the community group (P , 0.001). The mean difference of the NSA of the repaired side compared with the uninjured side was 2.5°of valgus in the trauma group compared with 5°of varus for the community group (P , 0.001). There were 93 good reductions in the trauma group compared with 19 in the community group (P , 0.001). There were 0 poor reductions in the trauma group and 49 in the community group (P , 0.001).
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