Purpose After intramedullary nailing of tibial shaft fractures using an infrapatellar/transtendinous approach, several patients suffer anterior knee pain. We suspect that the approach is associated with soft tissue scars and the development of a postoperative patella baja. The goal of the study is to investigate whether the development of patella baja is associated with worse subjective outcomes. Methods We retrospectively analyzed all patients in our orthopedic trauma department between 2011 and 2020 who underwent tibial fracture fixation via intramedullary nailing via an infrapatellar/transtendinous approach. Pre- and postoperative lateral knee x-rays were evaluated by measurement of the Insall-Salvati Index, and nail tip position. All patients were asked to answer the self-assessment Kujala questionnaire and Lysholm questionnaire. Results We included 78 patients (age: 44 ± 18 years) with a minimum follow-up of 12 months. Mean follow up was 59 ± 25 months. We included 50 male and 28 female patients. Patella baja detected by Insall-Salvati Index could be observed in 8 (10.3%) patients. Patients with patella baja showed significant worse function measured by the Kujala score 54 ± 18 vs. 80 ± 14 (p < 0.01). Likewise, Lysholm score did show significant differences between both groups (60 ± 24 vs. 86 ± 11; p < 0.01). Nail tip position was not associated with worse subjective function. Conclusions Patella baja in patients after tibial intramedullary nailing via an infrapatellar/transtendinous approach, is associated with worse subjective function and increased pain.
Zusammenfassung Hintergrund Im Rahmen der COVID-19-Pandemie wurden zur Reduktion der Infektionszahlen politische Entscheidungen getroffen, die die soziale Interaktion reduzieren sollen. Ziel hierbei war das Schaffen von Kapazitäten zur innerhospitalen Versorgung der erkrankten Patienten. Ziel der Arbeit Ob seit Beginn der getroffenen Maßnahmen auch eine Reduktion des unfallchirurgischen Patientenaufkommens im Vergleich zum Mittelwert der 3 Vorjahre zu beobachten ist, sollte geprüft werden. Material und Methoden Es wurden retrospektiv alle Patienten, die sich in unserer unfallchirurgischen Notaufnahme im Zeitraum vom 01.03.2020 bis 15.04.2020 vorgestellt haben, mit dem Mittelwert der Patienten der 3 Vorjahre 2017–2019 verglichen. Es wurden Alter der Patienten, Vorstellungszeitpunkt, Diagnosen, Verbleib der Patienten, stationär oder ambulant, Anzahl und Dauer der operativen Versorgung und benötigte Kapazität auf Normal- und Intensivstation erhoben. Der Verletzungsmechanismus wurde ebenfalls untersucht. Ergebnisse Es wurden insgesamt 4967 Patienten im Beobachtungszeitraum vom 01.03.–15.04. eingeschlossen. Im Schnitt der 3 Vorjahre wurden insgesamt 1348 Patienten, d. h. pro Tag 29,3 Patienten vorstellig. Im Jahr 2020 wurden insgesamt 923, d. h. pro Tag 20 Patienten vorstellig (p < 0,01). Im Schnitt der Vorjahre wurden 227 (24,6 %) im Vergleich zu 2020 311,5 (23,1 %) stationär aufgenommen. Im Schnitt der Vorjahre resultierten 143 im Vergleich zu 2020 mit 136 Operationen hieraus. Die stationären Tage waren von 2442 im Schnitt der Vorjahre, im Jahr 2020, mit 1172 Tagen um 52,1 % reduziert. Die Anzahl der Tage auf der ICU betrug im Mittel der Vorjahre 450 Tage und im Jahr 2020 303 Tage (−32,7 %). Diskussion Das Patientenaufkommen in der unfallchirurgischen Notaufnahme war im Beobachtungszeitraum im Jahr 2020 im Vergleich zum Mittelwert der 3 Vorjahre deutlich reduziert. Hierdurch sind direkt Ressourcen für die Betreuung von COVID-19-Patienten frei geworden.
Background/Aim: Proper radiographic documentation of implant alignment is needed to analyse malrotation and malpositioning. We examined whether intraoperative fluoroscopic images can achieve more accurate image quality than postoperative radiographic Xray images. Patients and Methods: We prospectively analysed 30 consecutive patients after total knee arthroplasty (TKA). We compared intraoperative fluoroscopic images with postoperative radiographic X-ray images. Radiation exposure was documented. Results: Fluoroscopic anteriorposterior images could achieve accurate image quality in 77% compared to 60% in radiographic images (p=0.016) and 54% compared to 34% on lateral view, respectively (p=0.008). Very good intra-observer correlation for fluoroscopic images could be achieved for femoral α angle with 0.84. Radiation exposure was 0.087+/-0.128 mGy. Conclusion: We observed significantly better image quality in fluoroscopic images than in radiographic X-ray images. The observed radiation exposure is lower than those expected for radiographic X-ray images. We conclude that fluoroscopic images can produce higher image quality and decreased radiation exposure. Exact component fixation and alignment of total knee arthroplasty (TKA) is imperative to reduce postoperative pain and obtain patient satisfaction and good clinical function (1-4). Therefore proper radiographic documentation of coronal and sagittal implant alignment is needed to analyse malrotation and malpositioning (5, 6). Due to a lack of consistency in roentgenographic reporting of findings, rating systems have been described (2, 5, 7). The original Knee Society Clinical Rating System had been described in 1989 by Ewald et al. and has been adapted by Meneghini et al. They intended to modernized and updated the radiographic evaluation system as a rising diversity and complexity in implant design came up. Therfore they aimed to accumulate radiographic data in a standardized manner (5, 7, 8). In addition, a well aligned postoperative image is inevitable for compareability to detect implant loosening over time. However, accurate and precise radiographic images are difficult to obtain as they depend on several parameters. Using either standing or portable radiographs for the measurement of the knee joint centre gives significant different values due to changes in the rotation of the knee in the presence of knee flexion (9). Limb rotation and knee flexion of 10˚, either alone or in combination, has a significant effect on measured values of the anatomic alignment (10-13). Further patients' specific parameters like pain and casts can make proper radiograph acquisition challenging. Looking for improvement of measured parameter reliability and reproducibility, the use of 3D-CT has shown better reliability than 2D-CT. However, radiation exposure is much higher compared to radiographic X-ray images (1, 14). The use of intraoperative fluoroscopy of the anaesthetized patient reduces the patient's incompliances due to pain and 2521 This article is freely accessible online.
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