PURPOSE OF THE STUDYSubtotal or total meniscectomy will increase weight-bearing per square unit of the cartilage surface approximately threeand-half-times. A long-term overloading of cartilage is clinically manifested by pain, swelling and a rapid onset of early arthritic lesions discernible on radiograms. One of the options for the treatment of degenerative changes in the joint is meniscal transplant. The authors present their first experience with the transplantation of deep frozen meniscal tissue in the Czech Republic. MATERIALBy September 2006, we had treated 26 patients with clinical problems following subtotal or total meniscectomy. The patients, 15 women and 11 men, were between 24 and 46 years of age. Eighteen patients underwent transplantation of the medial meniscus and eight received a lateral meniscal transplant. Concomitant repair of the anterior cruciate ligament (ACL) was indicated in 11 patients, of whom 10 were treated with semitendinosus tendon graft and one with patellar ligament allograft.One patient with a lateral meniscal transplant and ACL reconstruction also had suture of the medial meniscus for a previously sustained injury.In 16 patients, chondromalacia was at the level of Outerbridge grade II and, only in five patients, the finding was Outerbridge grade I. Five patients with grade III chondromalacia were treated using the microfracture technique. Valgus or varus osteotomy was not indicated at all. METHODSThe goal of meniscal transplant surgery is: 1) to relieve pain after meniscectomy; 2) to prevent degenerative changes of cartilage; 3) to eliminate or reduce the risk of development of osteoarthritic lesions; 4) to restore normal mechanics of the knee joint. Patient selection is important and it is necessary to take into consideration: 1) level of cartilage degenerative changes; 2) knee alignment; 3) knee joint stability; 4) graft size. In patients with instability of the knee and indications for meniscal graft, it is necessary to stabilize the joint by ligament reconstruciton prior to transplantation; in the case of malalignment corrective osteotomy is required. RESULTSAll patients healed without complications. At the end of the third follow-up month, the range of motion was S-0-0-130 in 22 patients and S-0-0-120 in three patients. Only one patient had the range of motion restricted to S-0-0-110. Evaluation showed improvement from pre-operative values to those at 6 months and two years post-operatively as follows: IKDS score, 57-64 to 73-80 to 76-84; Lysholm score, 50-76 to 80-90 to 85-95; and Tegner score, 2-4 to 4-7 to 5-8.No complications associated with meniscal transplant incorporation were recorded. Also in five patients with Outbridge grade III degenerative changes, meniscal transplantation was successfully carried out. In four patients, of which two had a cartilage defect treated, second-look arthroscopy showed that the lesions healed with healthy fibrocartilaginous tissue. CONCLUSIONSAll patients reported resolution of subjective complaints, as seen from the results of the IKDC...
Evidence is lacking from these trials concerning the optimal surgical procedure for treatment of displaced intraarticular calcaneal fractures. Clinical trials comparing different treatments, especially as they relate to potential risk factors such as fracture classification, should be explored. AO Journal Club | Evidence from the Literature Downloaded by: University of Pennsylvania Libraries. Copyrighted material. Studies Study 1 Huang PJ, Huang HT, et al. (2002) Open reduction and internal fixation of displaced intra-articular fractures of the calcaneus. J Trauma; 52(5): 946-50. Study 2 Tennent TD, Calder PR, et al. (2001) The operative management of displaced intra-articular fractures of the calcaneum: a two-centre study using a defined protocol. Injury; 32(6): 491-6. Study 3 Geel CW, Flemister AS Jr (2001) Standardized treatment of intra-articular calcaneal fractures using an oblique lateral incision and no bone graft. J Trauma; 50(6): 1083-9. Study 4 Harvey EJ, Grujic L, et al. (2001) Morbidity associated with ORIF of intra-articular calcaneus fractures using a lateral approach. Foot Ankle Int; 22(11): 868-73. Study 5 Naovaratanophas P, Thepchatri A (2001) The long-term results of internal fixation of displaced intra-articular calcaneal fractures. J Med Assoc [Thai]; 84(1): 36-44. Study 6 Park IH, Song KW, et al. (2000) Displaced intra-articular calcaneal fracture treated surgically with limited posterior incision. Foot Ankle Int; 21(3): 195-205. Study 7 Ebraheim NA, Elgafy H, et al. (2000) Sinus tarsi approach with trans-articular fixation for displaced intra-articular fractures of the calcaneus. Foot Ankle Int; 21(2): 105-13. Objective To critically summarize recent published studies regarding the operative management of intraarticular fractures of the calcaneus.Common outcome measures ■ Clinical score of excellent, good, fair, or poor. ■ Return to work. ■ Subtalar joint (STJ) fusion. ■ Infection. Intervention ■ Patients were treated with open reduction and internal fixation through either a lateral approach utilizing plate fixation [Huang, Tennent, Geel, Harvey, and Naovaratanophas], a posterior approach utilizing screw or pin fixation [Park], or a sinus tarsi approach utilizing pin fixation [Ebraheim].
A traumatic dislocation of the clavicle is a rare injury. So far 37 reports of this trauma have been found in the relevant literature; they are most often treated by surgery.A 32-year-old woman was admitted to local hospital for polytraumata sustained in a motor car accident. Once the patient had been stabilised, at three months after injury, stabilisation of the left dislocated clavicle was undertaken. The medial end was stabilised, using a strip dissected from the ligament of the sternoclavicular (SC) joint capsule, with Orthocord sutures, and laterally by coracoacromial ligament transfer (Weaver and Dunn technique) and K-wire fixation through the acromioclavicular (AC) articulation. The K-wire was removed 10 weeks after stabilisation.At 6 months after the repair surgery, the patient was free of any complaint, with no motion restriction and with good configuration of the SC and AC joints. The mean scores according to the University of California at Los Angeles (UCLA) rating system were 14 points before surgery and 28 points at 6 months after surgery; the mean Constant scores were 56 and 92 at the respective intervals.The clinical outcome of surgical stabilisation in this patient was very good. She had no signs of instability and no restriction of motion at the joints treated.
PURPOSE OF THE STUDYIn this retrospective evaluation the authors present the group of patients with intraarticular calcaneal fractures that were treated from an extended lateral approach. MATERIALIn the period from 2001 to 2003, 32 patients with intra-articular calcaneal fractures were treated by osteosynthesis, using a plate, from the extended lateral approach. All patients were men at an average age of 41.7 years (range, 20 to 63 years). The most frequent cause of injury was a fall from height. A combined injury was recorded in eight patients. The right calcaneus was broken in 11 and the left one in 21 patients. Patients with bilateral calcaneal fractures were not included in the evaluation. METHODSPreoperative X-ray and CT examinations of the fractured calcaneus were carried out in all patients. The Sanders classification of calcaneal fractures was used for fracture evaluation. All patients were treated from the extended lateral approach by osteosynthesis with the use of a plate. Spongioplasty using an autologous graft from the iliac crest or an allogenous graft was carried out in 21 and 11 patients, respectively. The patients were operated on within an average of 7.3 days of admission (1 to 16 days), and were followed up for at least one year (average, 30 months) after surgery. Postoperative evaluation was based on radiographs and the results of the Kerr rating system obtained from questionnaires. RESULTSThe outcomes were excellent, 36 %; very good, 44 %; good, 17 %; and poor, 3 %. The Böhler angle postoperatively assessed on radiographs was on average + 28.5 degrees. All patients showed bone union, and no pseudoarthrosis was recorded. One patient had to be treated for a late purulent complication requiring metal removal. One patient underwent early wound revision due to postoperative hematoma. The metal was removed on average at 13 months postoperatively (range, 2.5 to 26 months). DISCUSSIONThe treatment of intra-articular calcaneal fractures is determined by the type of injury, state of soft issues in the limb injured, patient's status and surgeon's experience. CONCLUSIONSOur results as well as literature data show that exact reduction of the posterior subtalar joint with internal osteosynthesis can achieve good clinical outcomes in patients with intraarticular calcaneal fractures, particularly when the fractures are classified as Sanders II and III types.
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