IMN has the fastest time to fracture union, however there are concerns regarding an increased deep infection rate in open segmental tibial fractures. In this subgroup, the data suggests CEF provides the most satisfactory results. However, the available literature does not provide sufficient detail to make this statement with certainty. We recommend a randomised controlled study to further investigate this challenging problem.
Purpose This study aimed to identify the most effective method for the treatment of the symptomatic bipartite patella. Methods A systematic review of the literature was completed, and all studies assessing the management of a bipartite patella were included. Owing to the paucity of randomised controlled trials, a narrative review of 22 studies was completed. A range of treatments were assessed: conservative measures, open and arthroscopic fixation or excision and soft tissue release and excision. Results All of the methods provided results ranging from good to excellent, with acceptable complication rates. Conclusions This is a poorly answered treatment question. No firm guidance can be given as to the most appropriate method of treating the symptomatic bipartite patella. This study suggests that there are a number of effective treatments with acceptable complication rates and it may be that treatments that conserve the patella are more appropriate for larger fragments. Level of evidence IV.
Acetabular fractures in the elderly are a challenging clinical problem due to both the complex nature of operative intervention, osteoporotic bone and the multiple comorbidities of the patients involved. They are associated with poor functional outcomes and high levels of morbidity and mortality. Treatment currently ranges from conservative treatment, open reduction internal fixation and variations of total hip arthroplasty. We present the surgical technique and early results of the use of a coned hemipelvic acetabular component in the primary treatment of these complex injuries. Five patients (six cases) with a mean age of 75 years have been followed up for 15 months. There were five minor post-operative complications: two patients suffered mild serous wound ooze, two sustained an acute kidney injury, and one a lower respiratory tract infection. One patient suffered pre-operative bilateral sciatic nerve injury, which has partially resolved. There have been no thromboembolic events, dislocations or infections. There have been no cases of prosthesis migration. Four of five patients were able to mobilise fully weight-bearing day one post-operatively, and at latest follow-up four of five mobilised independently with a walking aid. We feel that early weight-bearing mobilisation is essential to achieve a successful outcome in these patients, in a similar way to neck of femur fracture patients. The coned acetabular prosthesis bypasses the fracture, creating an immediately stable construct which allows mobilisation day one post-operatively. The early results of this new technique are promising. Although follow-up is short, there have been no serious complications, a high level of patient satisfaction and radiological evidence of fracture healing, with no prosthesis migration. We aim to continue utilising this technique, with close monitoring of longer-term results.
The study provided encouraging results, although conclusions drawn from them were limited by the paucity of data. We believe that MRI should be the current investigation of choice for GTPS. However, further study is required in the form of multicentre, randomized controlled trials to confirm the validity of the conclusions presented here.
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