Background: To determine the clinical outcomes following fibula nail fixation and to identify the indication for the use of fibula nails in lower limb fractures. Methods: Retrospective study of adult patients from 2 major trauma centers (MTCs) and 9 trauma units (TUs) who underwent fibula nail fixation for AO/OTA 44 fractures between January 1, 2018, and October 31, 2020. Outcome measures included infection, metalwork complications, nonunion or malunion, time to union, and length of inpatient hospital stay. Results: Ninety-five patients were included, with a mean age of 66 years; 57.9% of patients were female. The average body mass index was 30. Sixty-nine patients (72.6%) sustained a Weber B and 24 (27.4%) sustained a Weber C fracture. In addition, 26.3% were open fractures and all patients had soft tissue compromise affecting the lateral malleolus. The calculated infection rate for fibula nail was 4.2% and metalwork complication rate was 5.2%. The nonunion and malunion rate was 8.4% and rate of removal of hardware was 2.1%. The average time to union was 12.5 weeks, and length of inpatient stay was 9.4 days (SD 10). Conclusion: This multicenter study demonstrates that use of a fibula nail appears to be a safe approach to treating patients who have a physiologically higher risk of surgery, poor skin condition, and a complex fracture pattern.
Patellofemoral joint instability (PFJI) is a challenging condition affecting primarily young patients. It can be both physically and mentally disabling. There are numerous factors which contribute to stability of the patellofemoral joint and thorough clinical assessment and appropriate radiological investigations are essential in determining which risk factors need to be corrected to prevent further episodes of dislocation. One of the key operations utilized in the management of PFJI is medial patellofemoral ligament (MPFL) reconstruction, to restore the patellar restraint against lateral translation. The complications that can result from MPFL reconstruction can be largely divided into complications resulting from technical error or selection of operation for a patient’s specific risk factors. Some risk factors of PFJI can precipitate the need for additional operations being performed alongside MPFL reconstruction, including trochleoplasty, lateral retinacular lengthening, and tibial tuberosity osteotomy. Failure to identify the need for concurrent operations will result in persistent PFJI. This update article will outline the approach to assess a patient presenting with PFJI and the risk factors which should be identified and corrected. It will also cover the various management options with respect to these factors, with some important considerations for each.
Objective: To report a case of a man who developed bilateral Charcot arthropathic feet 11 years after a simultaneous pancreas-kidney transplant (SPKT) for type 1 diabetes mellitus (DM). The patient had remained normoglycemic after surgery. Methods: We present a retrospective review of the case notes and serial imaging. Results: The patient developed dense peripheral diabetic neuropathy due to poor glycemic control. His biochemical markers of DM all normalized following SPKT, and he was discharged by his primary and secondary care diabetes services. Eleven years later, he developed Charcot arthropathy in one foot and, within a month, the other foot as well. Conclusion: Individuals with DM who had preoperative end organ diabetes-related damage who went into biochemical remission after SPKT may be at risk for future complications. They should not be discharged from specialist diabetes services, and they need continued education about foot care. (AACE Clinical Case Rep. 2019;5:e259-e262) Abbreviations: CA = Charcot arthropathy; DM = diabetes mellitus; SPKT = simultaneous pancreas-kidney transplant e260 Bilateral CA after SPKT, AACE Clinical Case Rep. 2019;5(No. 4)
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