This biomechanical study showed that cement augmentation of the LISS-PLT plate screws in osteoporotic proximal extraarticular tibial fractures significantly lowers the propensity toward screw migration and secondary varus displacement.
Background: Numerous strategies exist for pain management after total knee arthroplasty (TKA), with a fast recovery and early ambulation required for full function. Currently, there is no universal standard of care to facilitate this management. We assessed pain management safety and efficacy after TKA, using intra-articular infiltration associated with peripheral saphenous nerve block (SNB) vs intra-articular infiltration alone. Methods: We performed a controlled, double-blinded, and randomized trial to evaluate postoperative pain in TKA. One group was treated with intra-articular analgesia associated with SNB, whereas a second group received the same intra-articular cocktail, associated with placebo. Efficacy was evaluated according to average pain, pain-free time, and morphine rescue indices. Safety was assessed by intervention complications and surgery. Results: About 70 patients were recruited. At time 0 (immediately postoperative), 51.43% of the intraarticular analgesia þ placebo group presented pain <3, whereas in the intra-articular analgesia þ SNB group, 8.82% (P ¼ .001) presented with pain. This difference was maintained at 6, 12, and 24 hours, postoperatively. After 24 hours, the placebo group received an average 0.66 morphine rescues (standard deviation, 0.86), when compared with the SNB group that received 0.14 rescues (standard deviation, 0.43), (P ¼ .002). We recorded a paresis of the external popliteal sciatic nerve, with spontaneous recovery without other complications. Conclusion: Complementary SNB to intra-articular analgesia was more effective in reducing average pain and the amount of pain-free time in the first 24 hours after TKA, with fewer requests for morphine rescue analgesia.
Septic arthritis due to
Listeria monocytogenes
(LM) is extremely rare and most infections due to this organism are seen in immunocompromised patients. We describe a patient without immunological compromise, with a late total knee arthroplasty infection caused by LM treated with one-stage revision surgery. She had an elevated erythrocyte sedimentation rate (79 mm/h) and C-reactive protein (13 mg/dL). Aspiration of the knee joint yielded purulent fluid; cultures showed LM. The patient was given 6 weeks of intravenous ampicillin, followed by trimethoprim/sulfamethoxazole, and finally amoxicillin orally for 7 months. Two years after revision surgery, radiographs showed no evidence of implant loosening. This is a single case and although one-stage approach seemed to have worked, it should not be recommended on the basis of a single report.
Reliable osteosynthesis of intraarticular fractures depends on lasting interfragmentary compression. Its amount differs in the applied fixation method. The interfragmentary compression of cancellous and cortical lag screws and angle stable locking plates was quantified in an osteoporotic and non-osteoporotic synthetic human bone model.A split fracture of the lateral tibia plateau (AO/OTA type 41-B1.1) was mimicked by an osteotomy in right adult synthetic human tibiae with hard or soft cancellous bone. Specimens were fixed with either two 6.5 mm cancellous, four 3.5 mm cortical lag screws, or 3.5 mm LCP proximal lateral tibia plate preliminary compresed by a reduction clamp (n = 5 per group). A pressure sensor film was used to register the interfragmentary compression. One-way analysis of variance (ANOVA) with Bonferroni post hoc correction was performed for statistical analysis (p < 0.05).Interfragmentary compression under reduction clamp was 0.59 ± 0.12 MPa in the non-osteoporotic and 0.55 ± 0.14 MPa in the osteoporotic group. The locking plate itself maintained the compression in non-osteoporotic (0.53 ± 0.11 MPa) and osteoporotic bone (0.50 ± 0.14 MPa). Four 3.5 mm cortical lag screws provided a compression of 1.69 ± 0.65 MPa in non-osteoporotic bone, being not significantly different to the osteoporotic bone group (1.43 ± 0.47 MPa, P = 1.0). Two 6.5 mm cancellous lag screws showed a significantly higher compression in non-osteoporotic (2.1 ± 0.59 MPa) compared to osteoporotic (0.77 ± 0.21 MPa, P < 0.01) bone.Angle stable locking plates maintained the compression preliminarily applied by a reduction clamp. Two 6.5 mm cancellous lag screws are especially suited for non-osteoporotic bone, whereas four 3.5 mm cortical screws exhibited comparable compression in both bone qualities.
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